Category: Statistics

JAMA Netw Open. 2026 May 1;9(5):e2610552. doi: 10.1001/jamanetworkopen.2026.10552.

ABSTRACT

IMPORTANCE: Hospital-based shootings represent an extreme form of workplace violence, with notable consequences for staff, patients, and visitors. Despite growing concern, these events remain poorly understood.

OBJECTIVE: To categorize hospital-based shootings from 2012 to 2024 and incorporate prior published events between 2000 and 2011 to examine trends in shootings over a 25-year span.

EVIDENCE REVIEW: Events in this systematic review of acute care hospital-based shootings in the US from January 1, 2012, through December 31, 2024, with subgroup analysis of previously published data trending shootings over 25 years (January 1, 2000, through December 31, 2024), were identified using EBSCO Regional Business News, ProQuest US Newsstream Collection, Gun Violence Archive, and Google News Search. Selected shooting events involved at least 1 injured person (a nonperpetrator or perpetrator) that occurred within or on the immediate property of the hospital.

FINDINGS: A total of 327 news articles of unique hospital-based shooting events (5.2 per year per 1000 hospitals) were included from a review of 6658 articles, spanning 47 US states (94.0%). There was an overall incidence of 25.2 hospital-based shootings per year. Between 2012 and 2024, shootings increased by a mean (SD) of 1.7 (0.5) events per year, from 14 to 34 events (8.4% increase per year). Large hospitals accounted for the highest rate of shootings (258.1 events per 1000 hospitals). Events primarily occurred in urban settings (314 [96.0%]), and 161 (49.2%) occurred in the US South. Nearly one-third (105 [32.1%]) were potentially preventable by weapons screening. From 2000 to 2024, shootings increased by a mean (SD) of 1.1 (0.2) events per year, from 6 to 34 events (6.4% increase per year). A positive correlation was found in annual firearm fatalities in hospital settings and US firearms fatalities overall between 2012 and 2023 (r = 0.42).

CONCLUSIONS AND RELEVANCE: This systematic review found that hospital-based shootings in the US have increased steadily over the past 25 years, representing an intersection between broader national trends in workplace and firearm violence. Large hospitals, those in the US South, and hospitals in urban communities are particularly at-risk settings. These findings underscore the need for hospital-specific prevention strategies, including consideration of weapons screening technology, alongside broader societal efforts to address rising firearm violence.

PMID:42081243 | DOI:10.1001/jamanetworkopen.2026.10552

JAMA Netw Open. 2026 May 1;9(5):e2610559. doi: 10.1001/jamanetworkopen.2026.10559.

ABSTRACT

IMPORTANCE: As of September 2024, federal legislation mandates that patients be informed of their breast density, a modest breast cancer risk factor and known cancer-masking agent. This binary metric, dense vs nondense, applies to 40% to 50% of women and is subjectively assessed with interreader variability, limiting its utility for guiding supplemental imaging.

OBJECTIVE: To compare the performance of a deep learning (DL) breast cancer risk model vs radiologist-assessed breast density in estimating future breast cancer and false-negative (FN) screening results.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study included consecutive bilateral screening mammograms from women 30 years or older performed from January 1, 2009, to December 31, 2018, across 5 sites of a large academic health system, with follow-up through December 31, 2023, to allow ascertainment of 5-year breast cancer outcomes.

EXPOSURES: A DL risk model applied to standard screening mammograms and radiologist-assessed breast density categorized using the American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) Atlas.

MAIN OUTCOMES AND MEASURES: Primary outcomes were breast cancer diagnoses within 5 years of mammography and FN screening results, defined as BI-RADS 1 or 2 examinations followed by a cancer diagnosis within 1 year. DL risk scores were stratified as low (<1.7%), intermediate (1.7%-3.0%), or high (>3.0%). Cancer and FN rates were compared across DL risk groups and breast density categories. Discriminatory performance was assessed using the area under the receiver operating characteristic curve (AUROC) and compared using the DeLong test.

RESULTS: Among 123 091 mammograms in 67 019 women (median [IQR] age, 58.0 [50.0-67.0] years), 50 974 (41.4%) were classified as dense. The DL model demonstrated significantly higher discriminatory accuracy than breast density in predicting future cancer (AUROC, 0.71 [95% CI, 0.70-0.72] vs 0.53 [95% CI, 0.52-0.54]; P < .001). FN rates increased across DL risk groups (2.1 per 1000 examinations in high-risk vs 1.0 and 0.6 in intermediate and low-risk groups, respectively). Women with dense breasts had higher FN rates than those with nondense breasts (1.7 vs 0.6 per 1000 examinations; P < .001). Adding breast density to the DL model did not improve performance.

