Category: Statistics

J Pediatr Orthop. 2026 Mar 10. doi: 10.1097/BPO.0000000000003250. Online ahead of print.

ABSTRACT

INTRODUCTION: Pediatric buckle fractures are common. These are often referred to as orthopaedic surgery offices, despite evidence that specialty evaluation is unnecessary. Here, we sought to determine if the provision of an educational video instead of an in-person visit with an orthopaedic provider would be non-inferior for patient-reported outcomes and demonstrate improvement in other outcomes, such as patient, caregiver, and provider time spent on caring for this injury.

METHODS: This was a single-center, prospective, randomized controlled, non-inferiority trial of 41 patients with distal radius buckle fractures. The video group was emailed a 1.5-minute educational video and did not have any in-person visits with an orthopaedic provider. The in-person group had a standard in-person visit. Patients were followed over 6 weeks. A non-inferiority analysis was performed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Short Form v2.0-Upper Extremity 8a. Other outcome measures were collected for satisfaction, time spent on healthcare activities, missed time from work/school, and provider time spent delivering care.

RESULTS: Compared with the in-person group, the video group demonstrated a non-inferior PROMIS score improvement from baseline to 6 weeks post-injury. Both groups were overall satisfied with their care, with no statistically significant difference. Patients and caregivers in the video group spent significantly less mean±SD time on healthcare activities aside from learning (video: 59.8±54.1 min vs. in-person: 144.1±95.2 min; P=0.002), had less time missed from work (video: 8.5±27.4 min vs. in-person: 137.1±246.1 min; P=0.006), and less time missed from school (video: 95.1±209.3 min vs. in-person 191.4±259.2 min; P=0.037). In addition, the provider spent significantly less time delivering care for patients in the video group (video: 0.0±0.0 min vs. in-person: 33.7±17.9 min).

CONCLUSIONS: For patients with distal radius buckle fractures, video-based education should be considered as an alternative to an in-person orthopaedic visit.

LEVEL OF EVIDENCE: Therapeutic Level I.

PMID:41804710 | DOI:10.1097/BPO.0000000000003250

J Magn Reson Imaging. 2026 Mar 10. doi: 10.1002/jmri.70289. Online ahead of print.

ABSTRACT

BACKGROUND: Major adverse cardiovascular events (MACE) are a leading cause of morbidity and mortality in patients with end-stage renal disease (ESRD). However, risk stratification and prognostic prediction remain limited.

PURPOSE: To assess the incremental prognostic value of combined left atrial (LA) and left ventricular (LV) strain in predicting MACE among ESRD patients receiving renal replacement therapy.

STUDY TYPE: Prospective.

POPULATION: Three hundred thirteen ESRD patients (mean age: 53.8 ± 14.0 years; 202 males) undergoing maintenance dialysis.

FIELD STRENGTH/SEQUENCE: Balanced steady-state free precession (bSSFP) cine sequence at 3.0 T.

ASSESSMENT: Myocardial strain was analyzed from bSSFP cine images using feature-tracking software (CVI42). LA strain components were reservoir (LARS), conduit (LAScd), and contractile (LASct) strain, and LV strain included global longitudinal (GLS), radial (GRS), and circumferential (GCS) strain. Patients were followed up via clinical records and MACE were documented. Prognostic models were constructed using multivariable Cox proportional hazards regression. The baseline prediction model of conventional cardiovascular risk factors was then compared with models incorporating LARS and GLS to assess incremental prognostic value.

STATISTICAL TESTS: Cox proportional hazards regression identified predictors of MACE, and model performance was evaluated using C-index, Akaike and Bayesian information criteria (AIC/BIC), and Kaplan-Meier analysis. p < 0.05 was considered significant.

RESULTS: During a median follow-up of 16.93 months, 61 patients developed MACE. LARS (hazard ratio (HR) 0.90, 95% confidence interval (CI) 0.87-0.94) and LV GLS (HR 1.21, 95% CI 1.08-1.36) were independent predictors. The Cox model incorporating both LARS and LV GLS showed improved discrimination compared with the clinical risk factor model (C-index 0.79 vs. 0.70). Stratification by both LA and LV strain markers significantly improved MACE prediction (log-rank: p < 0.001).

