Category: Statistics

JMIR Res Protoc. 2026 Jul 17;15:e93012. doi: 10.2196/93012.

ABSTRACT

BACKGROUND: African American and Black women are among the least physically active demographic groups in the United States and experience disproportionate burdens of chronic disease that may be reduced through regular physical activity (PA). Mixed methods research is increasingly used to examine the behavioral, social, and contextual factors that influence PA in this population.

OBJECTIVE: This study aims to identify, examine, and describe the mixed methods designs used in research on PA practices among African American and Black women in the United States; compare methodological approaches; identify gaps in the literature; and provide recommendations for future research.

METHODS: This scoping review will follow Joanna Briggs Institute methodology. A 3-step search strategy was developed and peer reviewed using the Peer Review of Electronic Search Strategies guideline. Seven databases will be searched: Academic Search Ultimate, Agricultural and Environmental Science Database, APA PsycINFO, CINAHL Ultimate, PubMed, SocINDEX, and SPORTDiscus. Eligible studies will be primary mixed methods investigations involving non-Hispanic African American or Black women aged ≥18 years residing in the United States. Studies must include both quantitative and qualitative components with evidence of integration. Records will be deduplicated and screened in Rayyan according to population, concept, and context eligibility criteria. Data will be summarized using descriptive statistics, tables, and an evidence map. The review will be limited to English-language studies published from February 1, 2011, through February 18, 2026.

RESULTS: The protocol was registered with the Open Science Framework. The search strategy was piloted, refined, and finalized on February 18, 2026. Database searching has been completed, records have been imported and deduplicated, and screening is currently ongoing. Data extraction and synthesis have not yet commenced. Completion of study selection, data charting, and synthesis is anticipated by August 2026, with submission of the completed scoping review planned thereafter.

CONCLUSIONS: This review will provide a methodological map of mixed methods studies examining PA among African American and Black women, including design types, integration strategies, timing, prioritization, use of joint displays, and reporting practices. Findings will inform future mixed methods research and support the development of more rigorous and transparent investigations in this field.

TRIAL REGISTRATION: Open Science Framework 10.17605/OSF.IO/NA9ME; https://osf.io/na9me/overview.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/93012.

PMID:42470183 | DOI:10.2196/93012

J Neuroendocrinol. 2026 Jul;38(7):e70235. doi: 10.1111/jne.70235.

ABSTRACT

Hyperthyroidism is associated with cognitive impairment and neuropsychiatric symptoms, yet its effects on white matter architecture and neuromolecular organization remain poorly understood. We examined how hyperthyroidism alters white matter wiring architecture and the neuromodulatory systems underlying these disturbances. Diffusion MRI-derived structural connectomes were analyzed in 30 patients with hyperthyroidism (HT) and 28 matched healthy controls (HC). Structural connections were classified into short-, medium-, and long-range pathways, and global and nodal network topology was quantified using graph theoretical analysis. Molecular associations were examined using nine PET-derived neurotransmitter receptor density maps through spatial correlation, multiple regression, and dominance analysis. Associations with thyroid hormone levels, clinical measures, and cognitive scores were evaluated using permutation-based statistical testing. Neurotransmitter-weighted network measures were computed by linking normative neurotransmitter density with graph theoretical metrics. Spatial autocorrelation was controlled using spin permutation testing, with results additionally corrected for multiple comparisons using false discovery rate (FDR) correction. Hyperthyroid patients exhibited significantly increased medium-range (p = .002) and long-range connectivity (p = .02), reduced modularity (p = .009), and increased characteristic path length (p = .032) as compared to controls, indicating disrupted segregation and efficiency. Nodal alterations were predominantly right-lateralized, involving cortical, subcortical, and cerebellar regions. Clinically, BMI predicted modularity (p = .01), while free thyroxine levels predicted characteristic path length (p = .04) and long-range connectivity strength (p = .03). The Nahor-Benson score was associated with increased medium-range connectivity (p = .02) and nodal degree (p = .03) in right cerebellar lobule IV-V. Neurotransmitter receptor distributions explained substantial variance in network topology (adjusted R² = 0.45 in controls; 0.38 in hyperthyroidism), with dominant contributions from 5-HT_1A (33%) and dopamine transporter (17%). Furthermore, 5-HTT-weighted within module degree z-score predicted thyroid-stimulating hormone (TSH) levels in hyperthyroidism (p = .03), linking hormonal dysregulation to molecular connectomic reorganization. Our findings suggest that excess thyroid hormone drives right-lateralized connectomic reorganization and increased metabolic demand, mediated by serotonergic and dopaminergic receptor architecture, linking endocrine dysfunction to large-scale brain network vulnerability. These insights inform mechanistic models and biomarkers for clinical translation.