CONCLUSIONS AND RELEVANCE: In this cohort study of screening mammography, a DL risk model outperformed breast density in estimating risk of future breast cancer and stratified FN screening results across risk groups. These findings support transitioning from density-based policy triggers toward more precise image-derived risk models to guide access to supplemental imaging.

PMID:42081242 | DOI:10.1001/jamanetworkopen.2026.10559

JAMA. 2026 May 4. doi: 10.1001/jama.2026.5027. Online ahead of print.

ABSTRACT

IMPORTANCE: The presence of management consultants in the US health care industry has increased dramatically in recent decades and is now higher than in most other sectors of the US economy. Hospitals hire management consultants to provide external expertise and advise on strategic planning, organizational change, cost cutting, and revenue-enhancement activities. Despite the prominence and influence of these firms, there is no empirical evidence in the US documenting either how much is spent on these services or whether that spending leads to measurable improvements.

OBJECTIVE: To quantify nonprofit hospitals’ spending on management consultants and to evaluate changes in finances, operations, and quality of care following the initiation of a contract with a management consulting firm.

DESIGN, SETTING, AND POPULATION: Observational study using a stacked difference-in-differences design to compare 306 US nonprofit hospitals that used a management consultant firm for the first time in 2010-2022 with 513 matched hospitals that did not use management consultants during 2009-2023.

EXPOSURE: First use of a management consulting firm.

MAIN OUTCOMES AND MEASURES: Financial performance (eg, revenues, expenses, margins, cash reserves, and fixed assets), operational measures (eg, inpatient utilization, staffing, executive and worker compensation, charity care, and community benefits), and quality-of-care measures (eg, claims-based 30-day mortality and readmission for acute myocardial infarction, pneumonia, and stroke).

RESULTS: More than 20% of nonprofit hospitals hired management consultants during the study period. Nonprofit hospitals that hired management consultants paid an average of $15.7 million for their services, and nonprofit hospitals collectively spent more than $7.8 billion on these services from 2009 to 2023. Despite this substantial investment, analyses of hospitals’ financial performance, operational decisions, and claims-based patient outcomes revealed little evidence of substantial, statistically significant, or systematic improvements attributable to consulting engagements. Relative changes were estimated for financial measures, such as net patient revenue (-2.22%; 95% CI, -5.11% to 0.76%; P = .14), operating expenses (-1.07%; 95% CI, -3.56% to 1.49%; P = .41), fixed assets (2.05%; 95% CI, -6.54% to 11.42%; P = .65), bad debt (-6.31%; 95% CI, -19.82% to 9.48%; P = .41), days’ cash on hand (-8.56%; 95% CI, -28.00% to 16.13%; P = .46), total margin (-0.19 [95% CI, -1.20 to 0.82] percentage points; P = .71), and operating margin (0.15 [95% CI, -0.94 to 1.23] percentage points; P = .79). Relative changes were estimated for operational measures, such as inpatient length of stay (1.71%; 95% CI, -0.34% to 3.81%; P = .10) and total inpatient days (0.29%; 95% CI, -2.57% to 3.23%; P = .85). Relative changes for quality-of-care outcomes were also generally not significant. The sole exception was 30-day readmission for patients with stroke (1.37 [95% CI, 0.14 to 2.61] percentage points; P = .03), which was not robust to alternative specifications.

CONCLUSIONS AND RELEVANCE: Nonprofit hospitals expend substantial resources on management consultants, but there was no evidence of meaningful changes in hospital finances, operations, or quality of care. These findings raise questions about the net value that nonprofit hospitals receive from management consulting services and suggest the need to carefully examine the widespread use of management consultants by hospitals and other organizations across the health care industry.

PMID:42081210 | DOI:10.1001/jama.2026.5027

Pharmaceut Med. 2026 May 4. doi: 10.1007/s40290-026-00607-z. Online ahead of print.

