Category: Statistics

Mil Med. 2025 Jun 19:usaf191. doi: 10.1093/milmed/usaf191. Online ahead of print.

ABSTRACT

INTRODUCTION: Research suggests injury/disability type and individual demographic factors both impact return-to-work trajectories of those with injuries/disabilities. These questions of disability and return to work/service are particularly relevant to the military where service members are at increased risk of experiencing work-related physical and mental health injuries. The Army Warrior Care and Transition Program (WCTP) is a comprehensive rehabilitation program launched in 2007 to address injured service members’ needs. We sought to understand the WCTP’s efficacy in returning soldiers with physical and mental health injuries to military service (including active duty, Reserve, and Guard).

MATERIALS AND METHODS: This retrospective cohort study utilized the WCTP tracking database (Medical Operations Data System-Warrior Transition, MODS-WT) to explore outcomes for soldiers who participated in the program 2005-2018. The type of injury at program entry was categorized as being a purely physical injury, a purely mental health injury, or both a physical and mental health injury, the impact of injury type on return to military service was explored. Chi-squared and Wilcoxon rank-sum test compared covariates of length of time in the program, sex, age, and marital status by group. Adjusted Logistic regression analysis calculated odds of returning to service, and Joinpoint analysis identified trends in data.

RESULTS: A total of 83,274 soldiers who went through and completed the program 86,529 times 2005-2013 were included. A total of 54,032 program entries were for physical injuries, 7,898 entries for mental health injuries, and 24,599 entries were for both physical and mental health injuries. Odds of returning to military service were increased with officer and warrant officer rank (vs. enlisted), and decreased with age, female sex, and total months in the program. After adjustment for these factors, odds of returning to military service were 68% decreased for those with mental health injuries (OR 0.32 [95% CI 0.31-0.24]) and 72% decreased for those with physical and mental health injuries (OR 0.28 [95% CI 0.27-0.29]) as compared to those with purely physical injuries.For those with physical injuries, odds of returning to military service decreased 15% with every 3 months in the program. For those with purely mental health injuries, odds of returning to military service decreased dramatically the first 6 months, the decline was gradual from 6 to 18 months in the program, from 18 to 36 months in the program the rate of return to military service remained statistically consistent with a slight upward trend. For those with mental health and physical injuries, odds of return to military service declined by 40% over the first 6 months and by 12.5% thereafter.

CONCLUSIONS: Mental health injuries and time in the Warrior Care program were associated with decreased likelihood of return to military service. Longer periods of care for those with mental health issues may relate to less standardized, tested, or known efficacious mental health treatments. The study is limited by inclusion of only those with serious injury, and an inability to assess injury severity, but strengthened by equal access to high-quality care and a large population of injured service members.

PMID:40577821 | DOI:10.1093/milmed/usaf191

Mil Med. 2025 Jun 19:usaf091. doi: 10.1093/milmed/usaf091. Online ahead of print.

ABSTRACT

INTRODUCTION: Activity restrictions assigned because of patellofemoral pain syndrome (PFPS) among military members is a central component of care for these problems. However, no prior study has assessed the relationship between the parameters of such restrictions and later patient outcomes. The purpose of this study was to identify associations between initial activity restriction durations for PFPS and subsequent return to unrestricted activity.

MATERIALS AND METHODS: We studied active duty U.S. Army soldiers who received activity restrictions for PFPS during January 2014 to June 2016 (N = 15,085). Descriptive statistics were organized to support graphic display of the proportions of men and women who returned to activity after selected initial restriction durations. Sex-specific multivariable logistic regression models provided adjusted odds ratios (aORs) for activity return following restrictions.

RESULTS: Activity restrictions 30 to 32 days in duration were most prevalent (n = 5,496; 36.43%). However, the highest adjusted activity return odds were seen for restrictions of 14 to 19 days in duration (men: aOR = 2.00, 95% confidence interval [CI] = 1.73 to 2.32; women: aOR = 2.08, CI = 1.46 to 2.94). Reduced activity return odds were seen in subjects with high body mass index and tobacco use.

CONCLUSIONS: Shorter initial restrictions than were most commonly provided were associated with the highest probability of activity return. The findings support the potential for enhanced return to activity rates if shorter restrictions were assigned. However, they indicate the need for prospective research into activity restriction parameters in PFPS to confirm the associations seen.

PMID:40577813 | DOI:10.1093/milmed/usaf091

Clin Exp Dermatol. 2025 Jun 19:llaf272. doi: 10.1093/ced/llaf272. Online ahead of print.

ABSTRACT

Anifrolumab is a monoclonal antibody that targets the type I interferon receptor subunit 1. It was approved for the treatment of systemic lupus erythematosus by the FDA in 2021 and by the EMA in 2022. Although phase III clinical trials reported a statistically significant improvement in skin lesions, it has not yet been approved for the treatment of cutaneous lupus erythematosus. We present a case series that includes 10 patients with cutaneous lupus erythematosus who demonstrated a rapid and sustained response to anifrolumab.

PMID:40577812 | DOI:10.1093/ced/llaf272

Mil Med. 2025 Jun 19:usaf307. doi: 10.1093/milmed/usaf307. Online ahead of print.