PMID:42470173 | DOI:10.1111/jne.70235

Nurs Open. 2026 Jul;13(7):e70659. doi: 10.1002/nop2.70659.

ABSTRACT

AIM: This study aimed to explore latent categories of nursing and medical students’ knowledge, attitude and practice intentions regarding advance care planning (ACP), and to identify the factors influencing these categories. It sought to provide an evidence base for developing personalized, precision-targeted advance care planning educational interventions.

METHODS: From October to December 2023, a stratified cluster random sampling method was employed to select a sample of 1006 undergraduate students in clinical medicine and nursing (Years 1-4) from a medical university in eastern China. A total of 935 valid questionnaires were recovered. Research instruments included a self-developed demographic questionnaire, the advance care planning knowledge, attitude and practice intentions Questionnaire, the Death Attitude Profile-Revised, and the Meaning in Life Questionnaire. Latent profile analysis determined the optimal number of categories; logistic regression identified factors influencing different advance care planning knowledge, attitude and practice intentions categories; a nomogram was constructed using R software, and predictive performance was evaluated using area under the curve (AUC), Hosmer-Lemeshow test, and 1000-bootstrap calibration curves.

RESULTS: Latent profile analysis identified two latent categories: a “collaborative” group (33.6% of the sample) and a “lagging” group (66.4% of the sample). The collaborative group scored higher than the lagging group across all dimensions of advance care planning knowledge, attitude and practice intentions questionnaire. Logistic regression analysis indicated: palliative care training (OR = 1.5, 1.028-2.190), resuscitation experience (OR = 0.64, 0.424-0.966), clinical medicine student (OR = 0.537, 0.376-0.766), urban student (OR = 0.626, 0.419-0.935), high death escape scores, low natural acceptance scores, and low meaning in life questionnaire scores were more likely to be classified as “lagging type”. Senior students (OR = 7.217, 4.089-12.737) and those with positive major attitude (OR = 3.572, 1.228-10.386) were more likely to be classified as “collaborative type”. The nomogram demonstrated good discriminatory ability (AUC = 0.864; 95% CI 0.841-0.887; Brier score = 0.14) and high calibration (χ² = 13.845, p = 0.086; calibration slope = 0.97).

CONCLUSIONS: The established nomogram model identified the influencing factors of the knowledge, attitude and practice Intentions level of advance care planning among medical undergraduates, providing empirical evidence for the educational intervention of advance care planning for nursing and medical undergraduates. Universities needed to carry out refined advance care planning education in a targeted manner based on the different characteristics of students.

REPORTING METHOD: To strengthen the validity of the research, it was planned, conducted and reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

PATIENT OR PUBLIC CONTRIBUTION: All participants contributed to the conducting of this study by completing self-reported questionnaires.

PMID:42470172 | DOI:10.1002/nop2.70659

Health Serv Res. 2026 Aug;61(4):e70151. doi: 10.1111/1475-6773.70151.

ABSTRACT

OBJECTIVE: To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience.

STUDY SETTING AND DESIGN: Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization.

DATA SOURCES AND ANALYTIC SAMPLE: Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization).

PRINCIPAL FINDINGS: Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters.

CONCLUSIONS: VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.

PMID:42470152 | DOI:10.1111/1475-6773.70151

Equine Vet J. 2026 Jul 18. doi: 10.1002/evj.70227. Online ahead of print.

ABSTRACT

BACKGROUND: Campylorrhinus lateralis (‘wry nose’) is a rare congenital maxillofacial deformity of foals resulting in compromise of the airway and severe class 4 malocclusion. Various surgical techniques to correct the deformity have been described, but contemporary data on single-stage transection and fixation, including use of a rib graft, and long-term functional and cosmetic outcomes remain underreported.

OBJECTIVES: To describe the transection-and-fixation technique and perioperative management used to correct wry nose in horses, and to report postoperative complications and long-term outcomes of horses undergoing this treatment.

STUDY DESIGN: Retrospective case series.

METHODS: Wry nose of four horses was corrected by using a single-stage transection-and-fixation technique. Pre-operative assessment included physical, oral, and radiographic examinations, and when available, CT imaging. The surgical procedure involved temporary tracheostomy and laryngotomy, resection of the nasal septum, osteotomy and fixation of the nasal bones, and orthognathic transection and fixation of the premaxillae and maxillae, with bone grafting and alar fold resection performed when indicated. The outcome of horses with complete records and ≥12 months follow-up is reported using descriptive statistics.