DATA CONCLUSION: The integration of LA and LV strain offered superior prognostic value for MACE prediction in ESRD patients, enabling refined risk stratification beyond traditional measures.

EVIDENCE LEVEL: 2.

TECHNICAL EFFICACY: Stage 3.

PMID:41804678 | DOI:10.1002/jmri.70289

Environ Microbiol. 2026 Mar;28(3):e70278. doi: 10.1111/1462-2920.70278.

ABSTRACT

Microplastic (MP) biodegradation is critical for mitigating plastic pollution, yet the ecological mechanisms linking polymer properties to plastisphere microbiome assembly and catalytic function remain unclear. Using thermophilic composting as an accelerated model, we reveal a fundamental dichotomy in which biodegradable MPs (BMPs: polylactic acid [PLA] > polybutylene succinate [PBS] > poly (butylene adipate-co-terephthalate) [PBAT]) undergo rapid thermophilic degradation shaped by stronger environmental filtering of diverse degraders, whereas conventional MPs (CMPs: low-density polyethylene [LDPE]) exhibit delayed degradation with greater stochastic influence. Metagenomics uncovered 489 degradative genes predominantly distributed across uncultured taxa, enabling reconstruction of polymer-specific multi-enzyme pathways, supported by isolating 32 potential degraders (31 candidate novel). PLA/PBS degradation primarily relied on thermophilic-phase PLA depolymerase and cutinase, PBAT on late-stage polyesterase and PETase, and LDPE on alkane monooxygenase and laccase. Statistical modelling showed BMP degradation strongly associated with plastisphere-physicochemical interactions (> 90% variance), whereas CMP appeared primarily constrained by material properties (e.g., degrader succession in PLA, enrichment in PBS/PBAT, and high molecular weight in LDPE). Functionally dominant degraders (1.9% of total microbes) were estimated to contribute 52.4%-80.6% of biodegradation efficiency. This work elucidates the core polymer-plastisphere-functional nexus underlying MP biodegradation during composting, providing a predictive framework and microbial resource for targeted remediation.

PMID:41804664 | DOI:10.1111/1462-2920.70278

N C Med J. 2025 Dec 23;86(4). doi: 10.18043/001c.154041.

ABSTRACT

Medicaid expansion in North Carolina has notably improved payer mix, lowered rates of uninsured and charity care, and boosted billable revenue for safety-net organizations such as Federally Qualified Health Centers. At the same time, expansion has added administrative complexities and enrollment difficulties, which produced uneven benefits across the state’s FQHC programs.

PMID:41804618 | DOI:10.18043/001c.154041

Expert Rev Anticancer Ther. 2026 Mar 10. doi: 10.1080/14737140.2026.2644385. Online ahead of print.

ABSTRACT

BACKGROUND: Cutaneous malignant melanoma (CMM) is a highly malignant tumor that necessitates early diagnosis and precise survival prediction. The development of accurate prognostic models is essential for improving patient survival.

RESEARCH DESIGN AND METHODS: This retrospective study analyzed data from 5979 CMM patients in the SEER database (2004-2015), with external validation using the TCGA dataset. Patients were randomly allocated to training and testing sets in a 7:3 ratio. The SMOTE+DeepSurv (DeepSmote) model was compared against seven models, including DeepSurv, XGBoost, Logistic Regression (LR), Support Vector Machine (SVM), Random Forest (RF), K-Nearest Neighbors (KNN), and Decision Tree (DT). Model performance was evaluated using Area Under the Curve (AUC), accuracy, precision, recall, and F1-score.

RESULTS: The DeepSmote model demonstrated superior prognostic performance across both SEER and TCGA datasets. On the SEER test set, it achieved an AUC of 0.96, accuracy of 0.95, and F1-score of 0.95 for 1-year prediction. This strong performance was maintained in the external TCGA cohort (AUC: 0.91, accuracy: 0.88, F1-score: 0.87), and consistent superiority was observed for 3- and 5-year predictions, confirming its robustness and generalizability.

CONCLUSION: DeepSmote provides an accurate, generalizable prognostic tool for CMM survival prediction, outperforming other models across multiple datasets and evaluation metrics.

PMID:41804614 | DOI:10.1080/14737140.2026.2644385

Pulmonology. 2026 Dec;32(1):2640669. doi: 10.1080/25310429.2026.2640669. Epub 2026 Mar 10.

