Category: Statistics

BMC Nurs. 2026 Jul 15. doi: 10.1186/s12912-026-05018-8. Online ahead of print.

ABSTRACT

BACKGROUND: Competency training is essential for cultivating qualified anaesthesia Master of Nursing Specialist (MNS) graduates. Although a previous study has established relevant competency dimensions for anaesthesia nursing, no refined framework with operationalized indicators is currently available for Chinese MNS anaesthesia students.

OBJECTIVE: To construct an index system for the core clinical competencies of MNS anaesthesia students.

METHODS: Following literature screening, 26 eligible publications were selected to draft preliminary indicators. Semi-structured interviews with 15 participants were performed, and interview data were analysed via thematic coding.21 experts from 11 regions across China completed two rounds of Delphi surveys. Indicators were rated on a 5-point Likert scale, with expert consensus determined by predefined statistical cut-offs (mean importance score ≥ 3.5, coefficient of variation (CV) ≤ 0.25, ≥ 75% ratings ≥ 4) combined with comprehensive expert revision opinions.

RESULTS: The response rates of the two Delphi rounds were 100% and 95.24%, respectively. The expert authority coefficients (Cr) were 0.95 and 0.96, indicating high reliability of the consultation results. In the second round, Kendall’s concordance coefficients (W) for the first, second, and third-level indicators were 0.552 (strong consensus), 0.324 (moderate consensus), and 0.254 (weak-moderate consensus) respectively (P < 0.01), which indicated that the consistency of expert opinions was statistically significant and the consultation results were valid. The range of coefficient of variation was from 0.05 to 0.25. The final indicator system included 8 first-level indicators, 39 s-level indicators, and 109 third-level indicators.

CONCLUSION: Core clinical competency indicators for MNS anaesthesia students, established in this study, achieved expert consensus validity. These competency indicators can serve as a theoretical reference for the future training and assessment of MNS postgraduates in this field.

PMID:42458437 | DOI:10.1186/s12912-026-05018-8

Malar J. 2026 Jul 15. doi: 10.1186/s12936-026-06036-2. Online ahead of print.

ABSTRACT

Malaria remains a leading cause of morbidity and mortality among children in Malawi with transmission exhibiting marked geographic disparities. While standard regression models estimate the association between childhood malaria and risk factors across the entire study area, they assume spatial stationarity, thereby masking local-area variations in estimated effects. We applied Geographically Weighted Regression, a spatial non-stationarity modeling approach to data from the recent 2024 Malawi Demographic and Health Survey to estimate district-specific associations between childhood malaria and selected risk factors, namely mosquito net use, place of residence, household wealth, maternal age, and maternal education. The overall malaria prevalence among children aged five or under was 36.3%. By applying Geographically Weighted Regression, the study demonstrated substantial spatial heterogeneity in the associations between childhood malaria and the selected predictors across Malawi, revealing locally varying effects that would have been obscured under conventional global modelling approaches. These findings highlight the value of locally estimated relationships for understanding contextual differences in the predictors of childhood malaria and provide district-specific evidence to support geographically targeted intervention strategies and more efficient allocation of prevention and treatment resources within Malawi’s National Malaria Control Programme.

PMID:42458435 | DOI:10.1186/s12936-026-06036-2

BMC Health Serv Res. 2026 Jul 15. doi: 10.1186/s12913-026-15111-y. Online ahead of print.

ABSTRACT

BACKGROUND: China introduced the Supplementary High-Cost Illness Insurance (SHCII) to strengthen financial protection against medical impoverishment. This study assesses its effectiveness and, critically, examines the distribution of its benefits across population subgroups to identify who benefits more.

METHODS: We used 2013 and 2018 survey data from Shandong Province and a difference‑in‑differences design, restricting the sample to hospitalized patients (n = 3,136). The treatment group comprised patients whose out‑of‑pocket expenses exceeded city‑specific 2018 SHCII thresholds; the control group comprised those below the thresholds. The outcome was Vulnerability to Expected Poverty (VEP). Subgroup analyses were performed by income, urban‑rural residence, healthcare access, and age.

RESULTS: Patients who benefit from SHCII experienced a significant reduction in VEP relative to those below the threshold (OR = 0.624; average marginal effect = -0.064). The protective effect was statistically significant for low‑income individuals, rural residents, those with healthcare access within 15 min, and adults aged 45 years and above. No significant effect was found for urban residents or for those with poorer geographical access to care.

CONCLUSION: Patients who benefit from SHCII experienced a greater reduction in poverty vulnerability relative to those below the threshold, with effects concentrated among low‑income, rural, older, and well‑accessed populations. No significant association was observed for urban residents. The findings from Shandong, where policy parameters are broadly consistent with national guidelines, are likely generalizable to other provinces with similar policy designs and rural healthcare infrastructure. Future research is needed to test how different policy parameters affect the results.

