Category: Statistics

Biol Pharm Bull. 2026;49(8):1276-1284. doi: 10.1248/bpb.b26-00209.

ABSTRACT

Cytomegalovirus (CMV) infection is a major cause of morbidity and mortality in immunocompromised patients. While ganciclovir (GCV) is commonly used for its management, pharmacokinetic (PK) targets for optimal efficacy and minimal toxicity remain controversial. This study aimed to explore the association of PK parameters with the efficacy and safety of GCV in the treatment of CMV infection. We conducted a prospective study of adult patients who received intravenous GCV for CMV infection. Treatment efficacy was defined as a ≥50% reduction in CMV antigen-positive cells using a pp65 antigenemia test. The highest or lowest hematological, hepatic, and renal laboratory values were used to assess safety. Individual PK parameters (area under the concentration-time curve [AUC]_24h, trough [C_min], and peak [C_max]) plasma concentration were estimated using multiple GCV plasma concentrations from each patient. Associations between PK parameters and efficacy/safety were assessed. Of 23 patients, 20 (87.0%) exhibited an effective response. Median estimated AUC_24h, C_min, and C_max values were 45.5 mg·h/L, 0.5 mg/L, and 6.8 mg/L, respectively. AUC_24h and C_min were not significantly associated with the efficacy of GCV (odds ratio [OR] 1.05, 95% confidence interval [CI] 0.96-1.16, p = 0.301; OR 0.92, 95% CI 0.11-7.86, p = 0.942). C_max showed a relatively large but nonsignificant OR (OR 2.45, 95% CI 0.84-7.09, p = 0.099). No clinically relevant associations between PK parameters and safety were observed. Baseline laboratory values were associated with safety. In conclusion, no statistically significant associations were identified between GCV PK parameters and the treatment efficacy/safety of CMV infection in adult patients.

PMID:42633913 | DOI:10.1248/bpb.b26-00209

Int Wound J. 2026 Aug;23(8):e71011. doi: 10.1111/iwj.71011.

ABSTRACT

Pressure ulcers/injuries at the posterior heel commonly develop in patients with limited mobility or sensation, where movements such as sliding in bed generate shear forces that elevate the deep soft tissue stresses. Prophylactic multilayer dressings are recommended to reduce this injury risk, yet many current products incorporate high-friction silicone adhesives for attaching the dressing to the skin, which may increase shear transfer to the skin and subdermally while a patient is moving or being moved. This study evaluated a multilayer dressing featuring an Aquacel Hydrofiber Technology skin-contact layer that exhibits moisture-responsive friction reduction. Finite element models of a posterior heel resting on a support surface were developed to simulate compressive and shear loading during patient sliding-in-bed, comparing no dressing, dry (new) and moist (used) dressing conditions. Moisture exposure reduced the skin-dressing coefficient of friction from 1.55 to 0.22, leading to substantial reduction in soft tissue strain and stress exposures, such that high-magnitude strain and stress concentrations (> 75th-percentile) were effectively absent within the modelled loading domain under the simulated conditions. Moisture-induced friction reduction facilitated controlled micro-sliding at the skin interface, attenuating shear transfer into skin and subcutaneous tissues. These findings demonstrate that moisture-responsive interfacial friction adaptation is an important mechanism of action contributing to the biomechanical protective efficacy of prophylactic dressings.

PMID:42633909 | DOI:10.1111/iwj.71011

J Subst Use Addict Treat. 2026 Aug 23:210096. doi: 10.1016/j.josat.2026.210096. Online ahead of print.

ABSTRACT

BACKGROUND: Gender differences in substance use disorders (SUDs) are well documented globally; however, evidence from psychiatric inpatient populations in sub-Saharan Africa remains limited. In Nigeria, sociocultural norms, stigma, and structural barriers may differentially influence treatment access, clinical presentation, and outcomes among men and women with SUD. This study examined gender differences in substance use patterns, psychiatric comorbidity, treatment outcomes, and relapse among psychiatric inpatients in Nigeria.

METHODS: This retrospective study reviewed the medical records of adults admitted with a primary diagnosis of SUD to a tertiary psychiatric hospital in southeastern Nigeria between 2018 and 2024. Analyses compared male and female patients based on sex as recorded in the clinical records. Data on substance use patterns, psychiatric comorbidity, treatment outcomes, and relapse within six months after discharge were extracted and analyzed using bivariate statistics and multivariable binary logistic regression.

