Category: Statistics

JCO Precis Oncol. 2026 May;10(5):e2500597. doi: 10.1200/PO-25-00597. Epub 2026 May 14.

ABSTRACT

PURPOSE: Oligometastatic disease (OMD) is an intermediate state of metastatic disease in which metastasis-directed therapy (MDT) may improve outcomes. The classification of OMD is inconsistent, typically defined by number of metastases without considering tumor biologic characteristics. To help optimize patient selection for MDT, we analyzed integrated genomic sequencing results from patients with metastatic non-small cell lung cancer (NSCLC).

MATERIALS AND METHODS: Patients with metastatic NSCLC who had molecular sequencing through a validated institutional assay (MSK-IMPACT) were included. The number and location of metastases were manually annotated (assigned 1-10 and >10). Individual gene variant scores were analyzed by gene length and patient mutation burden. Analysis was completed in R and included maximally selected rank statistics, agglomerative hierarchical clustering, and the chi-square test for independence.

RESULTS: In total, 844 patients had clinical data, tissue sequencing, and annotated imaging for analysis. Of these, 635 had >10 metastases (75.2%), and 209 had 1-10 metastases (24.8%). The cutpoint that maximized overall survival (OS) was four metastases, and six mutation signatures were identified. For patients with 1-4 metastases, TERT and KMT2D had inferior OS, while for those with ≥5 metastases, EGFR, ALK, and TBX3 had superior OS.

CONCLUSION: The cutpoint that maximized difference in OS was four metastases, but incorporating genetic alteration information modified this criterion. These findings were proof of principle that integrating multimodal data beyond number of lesions can better identify patients with metastatic NSCLC who may be candidates for MDT.

PMID:42133899 | DOI:10.1200/PO-25-00597

JCO Precis Oncol. 2026 May;10(5):e2501125. doi: 10.1200/PO-25-01125. Epub 2026 May 14.

ABSTRACT

PURPOSE: Given the paucity of data regarding circulating tumor DNA (ctDNA) as a modality to guide diagnosis and treatment for children with advanced solid tumors, we conducted a prospective study to characterize the frequency and clinical impact of diagnostic and targetable genomic variants identified by clinical ctDNA testing.

METHODS: Our study cohort included 36 children and young adults with advanced solid tumors enrolled in the prospective, multicenter molecular profiling GAIN study. Tumor samples underwent next-generation sequencing, and serial blood samples were analyzed by the FoundationOne Liquid Companion Diagnostic ctDNA test. We evaluated the prevalence of ctDNA in our cohort using ctDNA tumor fraction (TF), the prevalence of genomic variants in ctDNA compared with those in tumor tissue stratified by ctDNA TF, the association between ctDNA TF and radiographic disease response, and the clinical impact of ctDNA testing.

RESULTS: In our cohort, 67% of patients had at least one liquid biopsy sample with detectable ctDNA by TF. Most patients (72%) had detection of a clinically relevant genomic alteration in at least one ctDNA sample. Most (85%) short variants and translocations identified in tissue were present in ctDNA when TF ≥ 1%, with variation by tumor type. We demonstrated statistically significant differences in absolute ctDNA TF changes among patients with radiographic disease progression (mean, +12.2%, standard deviation, 18.7%) and response (mean, -23.4%, standard deviation, 30.6%), P < .001. ctDNA results affected the clinical care of 26% of patients.

CONCLUSION: ctDNA is prevalent across a wide range of advanced pediatric solid tumors, identifies clinically important variants, changes with radiographic disease burden, and has a clinical impact.

PMID:42133898 | DOI:10.1200/PO-25-01125

JCO Precis Oncol. 2026 May;10(5):e2500500. doi: 10.1200/PO-25-00500. Epub 2026 May 14.

ABSTRACT

PURPOSE: Immune response to tumors defines patient outcomes and our goal was to identify where tumors lie on the self/nonself axis and if they exploit selfness to subvert immune destruction.