ABSTRACT

INTRODUCTION: The U.S. Army developed the Holistic Health and Fitness system and Army Combat Fitness Test (ACFT) to support the overall readiness of soldiers from a framework that assesses multiple domains of health. Although modifiable healthy lifestyle behaviors (MHLB)-diet, sleep, and physical activity (PA)-are presumed to influence ACFT performance, research on this relationship, particularly among Reserve Officers’ Training Corps (ROTC) cadets, is limited. This study examines the relationship between MHLB and ACFT performance to understand their impact on fitness outcomes.

MATERIALS AND METHODS: This cross-sectional study included 83 Army ROTC cadets from a single university. Participants completed 3 electronic surveys assessing dietary behaviors, sleep quality, and PA, and performed the ACFT. Anthropometric data, including height, mass, and body composition, were also collected. Nonparametric statistical tests were conducted to assess relationships between MHLB and ACFT performance.

RESULTS: Descriptive statistics revealed that 55.4% of cadets had poor sleep quality, and 9.6% exhibited poor dietary habits. All but 2 cadets passed the ACFT. No significant correlations were found between MHLB and ACFT scores, either across the entire sample or within gender and military science class subgroups.

CONCLUSIONS: The absence of significant correlations between MHLB and ACFT performance challenges common assumptions and highlights the complexity of optimizing readiness in military populations. Although most cadets reported adequate PA levels and acceptable diet quality, the prevalence of poor sleep quality highlights an area for targeted intervention. These results demonstrate the value of holistic health assessments to support the overall well-being and readiness of ROTC populations.

PMID:40577809 | DOI:10.1093/milmed/usaf307

JMIR Res Protoc. 2025 Jun 27;14:e69539. doi: 10.2196/69539.

ABSTRACT

BACKGROUND: Needs assessments in patients with juvenile idiopathic arthritis (JIA) have revealed a need for disease information, self-management skills, and peer support. We previously developed and tested the acceptability of an in-person and videoconference-based self-management program (SMP) to address these needs.

OBJECTIVE: The aim of this pilot randomized controlled trial (RCT; the VISTA-JIA trial) is to evaluate the feasibility and preliminary effectiveness of a virtual group-based SMP for adolescents with JIA in comparison to a waitlist control group.

METHODS: A total of 100 participants with confirmed JIA (aged 12-17 years) will be recruited from 5 Canadian pediatric rheumatology centers and randomized 1:1 to the intervention or waitlist control groups. Adolescents in the intervention group will receive the virtual SMP. Those randomized to the control group will receive standard of care alone and will later be eligible for the SMP. The SMP includes JIA disease education, self-management strategies, and peer support. Four 60- to 90-minute sessions will be conducted over 8 weeks with a group size of 4-6 participants. The primary feasibility outcome will be adherence to the SMP (defined as completion of all 4 sessions by at least 80% of participants). Other secondary feasibility outcomes will include recruitment and withdrawal rates, the proportion of completed questionnaires, engagement and satisfaction with the SMP measured through a semistructured virtual interview, and intervention fidelity (consistent content and technology delivery). Secondary preliminary effectiveness outcomes will be assessed by completing 5 validated questionnaires at pre- and postprogram time points: (1) the Medical Issues, Exercise, Pain, and Social Support Questionnaire to assess perceived ability to manage JIA (self-management); (2) the Children’s Arthritis Self-Efficacy Scale to assess self-efficacy; (3) the Pediatric Quality of Life Inventory 3.0 Rheumatology-Teen Module to assess health-related quality of life; (4) the PROMIS (Patient-Reported Outcomes Measurement Information System) Pediatric Pain Interference Scale to assess pain interference; and (5) Readiness for Adult Care in Rheumatology to assess transition readiness. Descriptive statistics and nonparametric tests will be used to analyze the data.

RESULTS: The study setup is complete at all centers, including training of the facilitators, revising and finalizing education sessions, participant’s handout guide, and fidelity checklist. Recruitment began in January 2024 and is expected to conclude by December 2025. Feasibility outcomes, including adherence and engagement, as well as preliminary effectiveness, will be analyzed post intervention.

CONCLUSIONS: This is the first evidence-based, virtual, interactive, group-structured JIA SMP in Canada. This SMP will address needs for disease information, self-management skills, and peer support in adolescents with JIA. The results of this pilot study will inform a full-scale RCT focused on the efficacy and cost-effectiveness of the program with the goal of integration in routine clinical practice across Canada.

TRIAL REGISTRATION: ClinicalTrials.gov NCT06184100; https://clinicaltrials.gov/study/NCT06184100.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/69539.

PMID:40577780 | DOI:10.2196/69539

Phys Rev Lett. 2025 Jun 13;134(23):230402. doi: 10.1103/xxlq-d1sw.