RESULTS: All four horses were presented with respiratory difficulty. The transected premaxillae were stabilised with pins and wires, and the transected nasal bones were stabilised with plates/screws; only one horse received a rib graft. All horses developed a plate-associated infection, and one horse developed an oronasal fistula. At the time of follow-up, all grazed and masticated normally, maintained good body condition, and owners were satisfied with the functional and cosmetic outcome.

MAIN LIMITATIONS: Small sample size, retrospective design.

CONCLUSIONS: Correcting wry nose of four foals using a single-stage transection-and-fixation procedure achieved satisfactory long-term outcomes. Respiratory function of all horses improved, and all horses grazed and masticated normally. Three horses were able to perform their intended athletic endeavour. All owners reported satisfaction with the functional and cosmetic outcome.

PMID:42470150 | DOI:10.1002/evj.70227

Nurs Health Sci. 2026 Sep;28(3):e70394. doi: 10.1111/nhs.70394.

ABSTRACT

Disaster response in neonatal intensive care units is particularly complex because care continuity depends on coordinated teamwork, stable infrastructure, and technology-dependent support for highly vulnerable infants. However, qualitative evidence on how nurses experience disaster response in these settings remains limited, especially in the context of the 2023 Türkiye-Syria earthquakes. This study explored how nurses working in neonatal intensive care units experienced disaster response during the earthquakes. Data were collected through semistructured in-depth interviews with 21 nurses and analyzed using descriptive phenomenological analysis. Participants described disaster response not only as a clinical emergency but also as a disruption of the systems supporting coordination, safe neonatal care, and practical preparedness. They reported breakdowns in communication and role clarity, fragility in care when electricity, oxygen delivery, monitoring systems, evacuation planning, and essential supplies became unstable, and a clear gap between general disaster education and unit-specific readiness. Overall, the findings highlight the need for neonatal intensive care-specific disaster preparedness.

PMID:42470148 | DOI:10.1111/nhs.70394

J Appl Physiol (1985). 2026 Jul 18. doi: 10.1152/japplphysiol.01180.2025. Online ahead of print.

ABSTRACT

Postmenopausal women (PW) experience hemodynamic and autonomic alterations that increase cardiovascular risk. While aerobic exercise is widely recognized for its cardioprotective benefits, the chronic effects of resistance training (RT) on cardiovascular and autonomic function in this population remain less established. This systematic review aimed to evaluate the effects of RT on hemodynamic and vascular structure and function, cardiovascular autonomic control and cardiac structural outcomes in PW. A comprehensive search of PubMed, Scopus, Web of Science, and SPORTDiscus was conducted up to February 2026. Randomized and non-randomized controlled trials investigating RT interventions (≥4 weeks) were included. Primary outcomes were resting heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean blood pressure (MBP). Secondary outcomes included vascular adaptations, heart rate variability (HRV), and cardiac structural characteristics. Meta-analyses were performed using a random-effects model, with pooled effects expressed as Hedges’ g; heterogeneity was quantified using I². Risk of bias, reporting quality exercise parameters, and methodological consistency were assessed. 60 studies met inclusion criteria. Meta-analyses showed statistically significant reductions in HR, SBP, DBP, and MBP after RT. The magnitude of the effects, was small for HR (g=0.30, 95% CI [0.02;0.58], I²=0.0%) and DBP (g=0.37, 95% CI [0.11;0.63], I²=0.0%) and moderate effects for SBP (g=0.68, 95% CI [0.40;0.96], I²=0.0%) and MBP (g=0.68, 95% CI [0.37;0.99], I²=0.0%). Qualitative synthesis showed modest improvements in vascular adaptations and HRV, while echocardiographic studies reported no adverse structural cardiac adaptations. RT produces favorable cardiovascular and autonomic adaptations in PW, improving hemodynamic regulation without structural cardiac alterations.

PMID:42470140 | DOI:10.1152/japplphysiol.01180.2025

Int J Epidemiol. 2026 Jun 24;55(4):dyag109. doi: 10.1093/ije/dyag109.

ABSTRACT

BACKGROUND: Colorectal cancer (CRC) screening programmes often use the faecal immunochemical test (FIT) to identify individuals for follow-up colonoscopy but evidence on its impact on CRC incidence remains limited. Using a regression discontinuity design (RDD), we investigated whether CRC screening affects CRC incidence among adults aged 71-75 years with FIT values close to the threshold-an age group not consistently included in screening programmes.