MATERIALS AND METHODS: A new measure for quantifying selfness was developed using transcriptomes based on a selfness model stemming from thymic education. The thymus-likeness score (TLS) was validated on data from the Human Protein Atlas and then used to interrogate tumor recognizability across 32 solid tumor cohorts from The Cancer Genome Atlas (TCGA). A robust statistical pipeline was devised to identify links between the TLS and disease outcomes such as immune infiltration and patient survival.

RESULTS: We first developed a novel selfness score (TLS) for estimating the T-cell recognizability in any sample, given its transcriptome. Using the TLS, we interrogated tumor recognizability across 32 solid tumor cohorts from TCGA and found that there is a consistent increase in selfness in tumors compared with their adjacent nontumor tissues. In our pan-cancer analysis, we found an unexpected inverse association between TLS and immune infiltration of macrophages, dendritic cells, CD8 T cells, and Treg cells. We found the selfness, when combined with the immune infiltration, to correlate with patient survival in multiple cohorts.

CONCLUSION: The TLS is one of the first models for quantifying tumor recognizability from an immune perspective. The increase in selfness in tumors, along with its inverse relationship with immune infiltration, and links to survival hints at the presence of an immune sculpting selection mechanism that selects for two types of tumors: (1) easily recognizable, but poorly infiltrated and (2) heavily infiltrated, but poorly recognizable. Our results provide a new direction for investigating tumor evolution trajectories.

PMID:42133896 | DOI:10.1200/PO-25-00500

JMIR Form Res. 2026 May 14;10:e85703. doi: 10.2196/85703.

ABSTRACT

BACKGROUND: Tobacco, alcohol, and illicit drug use continue to pose substantial public health challenges in China. Although public service announcements (PSAs) are widely used for prevention, little is known about how these messages are constructed or the extent to which they draw on established health communication theories.

OBJECTIVE: This exploratory study aimed to characterize the design features of anti-substance use PSAs in China, assess their use of constructs from the extended parallel process model (EPPM) and the elaboration likelihood model (ELM), and compare patterns across anti-substance use PSAs.

METHODS: We conducted a content analysis of 89 publicly available anti-substance use PSAs produced in mainland China. Messages were identified via major Chinese video platforms and institutional websites and then screened using predefined eligibility criteria. Variables captured message source, intended audience, framing, substance depiction, cultural appeals, and EPPM and ELM components. Frequencies and proportions were calculated, and χ2 tests were used to examine differences by PSA type. To account for multiple comparisons, P values were adjusted using the Holm-Bonferroni correction.

RESULTS: Most PSAs did not identify a target audience (54/89, 60.7%), and public security departments were the most common sponsors (n=37, 41.2%), while none were sponsored by public health agencies. Theory use was selective: response efficacy (n=63, 70.8%) and perceived severity (n=55, 61.8%) appeared more often than self-efficacy (n=45, 50.6%) and perceived susceptibility (n=34, 38.2%); peripheral cues (n=79, 88.8%) were more common than central route cues (n=16, 18%). Differences across PSA types were observed in sponsorship, message features, and theoretical constructs. After adjustment for multiple comparisons, associations involving sponsoring organizations (public security departments and Chinese media) and perceived susceptibility remained statistically significant (all adjusted P=.01). Antidrug PSAs were predominantly associated with public security sponsorship, whereas antialcohol and antitobacco PSAs were more frequently linked to Chinese media sources. Perceived susceptibility cues were more common in antismoking PSAs than in antidrug PSAs, while other differences in framing, substance cues, cultural appeals, and ELM or EPPM constructs were not statistically significant after adjustment.

CONCLUSIONS: Anti-substance use PSAs in China were characterized by limited audience segmentation and uneven use of theory-based persuasive strategies. Observed differences across alcohol-, tobacco-, and drug-focused messages suggest that PSA design may be shaped not only by partial application of communication theory but also by institutional influences and substance-specific contexts. These findings highlight the need for more context-sensitive and theory-informed approaches to anti-substance use PSA design in China.