ABSTRACT

BACKGROUND: Children remain underrepresented in clinical research, despite regulatory frameworks like the EU Paediatric Regulation and Paediatric Investigation Plans (PIPs). The 2024 Declaration of Helsinki revision now recognises excluding vulnerable populations from research as a potential ethical concern. The Clinical Trial Regulation (EU) No 536/2014 aims to harmonise clinical trial application assessment procedures through a coordinated process involving a Reporting Member State (RMS) and Member States Concerned (MSCs).

AIMS: To determine if harmonisation is occurring, we conducted the first systematic analysis of Phase I/II paediatric trial application assessments across Member States (MS) in the European Union (EU) focusing on assessment variability, evidence requirements, PIP integration, and adolescent inclusion practices in adult trials.

METHODS: In the context of a fellowship at the European Medicines Agency, non-public data of 160 paediatric Clinical Trial Applications (CTAs) submitted through the Clinical Trial Information System (January 2022-July 2024) were screened, with inclusion of 55 Phase I/II trials in the main analysis (selected for their focus on innovative treatments and complex risk-benefit assessments). For each CTA, requests for information (consisting of considerations stated by the RMS and MSCs), assessment reports, sponsor responses, and PIP documentation were reviewed. The number of considerations in the requests for information per MS was analysed with median values calculated. Also, considerations were systemically categorised and assessment patterns between RMS and MSC roles were compared. It was examined how PIPs were integrated into assessments and approaches to adolescent inclusion in adult trials was analysed through systematic review of MS considerations.

RESULTS: Of the 160 paediatric CTAs screened, 145 received authorisation, 10 were not authorised, and 5 were withdrawn. Among the 145 authorised CTAs, 61 were Phase I/II trials, 55 of which were included in the main analysis. Analysis of these applications revealed significant heterogeneity in both the number and type of considerations raised across MS, with the median number of considerations per CTA ranging from 5.5 to 26 across MSs (p = 0.025), with particularly marked variation when MSs acted as MSCs compared to RMSs-where additional considerations ranged from zero to 25 per CTA on top of those raised by the RMS. In 36% (20/55), MSs raised concerns about insufficient (pre-)clinical evidence pointing to divergent interpretations of evidence requirements. The degree to which PIPs were integrated into CTA assessments varied considerably-ranging from strict adherence to PIP elements to minimal consideration. In 92% (11/12), MSs showed reluctance to include adolescents in adult Phase I/II trials.

CONCLUSIONS: Despite the CTR’s harmonisation goals, substantial variations persist in assessment practices across MSs, particularly regarding evidence requirements, PIP integration, and adolescent inclusion in adult trials. These variations directly impact equitable access to clinical trials for children across the EU. Urgent regulatory guidance is needed to align interpretation of evidence standards, clarify the role of PIPs in CTA evaluation, and support evidence-based approaches to adolescent inclusion in adult trials.

PMID:42081189 | DOI:10.1007/s40290-026-00607-z

Am J Reprod Immunol. 2026 May;95(5):e70250. doi: 10.1111/aji.70250.

ABSTRACT

PROBLEM: Female genital mutilation/cutting (FGM/C) is harmful to physical, mental, and reproductive health, though the effect of this practice on a woman’s HIV susceptibility is poorly understood. Despite the known associations of FGM/C with short-term vaginal epithelial damage, neither genital inflammation nor the genital microbiome have been explored in women who have undergone FGM/C. In this study we compare the genital immune milieu and microbiome among female sex workers (FSWs) by FGM/C status, hypothesizing that these biological factors are dysregulated in women who have undergone FGM/C, heightening their risk of HIV acquisition.

METHOD OF STUDY: 1003 FSWs in Nairobi, Kenya, were enrolled in the Maisha Fiti study and visited a study clinic up to three times from June 2019 to March 2021. Participants self-reported any previous exposure to FGM/C as well as other relevant sociodemographic factors. Levels of proinflammatory cytokines and soluble E-cadherin (sE-cad), a biomarker of epithelial barrier disruption, were measured by multiplex immunoassay using self-collected cervicovaginal secretion samples provided by HIV-uninfected participants. Genital inflammation was defined using a composite score of inflammatory cytokines previously associated with HIV acquisition. The presence of inflammation was compared longitudinally between groups using mixed models to control for potential confounders including age, bacterial vaginosis (BV) status as defined by Nugent score, and others. Vaginal bacterial abundance, Shannon diversity, and total levels of key vaginal bacteria were measured by qPCR and compared by FGM/C status in an exploratory analysis.