CLINICAL TRIAL NUMBER: Not applicable.

PMID:42458432 | DOI:10.1186/s12913-026-15111-y

BMC Med Educ. 2026 Jul 15. doi: 10.1186/s12909-026-09901-5. Online ahead of print.

ABSTRACT

BACKGROUND: Digital technologies – including computer-aided design and manufacturing systems, three-dimensional printing, digital radiography, intraoral scanners, and artificial intelligence – are increasingly central to clinical dentistry, yet their integration into undergraduate curricula remains uneven. Clinical-year students, approaching graduation and patient-facing practice, are a critical group in whom to assess this transition, but evidence on how they perceive these technologies and relate them to curriculum expectations is limited. This study evaluated the awareness, attitudes, and curriculum expectations of clinical-year dental students regarding digital dentistry.

METHODS: A descriptive cross-sectional survey was conducted among fourth- and fifth-year students at a single dental faculty using a census-based approach. An 11-item online questionnaire assessed familiarity with five digital technologies, attitudes, and future professional perspectives, with an attention-check item and electronic informed consent. The questionnaire underwent multi-step validation, including expert-panel content validity, exploratory factor analysis, and internal-consistency reliability. Group comparisons by sex and year of study were examined with chi-square tests and Cramér’s V, applying the Benjamini-Hochberg procedure to control the false discovery rate.

RESULTS: Of 187 included students (85.0% response rate), the questionnaire showed strong content validity (scale-level content validity index = 0.94) and acceptable reliability (Cronbach’s alpha = 0.83 for familiarity and 0.92 for the positive-attitude scale). Familiarity was highest for digital radiography and lowest for artificial intelligence. Attitudes were strongly positive: most students reported high interest in digital dentistry and a clear desire for greater curricular coverage, and 74.3% considered digital dentistry teaching at their faculty insufficient. Apparent differences by sex and year of study did not remain statistically significant after correction for multiple comparisons.

CONCLUSIONS: Clinical-year dental students held favourable attitudes toward digital dentistry and expressed strong demand for expanded training, yet their self-reported familiarity remained modest and was lowest for artificial intelligence. This gap between motivation and perceived provision highlights a concrete target for curriculum development, suggesting that undergraduate dental education should strengthen structured, hands-on exposure to digital technologies – particularly artificial intelligence – to better prepare graduates for contemporary clinical practice.

PMID:42458426 | DOI:10.1186/s12909-026-09901-5

BMC Med Educ. 2026 Jul 15. doi: 10.1186/s12909-026-09927-9. Online ahead of print.

ABSTRACT

BACKGROUND: The aim of this study is to evaluate the role of social media in the career choices of first-year dental students in Turkey and to examine the relationship between this effect and demographic characteristics and social media usage habits.

METHODS: This descriptive cross-sectional study included first-year dental students enrolled in different dental faculties in Turkey during the 2025-2026 academic year. Data were collected through a two-part online questionnaire developed in line with the literature, with internal consistency assessed as a preliminary step (α = 0.84); formal psychometric validation was not conducted. The questionnaire assessed demographic characteristics, social media usage habits, exposure to dentistry-related content, and factors influencing career choice. Descriptive statistics and Chi-square test were used to analyze the data, and the significance level was set at p < 0.05.

RESULTS: 64.9% of the study sample reported being influenced by social media content during the career decision-making process; this figure reflects the study sample only and should not be interpreted as a population prevalence estimate. No statistically significant associations were found between social media influence and gender, type of high school graduated from, or year of university admission (p > 0.05). Among students influenced by social media, 47.9% reported using social media for 3 h or more per day, and TikTok was the most frequently used platform (20.3%). Animations were the most attention-grabbing content type (22.9%), while social prestige (22.9%) was the most common expectation associated with social media. Across all participants, the most frequently reported reasons for choosing dentistry were guidance counselor recommendations (15.5%) and the prestige of the profession (14.2%).

CONCLUSIONS: The findings indicate that a considerable proportion of first-year dental students in the study sample reported being influenced by social media during their career decision-making, and this reported influence was not significantly associated with demographic variables. Idealized professional representations on social media, particularly those emphasizing prestige and lifestyle expectations, may shape students’ perceptions of the profession. These findings highlight the need for dental faculties to develop realistic and balanced digital content strategies, and for guidance services to incorporate media literacy training, so that prospective students can critically evaluate social media content during the career choice period.

PMID:42458420 | DOI:10.1186/s12909-026-09927-9

Int Dent J. 2026 Jul 15;76(5):109739. doi: 10.1016/j.identj.2026.109739. Online ahead of print.

ABSTRACT

INTRODUCTION AND AIMS: This study aimed to determine the extent and trajectory of enamel caries from adolescence through young adulthood and the associated factors.