ABSTRACT

BACKGROUND: Exposure to cigarette smoke is a risk factor for endothelial dysfunction, leading to alterations in pulmonary vascular architecture and contributing to the development of pulmonary hypertension. Despite this evidence, the impact of smoking on pulmonary arterial hypertension (PAH) has only recently gained recognition.

RESEARCH QUESTION: The primary objective of this study was to further investigate the influence of cigarette smoking on the diagnosis and progression of patients with PAH and chronic thromboembolic pulmonary hypertension (CTEPH).

STUDY DESIGN AND METHODS: We assessed the prevalence of cigarette smoking and analysed the demographics and clinical outcomes of ever-smokers versus never-smokers included in the Spanish Registry of Pulmonary Arterial Hypertension (REHAP).

RESULTS: A total of 1763 patients from the REHAP registry were included in the study, of whom 1293 had PAH and 450 had CTEPH. Among these, 771 patients (43.7%) were classified as ever-smokers, comprising 44% (n = 570) of those diagnosed with PAH and 42.7% (n = 201) of those with CTEPH. In PAH patients, ever-smokers were significantly older at diagnosis and study enrolment compared to never-smokers. Notably, a poorer clinical course was observed in male PAH patients who were ever-smokers, with a statistically significant association. In contrast, no significant differences in survival rates were detected between ever-smokers and never-smokers with CTEPH.

CONCLUSION: Cigarette smoking is associated with delayed diagnosis and worse survival outcomes in PAH but not in CTEPH. Male ever-smokers patients with PAH has worse prognosis than female ever-smokers. Further research is warranted to elucidate the underlying mechanisms contributing to the negative correlation between smoking and PAH.

PMID:41804599 | DOI:10.1080/25310429.2026.2640669

Glob Health Action. 2026 Dec 31;19(1):2641401. doi: 10.1080/16549716.2026.2641401. Epub 2026 Mar 10.

ABSTRACT

BACKGROUND: Rwanda’s community-based health insurance (CBHI) has achieved near-universal enrollment, yet inequities in healthcare use remain. Understanding whether coverage translates into equitable utilization is critical for advancing universal health coverage (UHC). This study aims to examine how social protection complements health insurance in promoting equitable healthcare access.

OBJECTIVE: To examine the relationship between insurance coverage and healthcare utilization in sectors targeted by the Vision Umurenge Programme (VUP), assess socioeconomic inequities, and evaluate the complementary role of social protection.

METHODS: This study analyzed cross-sectional data from 15,039 households in VUP sectors using the 2023-2024 Seventh Integrated Household Living Conditions Survey. Socioeconomic inequality was measured using Erreygers-corrected concentration indices and need-standardized horizontal inequity analysis. Insurance effects were estimated using survey weighted logistic regression, propensity score matching, and doubly robust inverse-probability-weighted regression adjustment.

RESULTS: Insurance coverage was 85.8%, yet only 25.5% reported any formal healthcare utilization in the 12 months preceding the survey, including outpatient visits, inpatient admissions and preventive services. Utilization showed stronger pro-rich concentration (E = +0.066) than coverage (E = +0.026) and need-standardized analysis confirmed residual inequity. Insurance increased utilization by +14.6% points in regression models and ~+12% points in causal estimators. Participation in VUP components, particularly direct support, was consistently associated with higher service use.

CONCLUSIONS: In a high coverage setting, persistent pro-rich inequities highlight the role of non-financial barriers such as indirect costs and service readiness. Layering social protection with insurance and strengthening primary care delivery is critical to convert nominal coverage into equitable healthcare access.

PMID:41804591 | DOI:10.1080/16549716.2026.2641401

Nurs Open. 2026 Mar;13(3):e70427. doi: 10.1002/nop2.70427.

ABSTRACT

AIM: To address participants’ requests for an educational guide for midwifery students learning newborn resuscitation.

DESIGN: An explorative design and qualitative method were undertaken.

METHODS: From May 2018 to October 2020, midwives and midwifery students across Norway were interviewed individually (n = 16) and participated (n = 20) in four digital workshops. Participants collaborated to design a tailored newborn resuscitation course and subsequently developed an educational guide to simplify the learning process for midwifery students. A secondary analysis of previously collected qualitative data was conducted.