RESULTS: 44 of 1003 (4%) participants had undergone Type I or II FGM/C. These participants were older (p < 0.001) and more likely to test positive for herpes simplex virus-2 (HSV-2; p = 0.04), and less likely to have completed primary education (p = 0.03). Among HIV-uninfected participants, there was no evidence that genital inflammation was associated with FGM/C status after controlling for potential confounders (aOR = 0.70; 95% CI: 0.31-1.59; p = 0.40). There was no evidence of a difference in BV prevalence (p > 0.99), total bacterial abundance (p = 0.96), or Shannon diversity (p = 0.15) by FGM/C status.

CONCLUSIONS: Type I or II FGM/C was not associated with genital inflammation or microbial dysregulation in the long-term among HIV-negative FSWs in this cohort. This may be due to the duration elapsed since FGM/C occurred or the lowered mucosal immune activation previously observed in FSWs.

PMID:42081188 | DOI:10.1111/aji.70250

Discov Nano. 2026 May 4;21(1):163. doi: 10.1186/s11671-026-04597-4.

ABSTRACT

This study examines magnetohydrodynamic (MHD) heat and mass transfer of a ternary hybrid nanofluid over a rotating sphere incorporating thermophoretic particle deposition, thermal radiation, activation energy and chemical reaction effects. The nanofluid consists of [Formula: see text]-[Formula: see text]-[Formula: see text] nanoparticles dispersed in propylene glycol. The governing boundary layer equations are transformed into a system of nonlinear ordinary differential equations via similarity transformations, which are solved using the Gegenbauer wavelet method. Results indicate that increasing magnetic interaction suppresses velocity due to Lorentz force effects while enhancing thermal distribution. Higher nanoparticle volume fraction improves heat transfer but increases viscous resistance. Thermophoresis and activation energy significantly influence mass transfer characteristics. Comparative analysis reveals that the ternary hybrid nanofluid exhibits enhanced thermal performance relative to the corresponding hybrid nanofluid configuration. The findings provide theoretical insight into MHD-controlled rotating nanofluid systems.

PMID:42081179 | DOI:10.1186/s11671-026-04597-4

Clin Transplant. 2026 May;40(5):e70551. doi: 10.1111/ctr.70551.

ABSTRACT

OBJECTIVE: To evaluate whether the difficulty of surgery affects failure-to-rescue (FTR) after liver transplantation (LT).

SUMMARY BACKGROUND DATA: Predictors of FTR include both recipient and intraoperative factors, and their identification and improvement may reduce its incidence.

METHODS: This retrospective study included all first-time isolated LTs performed in six centers. A difficult LT was defined as one in which the number of blood units transfused, cold ischemia time, and duration of surgery were all at or above the median values for the study population. FTR was defined as death within 90 days after a major postoperative complication. The correlations of a difficult LT with outcomes, including FTR, were assessed. Predictors of FTR were identified.

RESULTS: The study population included 1341 patients. The respective incidences of difficult LT, 90-day major complications, 90-day mortality, and FTR were 17.4%, 53.6%, 5.8%, and 10.7%. Difficult LT was correlated with worse short-term outcomes, including a high FTR rate. Being in the intensive care unit, receiving renal replacement therapy at the time of LT, and difficult LT were independent predictors of FTR.

CONCLUSIONS: Mortality following a difficult LT may be correlated to FTR. Identification of modifiable predictors of FTR may help to improve the post-transplant management of these patients.

PMID:42081175 | DOI:10.1111/ctr.70551

Ophthalmic Physiol Opt. 2026 May 4. doi: 10.1007/s44402-026-00097-1. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate the growth and prescribing patterns of community-based independent prescribing (IP) optometrists managing acute eye conditions in Wales between 2020 and 2024, a period that saw the introduction and subsequent commissioning of National Health Service (NHS) funded acute eye care with prescribing in primary care optometry throughout Wales.

METHODS: Monthly prescribing data from NHS Wales Shared Services Partnership were analysed for all IP optometrists in Wales from 1st February 2020 to 31st January 2024. Data included drug name, British National Formulary classification, quantity, cost and health board location. Descriptive and correlational statistics were used to assess prescribing activity, regional distribution and cost trends.