RESULTS: A total of 286 patients were included, the majority of whom were male. Men were more likely to present with cannabis use, polysubstance use, and longer durations of substance use, whereas women more commonly presented with opioid use and shorter durations of use. Psychiatric comorbidity was common in both groups, although psychotic disorders predominated among men and anxiety disorders among women. Female patients had longer hospital stays and were more likely to achieve planned discharge following clinical improvement, whereas male patients had higher rates of discharge against medical advice and relapse within six months. Male sex remained independently associated with relapse after adjustment for age, duration of substance use, psychiatric comorbidity, and polysubstance use.

CONCLUSIONS: Important gender differences were observed in the clinical presentation, treatment outcomes, and relapse of psychiatric inpatients with SUD in Nigeria. These findings support the implementation of gender-responsive addiction services that improve treatment access for women while strengthening relapse prevention, discharge planning, and continuity of care for men.

PMID:42633882 | DOI:10.1016/j.josat.2026.210096

Int J Psychophysiol. 2026 Aug 23:113458. doi: 10.1016/j.ijpsycho.2026.113458. Online ahead of print.

ABSTRACT

The aim of this study was to examine the fine-grained interplay of episodic and associative-semantic long-term knowledge in a sentence-embedded paired-associate paradigm and to probe separable contributions to encoding-related event-related potential (ERP) amplitudes. Participants were instructed to learn sentences of the structure: article, subject-prime, auxiliary verb, closed-class word, and target-object (e.g., “the car has an engine”). Later, they had to recall the target-object, given the preceding sentence context. Words were displayed using rapid serial visual presentation. Corpus-based co-occurrence statistics were used to orthogonally manipulate direct association (strong vs. none) and semantic feature overlap (high vs. low) between the prime and the target word (cf. Hofmann et al., 2018). Strong direct associations led to more correct responses, whereas semantic feature overlap showed no reliable main effect and no interaction was observed. However, descriptive trends suggested a potential supportive contribution in the presence of direct associations. This aligns with the largely additive pattern of associative and semantic influences reported for lexical processing (Rölke et al., 2018). Response times were faster for strong direct associations, with no effect for semantic feature overlap. ERPs were recorded during target-object encoding, with condition-related analyses restricted to correctly recalled trials. Further, ERPs were contrasted between subsequently correct vs. incorrect recall to quantify subsequent memory effects. Strong direct associations elicited a greater Late Positive Component (LPC; 460-800 ms) with an occipito-parietal scalp distribution, whereas semantic feature overlap showed no LPC modulation. Correctly recalled targets showed more positive-going ERP amplitudes, reflected in an attenuated N400 (250-500 ms) and an enhanced P600 (500-800 ms), both with a centro-parietal scalp distribution and regardless of associative-semantic priming manipulations. This study demonstrates that classic priming patterns from lexical processing (Rölke et al., 2018) can extend to paired-associate learning outcomes and further identifies dissociable ERP signatures during encoding that track associative priming effects (LPC).

PMID:42633871 | DOI:10.1016/j.ijpsycho.2026.113458

J Stomatol Oral Maxillofac Surg. 2026 Aug 23:102962. doi: 10.1016/j.jormas.2026.102962. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to evaluate the effect of various sizes of regions of interest (ROIs) on fractal dimension (FD) in the evaluation of trabecular bone structure in dental radiographic images.

MATERIALS AND METHODS: This study included 12 sheep hemimandibles. One set of digital images was obtained from each hemimandible using either periapical radiography, panoramic radiography, or cone-beam computed tomography (CBCT). Fractal analysis (FA) was conducted using ImageJ 1.3 software with the box-counting method on small, medium, and large ROIs obtained from each image, using a novel ROI selection method. Comparisons of FD values obtained from the three different ROI sizes were conducted within each radiographic image using repeated-measures ANOVA. Post hoc pairwise comparisons were performed with Bonferroni correction. Data were analyzed using Jamovi 1.6.23. Statistical significance was accepted as p < 0.05.

RESULTS: In periapical radiography, the FD values ​​obtained in small, medium, and large ROI sizes were 1.60 ± 0.02, 1.60 ± 0.01, and 1.65 ± 0.01, respectively (p < 0.001). In panoramic radiography, they were 1.45 ± 0.04, 1.71 ± 0.02, and 1.59 ± 0.01, respectively (p < 0.001), and in CBCT, they were 0.76 ± 0.07, 1.21 ± 0.04, and 1.48 ± 0.04, respectively (p < 0.001).

