Category: Statistics

Cureus. 2026 Jun 9;18(6):e110560. doi: 10.7759/cureus.110560. eCollection 2026 Jun.

ABSTRACT

Introduction Effective labor analgesia plays a crucial role in improving maternal comfort and the overall childbirth experience. The aim of the present study was to compare maternal satisfaction and breakthrough pain between programmed intermittent epidural bolus (PIEB) and continuous epidural infusion (CEI) techniques for labor analgesia. Materials and methods This cross-sectional study was conducted in the Department of Anesthesiology among 192 term pregnant women who received epidural labor analgesia. The participants were equally divided into PIEB (n = 96) and CEI (n = 96) groups according to the maintenance epidural regimen received during labor. Maternal satisfaction was assessed using a 0-10 numeric rating scale. Secondary outcomes included breakthrough pain, physician-administered rescue boluses, patient-controlled epidural analgesia (PCEA) utilization, analgesic consumption, adverse events, and willingness to repeat the same analgesic technique. Statistical analysis was performed with p < 0.05 considered statistically significant. Results Maternal satisfaction scores were significantly higher in the PIEB group than in the CEI group (8.6 ± 0.9 vs. 7.9 ± 1.2; p = 0.001). High satisfaction (score ≥8) was observed in 72 (75.0%) participants in the PIEB group compared with 56 (58.3%) in the CEI group. Breakthrough pain occurred less frequently in the PIEB group than in the CEI group (p = 0.011). The number of physician-administered top-up boluses and PCEA activation was significantly lower in the PIEB group. Total local anesthetic volume and fentanyl consumption were also significantly reduced in the PIEB group (p < 0.05). Adverse maternal events were low and comparable between the groups. Conclusions PIEB provided superior maternal satisfaction and improved analgesic efficacy with lower anesthetic consumption than CEI while maintaining a comparable safety profile. These findings support the use of PIEB as an effective maintenance strategy for epidural analgesia during labor.

PMID:42434670 | PMC:PMC13350300 | DOI:10.7759/cureus.110560

Cureus. 2026 Jun 9;18(6):e110554. doi: 10.7759/cureus.110554. eCollection 2026 Jun.

ABSTRACT

Lumbar radiculopathy is a prevalent and debilitating spinal condition that causes severe pain, functional impairment, and diminished quality of life. Although conservative treatments are widely recommended as first-line management, establishing their comparative effectiveness remains challenging due to substantial heterogeneity in the literature. This systematic review synthesized and critically appraised the evidence evaluating non-surgical, conservative interventions for lumbar radiculopathy. Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines, this review was prospectively registered with PROSPERO (CRD420261407070). Comprehensive electronic searches were conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library up to 2026. Randomized controlled trials (RCTs) involving participants with clinically or radiologically confirmed lumbar radiculopathy were eligible for inclusion. Methodological quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Due to marked clinical and methodological heterogeneity, a quantitative meta-analysis was precluded, and a structured narrative synthesis was performed instead. Nineteen RCTs published between 2016 and 2026 met the inclusion criteria. The investigated therapies included manual therapy, neural mobilization, exercise rehabilitation, physical modalities, and multimodal regimens. Rather than purely qualitative benefits, individual trials demonstrated quantifiable short-term improvements. Manual therapy combined with exercise or neurodynamics yielded significant advantages over conventional care; for instance, adding spinal mobilization with leg movement (SMWLM) achieved a mean difference (MD) in leg pain reduction of 2.0 (95% CI: 1.4 to 2.6) at two weeks and 2.6 (95% CI: 1.9 to 3.2) at six months. Similarly, targeted neural mobilization outperformed traditional therapy at eight weeks (pain MD: -2.4, 95% CI: -3.1 to -1.7; disability MD: -12.8%, 95% CI: -16.1% to -9.5%). Traditional Persian manual therapy combined with exercise reduced low back pain by 4.28 units (95% CI: 3.36 to 5.19). However, clinical superiority was inconsistent across all outcome domains, long-term follow-ups were rare, and conservative treatment non-response or failure remained a distinct clinical possibility. Methodological limitations, including a high risk of bias regarding incomplete blinding of participants/therapists and selective outcome reporting, were frequently observed across multiple trials. Conservative interventions yield measurable, statistically significant short-term improvements in pain and function for lumbar radiculopathy. However, the overall certainty of the evidence is limited by high clinical heterogeneity and trial-level methodological constraints, which precluded data pooling. Findings should be interpreted cautiously, and further high-quality trials with standardized outcomes and adverse event reporting are required.