RESULTS: The number of active IP optometry practices increased from eight in February 2020 to 68 in January 2024, with 20,980 prescriptions (49,162 items) issued at a total cost of £339,426. Corticosteroids, anti-infective agents and ocular lubricants were the most frequently prescribed drug classes. Ocular lubricants accounted for 34.0% of the total spend. Regional variation in prescribing activity was observed, with positive correlations between the number of active practices and both prescription volume and cost. Generic prescribing accounted for 47.0% of prescriptions, lower than national averages.

CONCLUSION: NHS commissioning of IP services in Wales has significantly expanded the role of optometrists in managing acute eye conditions in primary care. The findings highlight the potential of IP optometry to reduce pressure on general medical practice and hospital eye services. Further research is needed to evaluate clinical outcomes, cost-effectiveness and the broader therapeutic use of ocular lubricants in acute care.

PMID:42081174 | DOI:10.1007/s44402-026-00097-1

J Endocrinol Invest. 2026 May 4. doi: 10.1007/s40618-026-02899-z. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to investigate the associations between composite inflammatory indicators and the presence of osteoporosis (OP) and sarcopenia in patients with type 2 diabetes mellitus (T2DM), and to explore the potential mediating role of inflammation in the relationship between sarcopenia and OP.

METHODS: In this cross-sectional study, 756 adults with T2DM were enrolled. Osteoporosis was defined as a Bone Mineral Density (BMD) T-score ≤ -2.5 at the hip or lumbar spine. Sarcopenia was diagnosed according to Asian Working Group for Sarcopenia (AWGS) 2019 criteria. Composite inflammatory indicators, including systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), pan-immune inflammation value (PIV), platelet-to-lymphocyte ratio (PLR), advanced lung cancer inflammation index (ALI), neutrophil-to-albumin percentage ratio (NPAR), platelet-to-neutrophil ratio (PNR), and neutrophil-lymphocyte-platelet ratio (NLPR) were calculated from routine blood parameters. Associations between composite inflammatory indicators and OP as well as sarcopenia were assessed using restricted cubic splines (RCS) and multivariate logistic regression analysis. The ability of composite inflammatory indicators to identify sarcopenia was evaluated using receiver operating characteristic (ROC) curves. Mediation analysis to assess the indirect effect of inflammation on the sarcopenia and osteoporosis relationship.

RESULTS: In this study, the prevalence of osteoporosis was 31.1%, and the prevalence of sarcopenia was 34.0%. RCS analysis revealed that ALI exhibited a linear negative correlation with osteoporosis, and SII, SIRI, NLR, PIV, PLR, NLPR, NPAR exhibited linear positive correlations with sarcopenia (all P for nonlinearity > 0.05). PNR and ALI demonstrated a negative nonlinear association with sarcopenia (all P for nonlinearity < 0.05). Logistic regression analysis indicated that sarcopenia was positively associated with osteoporosis (P< 0.05). However, ALI (aOR 0.99, 95% CI 0.98-1.00) showed inverse association with osteoporosis (P < 0.05). Logistic regression analysis also indicated that osteoporosis was positively associated with sarcopenia (P < 0.05). The multivariable regression analysis showed hs-CRR (aOR 1.03, 95% CI 1.01-1.05), SII (aOR 1.00, 95% CI 1.00-1.00), SIRI (aOR 1.46, 95% CI 1.13-1.93), PIV (aOR 1.00, 95% CI 1.00-1.00), NPAR (aOR 1.11, 95% CI 1.04-1.19), and NLR (aOR 1.20, 95% CI 1.05-1.38) showed positive associations with sarcopenia. Conversely, ALI (aOR 0.98, 95% CI 0.97-0.99) exhibited a inverse association with sarcopenia (P < 0.05). The area under the ROC curve (AUC) for ALI in identifying sarcopenia was 0.68. Mediation analysis showed that ALI mediated the statistical association between sarcopenia and osteoporosis with proportions (%) of 19.58.

CONCLUSION: Sarcopenia is positively associated with osteoporosis in patients with T2DM, and this relationship is partially mediated by systemic inflammation, as captured by the ALI. The ALI may serve as a useful and accessible clinical indicator to identify T2DM patients at higher risk for sarcopenia and osteoporosis, who may benefit from targeted screening and multimodal interventions.

PMID:42081166 | DOI:10.1007/s40618-026-02899-z

Acta Biotheor. 2026 May 4;74(3):14. doi: 10.1007/s10441-026-09523-w.

NO ABSTRACT

PMID:42081161 | DOI:10.1007/s10441-026-09523-w