PMID:42133889 | DOI:10.2196/85703

JMIR Res Protoc. 2026 May 14;15:e89056. doi: 10.2196/89056.

ABSTRACT

BACKGROUND: Neighborhood revitalization is a process through which land use rezoning and capital investment can spur new resources, such as access to healthful food and amenities for physical activity. While revitalization efforts may promote cardiovascular health, their benefits may not be distributed equally across sociodemographic groups.

OBJECTIVE: The objective of the study is to apply a socioecological framework that uses a multimethod approach incorporating quantitative data (longitudinal electronic health records and cross-sectional surveys) and qualitative data (longitudinal “walk-a-long” interviews) to examine the short-term effect of neighborhood land use rezoning and revitalization efforts on cardiovascular disease (CVD), CVD-related health behaviors, and access to and utilization of health care. System science methods, namely microsimulation modeling and system dynamics modeling, will be used to assess the long-term effects of land use rezoning policy and revitalization efforts on cardiovascular health and ways to sustain priority health equity goals in revitalized neighborhoods.

METHODS: We leverage a land use rezoning initiative in the Bronx, New York, where a largely commercial area is being rezoned along with capital investments to expand healthful neighborhood resources. Using electronic health records from a single hospital system, we will follow cohorts of midlife and older adults (≥50 y) residing in both the rezoned area and a comparison area. We will assess clinically measured incident CVD and other CVD risk factors to evaluate changes in cardiovascular health over time. In parallel, we will conduct a cross-sectional survey and a purposive sampling of patients for in-person “walk-a-long” qualitative interviews to understand how residents perceive neighborhood access to healthful resources after land use rezoning. To estimate long-term effects, we will use a validated microsimulation model to project CVD outcomes and costs. Finally, we will use system dynamics modeling to integrate quantitative and qualitative findings to inform future revitalization and public health strategies.

RESULTS: Midlife and older adult patients (N=10,813) in the intervention area and the comparison area will be followed for approximately 7 years following land use rezoning and revitalization efforts to compare CVD risk between neighborhoods. The cross-sectional survey (n=300) and qualitative assessment (n=36) will increase understanding of perceptions of access to healthful resources and related health behaviors among residents. Systems science approaches will estimate long-term CVD risk and related costs associated with revitalization efforts. An advisory committee of clinical and community stakeholders will assist in interpreting results and developing dissemination strategies for their constituents. This study was funded from January 2023 until December 2026.

CONCLUSIONS: This study uses a socioecological framework to provide a novel, transferable method for evaluating the impact of neighborhood revitalization efforts on cardiovascular health by combining methods to examine short- and long-term effects across individual, neighborhood, and structural (system) levels over time. Findings will inform policies aimed at reducing CVD through equitable urban revitalization.

PMID:42133886 | DOI:10.2196/89056

J Nurs Manag. 2026;2026(1):e4585472. doi: 10.1155/jonm/4585472.

ABSTRACT

BACKGROUND: Measuring unfinished nursing care (UNC) with valid and reliable instruments is essential for identifying systemic issues and improving patient safety and outcomes. The Unfinished Nursing Care Survey (UNCS) was developed as a comprehensive, valid, and reliable tool. This study aimed to examine the validity and reliability of the Turkish version of the UNCS (UNCS-TR).

METHODS: This validation study established the linguistic equivalence of the UNCS-TR using the translation and back-translation method. Content validity was evaluated based on expert opinions. Construct validity, internal consistency, hypothesis testing, and criterion validity were examined among 422 nurses in accordance with the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines.