METHODS: Data were from the first and third Fit Futures (FF) studies that followed a cohort of Norwegians from the first year of upper secondary school (FF1 2010-2011, age 17) for 10 years (FF3 2021-2022, age 27). Participants answered questionnaires and underwent clinical dental examinations. The study sample included participants with data on caries and restorations at both ages 17 and 27 (N = 584, 53% of the original FF1 cohort, 53% women). Data were analysed using descriptive statistics, and associations between risk factors and caries activity were examined using regression models.

RESULTS: Almost all participants had enamel caries lesions (median 12.0 and 9.0 lesions at ages 17 and 27, respectively), and 64% had lesions that had progressed into dentin during the observation period. At the tooth surface level, 10% of all surfaces had enamel caries at age 17, of which 18% had progressed to dentin caries by age 27. The highest progression rates were observed on proximal surfaces and for premolars of the upper jaw. In regression analyses, high caries activity was associated with female sex, low socioeconomic status, poorer self-reported general health, poor oral hygiene habits, and high soft drink intake.

CONCLUSION AND CLINICAL RELEVANCE: Enamel caries lesions were almost ubiquitous, but more than 80% did not progress over a 10-year period, lending strong support to nonoperative treatment of such lesions. Nevertheless, the study demonstrated relatively high caries activity during the transition from adolescence to adulthood and underlines the importance of dietary guidance and oral hygiene motivation to prevent caries. Having medium or low socioeconomic status and facing general health issues should also be considered important caries risk factors.

PMID:42456259 | DOI:10.1016/j.identj.2026.109739

Spectrochim Acta A Mol Biomol Spectrosc. 2026 Jul 11;363(Pt 1):128431. doi: 10.1016/j.saa.2026.128431. Online ahead of print.

ABSTRACT

Tip-Enhanced Raman Spectroscopy (TERS) provides nanoscale chemical sensitivity, but its routine use remains constrained by thermal drift, unstable optical coupling, heterogeneous hotspot formation, and inconsistent approaches to signal quantification. Here, we present a commissioning-oriented AFM-TERS workflow for planar Au thin films under the specific instrumental and substrate conditions used in this study. A 20 min thermal stabilization period reduced the lateral drift rate by approximately 3.6× (from 186 to 51 nm·min^-1), thereby improving platform stability; however, the residual drift remains significant for long spectral maps and requires cautious interpretation of pixel-level co-localization. Optical coupling was standardized through a camera-based scattering-footprint analysis used as an operational alignment proxy, not as a direct measurement of the TERS hotspot or as a quantitative predictor of absolute Raman enhancement. Near-field mapping of Rhodamine 6G, Methylene Blue, and Crystal Violet confirmed local molecular identification at selected nanoscale positions, while paired far-field controls were used to evaluate the near-field contribution. Under the present experimental conditions, ensemble SERS on planar Au was practically limited to ≈10^-6 mol·L^-1, whereas TERS allowed local identification of R6G at selected positions on samples prepared down to 10^-8 mol·L^-1 via isolated, hotspot-mediated observations rather than as evidence of a practical detection capability. These measurements should not be interpreted as a formal statistical detection-limit study. Concentration-dependent measurements revealed strong local variability, including regimes in which substrate-mediated far-field hotspots locally dominated the response (FF > NF). We therefore recommend reporting paired near-field/far-field (NF/FF) intensity ratios and the differential signal metric (ΔI) as directly measurable descriptors that complement, rather than replace, conventional enhancement-factor estimates when the assumptions required for molecule-normalized EF calculations are uncertain.

PMID:42456254 | DOI:10.1016/j.saa.2026.128431

Thromb Res. 2026 Jun 24;264:109759. doi: 10.1016/j.thromres.2026.109759. Online ahead of print.

ABSTRACT

BACKGROUND: Vitamin K antagonists (VKA) are the recommended treatment for thrombotic antiphospholipid syndrome (TAPS), but it remains uncertain whether direct oral anticoagulants (DOAC) could serve as an alternative to VKA in a subgroup of low-risk TAPS patients with venous thromboembolism (VTE).

OBJECTIVES: To compare the incidence of thrombosis recurrence between DOACs and VKAs in TAPS patients with VTE as index event.

METHODS: In this retrospective cohort study, we included adults with TAPS and index VTE treated with a DOAC or VKA between January 2013 and March 2023. Outcomes were recurrent thrombosis, defined as arterial thromboembolism (ATE) or VTE, and bleeding. Cox regression with time-varying covariates was applied, adjusted for age and sex and stratified by laboratory risk profile according to the 2023 ACR/EULAR criteria.