RESULTS: Simplified guidance on newborn resuscitation was developed using the ADDIE model, emphasising midwives’ roles in quickly managing complex tasks. A three-step pocket guide was created to help midwifery students prepare effectively.

PATIENT OR PUBLIC CONTRIBUTION: Midwives and midwifery students willingly shared their experiences and suggestions in interviews and workshops, where they collaborated to develop a tailored course in newborn resuscitation and an educational guide to support midwifery students’ learning in newborn resuscitation.

CONCLUSION: Stimulate, ventilate and collaborate are key elements in newborn resuscitation. Midwifery students and midwives requested simplified guidance for learning, training and performing newborn resuscitation. Given the close association, further research is recommended to evaluate the ‘Stimulate, Ventilate, Collaborate’ educational guide by implementing and evaluating its effectiveness across diverse international midwifery educational and clinical settings. This study underpins the importance of addressing participants’ request for an educational guide for midwifery students learning newborn resuscitation. The educational guide offers this requested guide to newborn resuscitation, addressing the need for simplified guidance identified by midwifery students and midwives. By providing clear, memorable steps for learning, training and clinical application, this educational guide has the potential to enhance confidence and competence in performing newborn resuscitation. Implementing and evaluating this guide across diverse international settings can improve midwifery education and midwives’ clinical practice. However, implementation and evaluation are still pending.

PMID:41804581 | DOI:10.1002/nop2.70427

Sports Biomech. 2026 Mar 10:1-14. doi: 10.1080/14763141.2026.2638941. Online ahead of print.

ABSTRACT

The purpose of this study was to evaluate how floating toes affect baseball pitching motion. Fifteen young male baseball players pitched from a pitching mound after physical examination, including floating toes, determining if any toes are not in contact with the ground. At least 20 pitches were thrown and the 10-best pitches were selected for the analysis. Images of the ball release point for sagittal and coronal views were captured from the videos recording the pitching motion. The positions of the ball, wrist, and leading foot were measured and the variability of each position over the 10 pitches was expressed as a standard deviation (SD). Each SD between the players with and without floating toes was statistically compared. The prevalence of floating toes on the pivot and plant foot was 47% and 33%, respectively. Those with floating toes on the pivot foot showed significantly greater SD in the antero-posterior position on the ball, wrist, and leading foot at ball release (p = 0.04, 0.02, and 0.01, respectively). Those with floating toes on the plant foot showed a significantly greater SD in the antero-posterior position of the plant foot (p = 0.02). Pitching with floating toes may lead to inconsistent pitching motion.

PMID:41804542 | DOI:10.1080/14763141.2026.2638941

Work. 2026 Mar 10:10519815261427709. doi: 10.1177/10519815261427709. Online ahead of print.

ABSTRACT

BackgroundWork-life balance (WLB) is crucial for occupational health, especially for bus conductors, who face high levels of stress and irregular schedules. Despite the extensive exploration of WLB across occupations globally, a pronounced research gap exists for bus conductors, notably in the Sri Lankan context.ObjectiveThe objective of this study was to develop and validate a context-specific WLB tool for Sri Lanka Transport Board (SLTB) bus conductors.MethodsThe tool was developed via qualitative methods (in-depth interviews, focus group discussions, and key informant interviews) and a review of existing tools, followed by pilot testing. Statistical analyses were conducted for exploratory factor analysis (EFA), whereas confirmatory factor analysis (CFA) was performed using the lavaan package in R. The sample sizes for the factor analyses adhered to the established subject-to-item ratio guidelines, ensuring the statistical robustness of the psychometric validation.ResultsThe tool showed high reliability (Cronbach’s α = 0.784) and strong construct validity, as supported by EFA with 147 bus conductors and CFA with a separate sample of 100. It comprises 10 items with three dimensions, namely, work-family integration, institutional support and work satisfaction, and health and work interference, collectively explaining 75.7% of WLB variance.ConclusionThis study provides a validated, context-specific instrument to measure the WLB of bus conductors, which can be used by relevant stakeholders to assess, compare, and improve WLB following targeted interventions, thereby enhancing the efficiency of public transportation bus services.

PMID:41804531 | DOI:10.1177/10519815261427709