RESULTS: The overall content validity index of the UNCS-TR was 0.98. Mokken Scale Analysis for Part A demonstrated strong scalability (H = 0.616) and excellent internal consistency (Molenaar-Sijtsma statistic = 0.966; Cronbach’s alpha = 0.964; Guttman’s lambda 2 = 0.965). All 21 items reflecting elements of unfinished care loaded onto a unidimensional structure in Part A. For Part B, which measures reasons for UNC, confirmatory factor analysis supported an 18-item, six-factor structure with acceptable to good fit indices and excellent internal consistency (Cronbach’s α = 0.950). Nurses with greater professional experience reported significantly lower perceptions of UNC. No significant differences were found between bedside nurses and nurse managers. Nurses over 30 years of age perceived significantly fewer instances of UNC compared to younger nurses, and intensive care nurses reported significantly fewer instances than those working in medical-surgical units.

CONCLUSION: The Turkish version of the UNCS (UNCS-TR) is a valid and reliable instrument for measuring UNC.

PMID:42132010 | DOI:10.1155/jonm/4585472

Work. 2026 May 14:10519815261450932. doi: 10.1177/10519815261450932. Online ahead of print.

ABSTRACT

BackgroundMedication vending machines (MVMs) have emerged as a convenient and technology-driven solution for improving access to over-the-counter medications on university campuses.ObjectiveThis study investigates the cultural determinants of MVM acceptance among university students in South Korea and the United Arab Emirates (UAE), providing cross-cultural insights into their attitudes and functional preferences.MethodsA cross-sectional survey was conducted with 48 participants (24 from each country). The questionnaire measured demographic characteristics, familiarity with vending machines, acceptance of MVMs, and the perceived importance of various MVM features.ResultsThe results indicate that both Korean and UAE students expressed positive attitudes toward the installation of MVMs (Mean on a 5-point Likert scale = 3.88 and 4.17, respectively), and the between-group difference was not statistically significant (F = 1.306, p = 0.259). However, cross-cultural differences emerged in functional preferences: UAE students prioritized ease of use (χ² = 5.42, p = 0.020), while Korean students valued convenient location, diverse medication availability, and secure identification features.ConclusionsThese findings underscore the importance of culturally sensitive deployment strategies for autonomous healthcare technologies. This study contributes to the growing literature on technology acceptance in healthcare by highlighting how cultural and behavioral factors shape the adoption of MVMs. Practical recommendations for universities and policymakers include emphasizing usability in UAE campuses and strategic placement, diversity, and security features in Korean campuses to maximize acceptance.

PMID:42132008 | DOI:10.1177/10519815261450932

Pediatr Pulmonol. 2026 May;61(5):e71662. doi: 10.1002/ppul.71662.

ABSTRACT

INTRODUCTION: Nutritional status plays an important part in the health of children and teenagers. It also has an impact on the clinical outcomes of disease situations. This paper’s objective is to evaluate the impact of nutritional status in the clinical outcomes of critically ill children diagnosed with COVID-19.

METHODS: This is an observational, longitudinal, and multicentric study, developed between March 2020 and December 2021, in 36 Pediatric Intensive Care Units in Brazil. The patients included were between the ages of 1 month old and 18 years old, with the diagnosis of COVID-19, confirmed by RT-PCR, from nasopharyngeal and oropharyngeal swabs, tracheal aspirates, or blood serology for the detection of IgA/IgM/IgG antibodies. Nutritional status was evaluated based on the z-score of the body mass index for age (BMI/A), weight for age (W/A), and stature for age (S/A). The outcomes evaluated included final clinical diagnosis of respiratory syndromes, need for ventilatory support, prolonged length of hospital stay, and mortality. A model of regression linear analysis was used to evaluate the independent association with the nutritional status.

RESULTS: Four hundred and thirty-two patients were included in the study. The average age was 30 months (IQR, 11-85); 200 (46.3%) were under 24 months old, and 29 (6.7%) had comorbidities. There were 302 (69.9%) patients with average weight, 54 (12.5%) were underweight, 76 (17.6%) were overweight, and 44 (23%) had short stature. The underweight category presented independent association with the outcomes of Acute Respiratory Distress Syndrome (ARDS) (RR 2.12; 95% CI 1.01-4.46; p = 0.04), need for invasive mechanical ventilation (IMV) (RR 1.8; 95% CI 1.1-3.1; p = 0.02), prolonged length of stay (LOS) (RR 1.5; 95% CI 1.01-2.1, p = 0.03), and mortality (RR 8; 95% CI 1.9-36; p = 0.005).