ABSTRACT

Our current understanding of quantum chaos in many-body quantum systems hinges on the random matrix theory (RMT) behavior of eigenstates and their energy level statistics. Although RMT has been remarkably successful in describing “coarse” features of many-body quantum Hamiltonians in chaotic regimes, such as the Wigner-Dyson level spacing statistics or the volume-law behavior of eigenstate entanglement entropy, it remains a challenge to describe their “finer” features, particularly those arising from spatial locality. Here, we show that we can accurately describe the statistical behavior of eigenstate ensembles in many-body Hamiltonians by using pure random states with physical constraints that capture the essential features of the Hamiltonian, specifically spatial locality and symmetries. We demonstrate our approach on local spin Hamiltonians with a scalar U(1) charge. By constructing ensembles of constrained random states that account for two commuting scalar charges playing the role of energy and magnetization, we describe the patterns of entanglement of midspectrum eigenstates beyond their average volume-law behavior, including O(1) corrections and fluctuations, analytically and numerically. When defining the correspondence between quantum chaotic eigenstates in many-body Hamiltonians and RMT ensembles, our work highlights the important role played by spatial locality in describing universal features beyond the volume-law behavior.

PMID:40577753 | DOI:10.1103/xxlq-d1sw

Phys Rev Lett. 2025 Jun 13;134(23):237402. doi: 10.1103/g1cz-wk1l.

ABSTRACT

Traditional studies of memory for meaningful narratives focus on specific stories and their semantic structures but do not address common quantitative features of recall across different narratives. We introduce a statistical ensemble of random trees to represent narratives as hierarchies of key points, where each node is a compressed representation of its descendant leaves, which are the original narrative segments. Recall from this hierarchical representation is constrained by working memory capacity. Our analytical solution aligns with observations from large-scale narrative recall experiments. Specifically, our model explains that (1) average recall length increases sublinearly with narrative length and (2) individuals summarize increasingly longer narrative segments in each recall sentence. Additionally, the theory predicts that for sufficiently long narratives, a universal, scale-invariant limit emerges, where the fraction of a narrative summarized by a single recall sentence follows a distribution independent of narrative length.

PMID:40577734 | DOI:10.1103/g1cz-wk1l

Phys Rev Lett. 2025 Jun 13;134(23):230404. doi: 10.1103/fk9d-k8dc.

ABSTRACT

We investigate the dynamics of multimode optical systems driven by two-photon processes and subject to nonlocal losses, incorporating quantum noise at the Gaussian level. Our findings show that the statistics retrieved from a single Gaussian quantum trajectory exhibits emergent thermal equilibrium governed by an Ising Hamiltonian, encoded in the dissipative coupling between modes. The system’s effective temperature is set by the driving strength relative to the oscillation threshold. Given the ultrashort timescales typical of all-optical devices, our Letter demonstrates that such multimode optical systems can operate as ultrafast Boltzmann samplers, paving the way toward the realization of efficient hardware for combinatorial optimization, with promising applications in machine learning and beyond.

PMID:40577733 | DOI:10.1103/fk9d-k8dc

Phys Rev Lett. 2025 Jun 13;134(23):237102. doi: 10.1103/xlmq-g6m5.

ABSTRACT

The principle of covariance, a cornerstone of modern physics, asserts the equivalence of all inertial frames of reference. Fluctuation theorems, as extensions of the second law of thermodynamics, establish universal connections between irreversibility and fluctuation in terms of stochastic thermodynamic quantities. However, these relations typically assume that both the thermodynamic system and the heat bath are at rest with respect to the observer, thereby failing to satisfy the principle of covariance. In this Letter, by introducing covariant work and heat that incorporate both energy-related and momentum-related components, we promote fluctuation theorems into covariant forms applicable to moving thermodynamic systems and moving heat baths. We illustrate this framework with two examples: the work statistics of a relativistic stochastic field and the heat statistics of a relativistic Brownian motion. Although our Letter is carried out in the context of special relativity, the results can be extended to the nonrelativistic limit. Our Letter combines the principle of covariance and fluctuation theorems into a coherent framework and may have applications in the study of thermodynamics relevant to cosmic microwave background as well as the radiative heat transfer and noncontact friction between relatively moving bodies.

PMID:40577730 | DOI:10.1103/xlmq-g6m5

Phys Rev Lett. 2025 Jun 13;134(23):236601. doi: 10.1103/ggls-zhl8.

ABSTRACT

We develop a theory of edge excitations of fractonic systems in two dimensions, and elucidate their connections to bulk transport properties and quantum statistics of bulk excitations. The system we consider has immobile point charges, dipoles constrained to move only along lines perpendicular to their moment, and freely mobile quadrupoles and higher multipoles, realizing a bulk fractonic analog of fractional quantum Hall phases. We demonstrate that a quantized braiding phase between two bulk excitations is obtained only in two cases: when a point quadrupole braids around an immobile point charge, or when two non-orthogonal point dipoles braid with one another. The presence of a boundary edge in the system entails two types of gapless edge excitation modes, one that is fractonic with immobile charges and longitudinal dipoles, and a second non-fractonic mode consisting of transverse dipoles. We derive a novel current algebra of the fractonic edge modes. Further, investigating the effect of local edge-to-edge tunneling on these modes, we find that such a process is a relevant perturbation suggesting the possibility of edge deformation.

PMID:40577726 | DOI:10.1103/ggls-zhl8