RESULTS: We included 277 patients (mean follow-up 3.9 ± 2.8 years); 87% single positive. Recurrent thrombosis occurred in 26 patients (9.4%). The risk of the combined ATE/VTE outcome was higher in the DOAC group than in the VKA group, but not statistically significant (aHR 1.90, 95% CI 0.81-4.49). When analyzed separately, DOAC use was associated with more arterial events (1.34 vs. 0.51 per 100 person-years; HR = 3.72 95% CI 1.04-13.29). Major bleeding occurred in 4.0% of patients, with similar rates between treatments (aHR 0.67, 95% CI 0.34-1.31).

CONCLUSION: In TAPS patients with index VTE, DOACs were associated with more arterial recurrences, with no significant difference in the combined ATE/VTE outcome. Interpretation is limited by few events and retrospective design.

PMID:42456240 | DOI:10.1016/j.thromres.2026.109759

Neurotherapeutics. 2026 Jul 15;23(4):e00967. doi: 10.1016/j.neurot.2026.e00967. Online ahead of print.

ABSTRACT

Thalamic neuromodulation has emerged as a promising therapy to reduce seizures in patients with drug-resistant epilepsy who are not candidates for resective or ablative surgical treatments. This advance creates therapeutic opportunities for patients with seizure foci that are generalized, poorly localized, multifocal, or in eloquent cortex. However, optimal treatment requires improved understanding of the thalamocortical circuits and cellular mechanisms that support seizure initiation, propagation, and termination. With its dense, nucleus-specific reciprocal connectivity with cortical and limbic regions and intrinsic oscillatory properties, the thalamus is well-constructed and well-positioned to influence epileptic activity. Importantly, distinct thalamic nuclei exhibit differing engagement depending on seizure type and propagation patterns. Here, we review current knowledge of thalamocortical anatomy and function, cellular mechanisms of ictal propagation, and the role of the thalamus in generalized and focal seizures, with emphasis on human studies. We further examine how these anatomical and mechanistic insights inform neuromodulatory interventions aimed at improving seizure control.

PMID:42456232 | DOI:10.1016/j.neurot.2026.e00967

J Forensic Leg Med. 2026 Jul 15;122:103215. doi: 10.1016/j.jflm.2026.103215. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess whether transfer-learning models applied to panoramic radiographs (PANs) can classify individuals at the threshold of legal majority (≥18 years).

MATERIALS AND METHODS: Vision Transformer (ViT) and EfficientNetV2 models were trained on PANs from Bosnian and Lebanese individuals aged 14-24.99 years (n = 1764), considering pooled and sex-specific datasets with and without augmentation. Binary classification, multiclass classification, and regression models were trained and evaluated. Model performance on an internal test set derived from the same sample was summarized using accuracy, sensitivity, specificity, F1 score, and area under the receiver operating characteristic curve (ROC AUC). For regression and multiclass models, legal majority classification was additionally assessed by thresholding predicted ages or age categories at 18 years. External validation employed an independent Brazilian dataset (n = 1579; 14-24.99 years). Formal statistical comparison between internal and external performance employed two-proportion z-tests for accuracy and DeLong’s test for ROC AUC.

RESULTS: On the internal test set, the best-performing binary classification model, EfficientNetV2 with augmentation on the pooled dataset, achieved an accuracy of 0.90, sensitivity of 0.92, specificity of 0.86, F1 score of 0.91, and ROC AUC of 0.93. Using the same pooled, augmented configuration, thresholded regression predictions achieved accuracies of 0.85 for EfficientNetV2 and 0.83 for ViT, whereas thresholded multiclass predictions achieved accuracies of 0.84 and 0.73, respectively. Compared with direct binary classification, these thresholded outputs showed no clear advantage, and multiclass models generally showed higher specificity but lower sensitivity. This same pattern was retained when thresholded models were evaluated on the external validation set, with thresholded regression remaining comparatively stable and thresholded multiclass performance declining more markedly, especially for ViT. Visualization maps (gradient-weighted class activation mapping [Grad-CAM] and occlusion sensitivity) confirmed attention to relevant dental structures. On external validation, the same binary EfficientNetV2 configuration achieved an accuracy of 0.81, sensitivity of 0.90, specificity of 0.61, F1 score of 0.87, and ROC AUC of 0.85. Sex-specific models performed similarly, showing no clear advantage over pooled training. Statistical testing confirmed significant AUC degradation on external validation for both models (EfficientNetV2: p = 0.004; ViT: p < 0.001), while the accuracy drop was significant only for ViT (p = 0.035).

CONCLUSIONS: This study demonstrated that transfer learning with EfficientNetV2 and Vision Transformer can distinguish minors from adults using PANs with high internal performance and acceptable external generalization. Direct binary classification provided the most robust approach for legal age assessment in the present dataset. The findings support the forensic potential of these models, while also indicating the need for further work to improve robustness and real-world applicability.

PMID:42456231 | DOI:10.1016/j.jflm.2026.103215