CONCLUSION: Independent association was identified between low weight in children with COVID-19 in Pediatric Intensive Care Units and longer length of hospital stay, need for IMV, ARDS and higher risk of mortality.

PMID:42132001 | DOI:10.1002/ppul.71662

J Pediatr Endocrinol Metab. 2026 May 15. doi: 10.1515/jpem-2026-0108. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the association of maternal β-human chorionic gonadotropin (β-hCG), neonatal thyroid hormones including free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH), and neonatal serum testosterone with anogenital distance (AGD) in term male and female newborns, and to assess sex-related differences.

METHODS: This hospital-based cross-sectional study included 133 term newborns (90 males and 43 females) delivered between 37 and 40 weeks of gestation. Maternal serum β-hCG levels were measured before delivery. Cord blood samples were analyzed for fT3, fT4, TSH, and neonatal venous blood samples for serum testosterone. AGD and neonatal anthropometric parameters were measured shortly after birth. Sex-wise comparisons and correlation analyses were performed.

RESULTS: Mean AGD was significantly greater in male newborns than in females (2.62 ± 0.09 cm vs. 1.15 ± 0.05 cm; p = 0.001). Maternal β-hCG levels differed between mothers of male and female newborns (p<0.05). Neonatal serum testosterone levels were higher in males, though not statistically significant (p=0.16). AGD showed positive correlations with maternal β-hCG and neonatal serum testosterone levels. Among thyroid hormones, mean fT3 levels were significantly higher in females (p=0.0001), while fT4 and TSH were comparable.

CONCLUSIONS: AGD at birth shows marked sexual dimorphism and is associated with maternal β-hCG and neonatal serum testosterone measured at birth. These findings provide reference data from an Indian newborn population. Given the timing of measurements, results should be interpreted with caution, and further longitudinal studies are required to clarify developmental determinants of AGD.

PMID:42131996 | DOI:10.1515/jpem-2026-0108

Psychol Med. 2026 May 14;56:e153. doi: 10.1017/S0033291726104644.

ABSTRACT

BACKGROUND: Recent proposals for revising the Diagnostic and Statistical Manual of Mental Disorders (DSM) aim to improve psychiatric diagnosis. While these efforts reflect substantial ambition, they continue to operate within assumptions embedded in the DSM’s underlying classificatory logic. This editorial examines whether such incremental revision is sufficient.

METHODS: We provide a critical analysis of the recently published DSM roadmap and accompanying subcommittee commentaries. Drawing on contemporary literature, we identify five structural blind spots in the current reform agenda: public mental health, scientific inference, lived experience, epistemic governance, and the function of diagnosis. Based on this analysis, we propose an alternative dialogical redesign for the DSM.

RESULTS: We argue that current revision considerations risk increasing complexity without resolving fundamental limitations in psychiatric classification. Specifically, our analysis highlights several areas that warrant further consideration, including the relationship between diagnostic expansion and societal conditions, the applicability of group-level scientific findings to individual care, the incorporation of experiential knowledge, participatory governance in revision processes, and the identity-related implications of diagnosis. In response, we propose redesigning the DSM as a hybrid dialogical system that retains coarse-grained classificatory categories for pragmatic purposes while shifting diagnostic practice toward contextual interpretation, collaborative meaning-making, relational understanding, and individualized care formulation.

CONCLUSIONS: The challenges facing psychiatric diagnosis require more than incremental refinement. We therefore argue for a dialogical redesign of the DSM that better reflects the context-dependent, experiential, and relational nature of mental health conditions, positioning diagnosis as a starting point for collaborative inquiry.

PMID:42131991 | DOI:10.1017/S0033291726104644