CONCLUSIONS: The study demonstrates that FD is affected by the ROI size.

PMID:42633839 | DOI:10.1016/j.jormas.2026.102962

J Pain. 2026 Aug 23:106423. doi: 10.1016/j.jpain.2026.106423. Online ahead of print.

ABSTRACT

Chronic pain is both prevalent and debilitating. It is often treated with interdisciplinary pain rehabilitation programs (IPRPs). While research has largely focused on the effectiveness of IPRPs in improving patient outcomes, negative treatment effects remain under-explored. This study aims to investigate both the prevalence and types of negative outcomes following IPRPs for chronic pain. Data for the current study were obtained from the Swedish Quality Registry for Pain, with 22771 patients undergoing IPRPs between 2016 and 2023. We calculated the Reliable Change Index to find reliable deterioration across 18 patient-reported outcome measures, including pain intensity, physical function, psychological well-being, and vitality. Descriptive statistics were employed to determine the prevalence of deterioration, the prevalence of less severe deterioration, and the frequency of multiple deteriorations per patient. Results showed that while most participants did not report any areas of deterioration, about 23% of patients did experience reliable deterioration on at least one measure at the end of rehabilitation. Deterioration was most frequent in measures assessing physical status and pain, while psychological measures showed less deterioration. Mild deterioration on at least one measure was observed in 44.5% of patients. This study shows that a substantial proportion of patients experience at least some negative short-term outcomes following IPRPs, primarily in physical and pain-related outcomes. The findings underscore the importance of acknowledging and further investigating negative outcomes in chronic pain rehabilitation, and to take measures to address this issue. PERSPECTIVE: This large registry study reveals that almost one in four patients experiences a statistically reliable short-term worsening in at least one outcome, primarily physical and pain-related, after interdisciplinary pain rehabilitation. Thus, there is a need to identify these patients and the mechanisms behind deteriorations.

PMID:42633810 | DOI:10.1016/j.jpain.2026.106423

Biosystems. 2026 Aug 23:105932. doi: 10.1016/j.biosystems.2026.105932. Online ahead of print.

ABSTRACT

Unifying physical and biological systems under a common information-theoretic framework requires reconciling two long-standing positions: that information is a universal structural feature of the environment and that it becomes meaningful only when a system registers a difference that alters its state. We propose a substrate-process-agency synthesis in which N-Space denotes a relational substrate of latent distinctions, while Order-Disorder-Reflexive Control (ODC) describes a phase-structured grammar through which bounded systems with memory render such distinctions operational. In this formulation, information becomes causally effective only through partition-mediated interaction that reduces uncertainty. Across domains, this framework predicts a set of falsifiable statistical signatures, including transient coordination during state alignment, non-memoryless persistence, boundary-dependent settling dynamics, and phase-dependent responses to perturbation. We argue, however, that these signatures need not appear identically in every system: some regimes are pulse-driven rather than sustained oscillators, and some support timing-sensitive responses more strongly than residence-time inference. To illustrate this point, we combine a minimal synthetic model, a nonlinear physical example, and an illustrative biological reanalysis of NF-κB signaling dynamics. Together, these analyses support the view that ODC is best interpreted as a phase-structured transition framework rather than a strictly periodic cycle model. The contribution of this work is not to introduce a new physical entity, but to provide a unified, empirically testable grammar for how relational structure, boundary conditions, memory, and timing jointly shape information flow across scales.

PMID:42633804 | DOI:10.1016/j.biosystems.2026.105932

Med Educ. 2026 Aug 23. doi: 10.1111/medu.70290. Online ahead of print.

ABSTRACT

BACKGROUND: Errors are an inevitable part of clinical learning, yet procedural training commonly emphasises error avoidance. This study examined the effect of deliberate replication of predefined procedural errors (Error Replication; ER), compared with error avoidance training (EAT), on post-test performance, retention and transfer in surgical simulation.

METHODS: In this randomised controlled trial, 70 medical students with no prior simulation-based osteosynthesis experience completed a pre-test of simulated dynamic hip screw (DHS) fixation before 60 min of ER or EAT training. ER participants deliberately reproduced predefined, clinically relevant errors, whereas EAT participants used simulator feedback to improve performance and minimise errors across successive iterations. Participants then completed an immediate DHS post-test, a DHS retention test after 6-10 days and a transfer test involving antegrade femoral nailing. Transfer-test performance was the primary outcome. Secondary outcomes included performance trajectories across pre-test, post-test and retention test; completed DHS iterations; self-perceived dexterity and spatial awareness; and perceived training efficacy.