METHODS: Using registry data from 2014 to 2024, we compared CRC incidence among screening participants aged 71-75 years with FIT values just above versus just below the 100-ng/ml referral threshold, where only those above were offered colonoscopy. We included 2773 individuals with borderline FIT values (80-120 ng/ml). An RDD was used to estimate the effect of colonoscopy referral based on FIT on CRC incidence at values close to the threshold while mitigating healthy-user bias.

RESULTS: Over a median 8.4-year follow-up, 165 CRC cases were observed. As expected from the lead time, early incidence was higher in FIT-positive individuals offered colonoscopy but cumulative incidence later plateaued in this group while it continued to rise in FIT-negative individuals. After 10 years of follow-up, a reduction was seen between the groups from 12.1 to 6.6 cases per 1000 person-years, equivalent to 5.5 fewer cases (95% confidence interval: 1.44-9.56) per 1000 person-years, corresponding to a 45.5% reduction.

CONCLUSION: CRC screening reduces CRC incidence among adults aged 71-75 years with FIT values close to the FIT threshold. This could guide cancer screening policies for an age group that is only eligible for screening in some countries.

PMID:42470136 | DOI:10.1093/ije/dyag109

Int J Epidemiol. 2026 Jun 24;55(4):dyag114. doi: 10.1093/ije/dyag114.

ABSTRACT

BACKGROUND: It has been hypothesized that the incidence of cryptorchidism may have increased in Japan following the Fukushima Daiichi Nuclear Power Plant (FDNPP) accident in March 2011; however, empirical evidence remains limited. This study aimed to assess the possible impact of the accident on cryptorchidism incidence over an extended period of time before and after the accident.

METHODS: Detailed information on all patients who underwent orchiopexy between April 2008 and March 2021 was obtained from the medical records of 86 hospitals in Fukushima Prefecture. Interrupted time series analyses were performed to evaluate the immediate post- versus pre-accident level change and the monthly post- versus pre-accident slope change in orchiopexy surgery rates and birth rates with cryptorchidism.

RESULTS: In total, 622 orchiopexy surgeries performed in Fukushima Prefecture during the study period were included. No significant increase was observed in the monthly orchiopexy surgery rate per 100 000 population in Fukushima Prefecture after the accident, in terms of either the immediate level change (incidence rate ratio [IRR], 1.21; 95% CI, 0.86-1.70) or the monthly slope change (IRR per month, 1.01; 95% CI, 0.99-1.04). The estimated monthly birth rate with cryptorchidism per 1000 live births in Fukushima Prefecture also showed no significant increase in either the immediate level change (IRR, 0.87; 95% CI, 0.52-1.44) or the monthly slope change (IRR per month, 1.01; 95% CI, 0.99-1.04).

CONCLUSIONS: Our study provided no evidence that the FDNPP accident increased the orchiopexy surgery rates or birth rates with cryptorchidism in Fukushima Prefecture.

PMID:42470134 | DOI:10.1093/ije/dyag114

Biostatistics. 2026 Jan 20;27(1):kxag021. doi: 10.1093/biostatistics/kxag021.

ABSTRACT

The three dimensional (3D) spatial organization of the genome is closely linked to biological functions and can be captured by Hi-C assays through interrogating genome-wide chromatin interactions. Methodologies for inferring 3D structures from Hi-C data summarized as a two-dimensional (2D) contact matrix can be broadly placed within the paradigms of optimization-based and sampling-based. Many optimization-based methods are capable of constructing whole genome 3D structures but do not account for spatial dependency in the 2D data matrix nor cell heterogeneity in bulk Hi-C data, which provide an average over millions of cells. Sampling-based methods, on the other hand, are probabilistic model-based and can account for not only dependency, heterogeneity, but also other features inherent in Hi-C data, such as over-dispersion and sparsity. However, whole-genome 3D structure recapitulation is too computationally expensive for sampling-based methods, while chromosome-by-chromosome strategies for sampling-based methods ignore important information on inter-chromosomal contacts. To address these issues, we propose the truncated Random effect EXpression-cut and paste (tREX-cap) method, which applies the tREX model within a divide and conquer strategy. The resulting method inherits the good data-feature-cognizant properties of tREX and, in the meantime, can efficiently infer the whole genome 3D structure. We demonstrate the performance of tREX-cap through an extensive simulation study and analyses of a Hi-C lymphoblastoid dataset and a Hi-C IMR90 dataset.

PMID:42470130 | DOI:10.1093/biostatistics/kxag021