RESULTS: Complete data were available for 68 participants. Performance improved substantially over time in both groups (p < 0.001, η² _p = 0.606), with no significant group-by-time interaction (p = 0.44). Transfer scores were 52.6 (SD 24.7) for EAT and 51.0 (SD 33.9) for ER (p = 0.82; d = 0.06, 95% CI – 0.42 to 0.53). No statistically significant differences were detected in the remaining secondary outcomes.

CONCLUSIONS: Participants improved following both instructional approaches, although those in the ER group spent most of the training period deliberately reproducing predefined errors. No statistically significant differences between ER and EAT were detected in post-test performance, retention or transfer. These findings suggest that structured exposure to clinically relevant procedural errors warrants further study as a distinct instructional modality.

PMID:42633790 | DOI:10.1111/medu.70290

J Am Vet Med Assoc. 2026 Aug 21:1-7. doi: 10.2460/javma.26.05.0429. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the importance human and veterinary providers and nonproviders place on One Health interprofessional collaboration and identify factors associated with provider comfort in making cross-species referrals.

METHODS: An online, cross-sectional survey was given to human and veterinary providers via professional associations and snowball sampling (January to February 2025) and to nonproviders via a nationally representative panel. Analyses included frequencies, ordinal logistic regression, and χ2 tests.

RESULTS: A total of 1,660 respondents were enrolled (144 human providers, 50 veterinary providers, 1,466 nonproviders). Among human providers, pet ownership was associated with higher importance for pet-ownership inquiry (OR, 3.44; range, 1.53 to 7.70), cross-species care inquiry (OR, 2.29; range, 1.09 to 4.78), and greater comfort making cross-species referrals (OR, 2.18; range, 1.04 to 4.57). Specialty human providers assigned lower importance to both inquiries versus primary human providers, with ORs of 0.46 (range, 0.21 to 1.00) and 0.45 (range, 0.21 to 0.98), respectively. Among veterinary providers, viewing client health as a proxy for patient health was statistically significantly associated with greater referral comfort (OR, 4.39; range, 1.11 to 17.36).

CONCLUSIONS: Pet ownership among human providers is the strongest predictor of engagement with One Health inquiry and referral. Specialty human providers are a key gap One Health training opportunity. Veterinary providers who frame client wellness as relevant to patient health show markedly higher comfort with client referral to a human provider.

CLINICAL RELEVANCE: Questions about pet ownership and cross-species health may yield relevant insights for providers. Incorporating One Health inquiries into standard intakes could improve patient/client outcomes and advance interprofessional collaboration.

PMID:42633779 | DOI:10.2460/javma.26.05.0429

Disabil Rehabil. 2026 Aug 23:1-17. doi: 10.1080/09638288.2026.2720757. Online ahead of print.

ABSTRACT

PURPOSE: To support early detection of cerebral palsy, capacity for General Movements Assessment (GMA) needs to be built in Denmark. This study aimed to evaluate the training and implementation of GMA across Danish hospitals. Objectives [1]: to develop a GMA training intervention [2]; to evaluate implementation [3]; to identify key factors for successful implementation.

MATERIALS AND METHODS: In this multicenter mixed-methods study, physiotherapists participated in GMA courses, in-person workshops, dialogue meetings, and online workshops from May 2023 to November 2024. Data was collected through surveys, field notes, and focus group interviews. Descriptive statistics and thematic analysis were used within the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation, Maintenance). (Clinicaltrials.gov NCT05835674).

RESULTS: Reach was high across training components. Effectiveness showed high post-training competencies, with median group scores of 70-80 on a 0-100 scale. Adoption was strong, driven by clinical relevance and interdisciplinary recognition. After 18 months, all participants working with infants aged 3-4 months used GMA in clinical practice. Maintenance was supported by a national GMA network. Key factors for sustainable use included video storage, peer-based training, and expert feedback.

CONCLUSION: GMA capacity was successfully built and implemented in clinical practice. Structural support and collaboration were essential for maintenance.

PMID:42633768 | DOI:10.1080/09638288.2026.2720757