PMID:42434659 | PMC:PMC13349735 | DOI:10.7759/cureus.110554

Vaccine. 2026 Jul 10;88:128916. doi: 10.1016/j.vaccine.2026.128916. Online ahead of print.

ABSTRACT

This study aimed to compare the immunogenicity of three meningococcal vaccines used as booster doses in children primed with MPCV-AC in China. A total of 250 eligible children were enrolled to receive MPSV-AC, MPCV-ACYW₁₃₅, or MPCV-AC as a booster dose. Participants were subdivided into day 7 and day 28 subgroups based on the timing of sample collection. Blood samples were collected at baseline, day 7, and day 28 to measure IgG antibodies against serogroups A and C by ELISA. Baseline GMCs of IgG were 4.34 μg/mL (seropositivity: 79.2%) for serogroup A and 4.36 μg/mL (seropositivity: 82.0%) for serogroup C, both negatively correlated with age and time interval (p < 0.05). All vaccines significantly increased IgG levels at days 7 and 28 post-booster compared with baseline (p < 0.01). In the day 7 group, MPSV-AC yielded a lower GMC (19.14 μg/mL) and seroconversion rate (43.8%) for serogroup A compared with MPCV-ACYW₁₃₅ (44.69 μg/mL, 78.9%) and MPCV-AC (43.06 μg/mL, 78.1%). In the day 28 group, MPSV-AC showed a comparable GMC for serogroup A (44.42 μg/mL vs. 60.39 μg/mL and 44.66 μg/mL) and a higher GMC for serogroup C (113.40 μg/mL) than MPCV-ACYW₁₃₅ (59.62 μg/mL) and MPCV-AC (72.75 μg/mL). Only two mild adverse events were reported during the study period. These findings suggest that boosting with MPSV-AC, MPCV-ACYW₁₃₅, or MPCV-AC is safe and immunogenic; however, further studies are warranted to assess the long-term persistence of immunity conferred by these booster vaccines.

PMID:42430875 | DOI:10.1016/j.vaccine.2026.128916

Vaccine. 2026 Jul 10;88:128910. doi: 10.1016/j.vaccine.2026.128910. Online ahead of print.

ABSTRACT

BACKGROUND: Vaccine-preventable diseases continue to burden U.S. population health. Despite the Affordable Care Act (ACA) eliminating cost-sharing for recommended vaccines in 2010, adult vaccination rates persistently fall below Healthy People 2030 targets, signaling that access alone is insufficient.

OBJECTIVES: To synthesize peer-reviewed literature (2010-2025) on interventions designed to increase vaccine intention or uptake among U.S. adults; characterize strategies, populations, settings, and study quality; and identify predictors of vaccine uptake rate.

METHODS: Following PRISMA 2020 guidelines, a multi-database search was conducted across PubMed, Web of Science, Ovid/MEDLINE, and EBSCOhost, with a final updated search in December 2025. Dual independent reviewers screened studies in two stages. Quality was assessed using the EPHPP tool and certainty evaluated using GRADE. Strategies were categorized per the WHO Behavioral and Social Drivers of Vaccination (BeSD) Model. A meta-regression was conducted on 79 studies, with narrative synthesis across all 92 included studies.

RESULTS: Of 11,219 records, 92 studies were included. Study designs were predominantly RCTs; Influenza and COVID-19 vaccines were most commonly studied. In the meta-regression (adjusted R² = 0.229), prioritizing a specific population (b=0.121, p=.027), using service quality improvement strategies (b=0.226, p=.040), and recruiting through community-based partner organizations (b=0.585, p=.005) or healthcare organizations (b=0.230, p=.040) were associated with significantly higher vaccine uptake rates. Onsite vaccination was associated with lower uptake rates (b=-0.185, p=.033), an effect confirmed as specific to the COVID-19 pandemic emergency-response context rather than a generalizable effect of the strategy in sensitivity analysis. Narrative synthesis identified message framing and educational campaigns as the most frequently deployed strategies, with multi-component designs and community partnerships showing the most favorable outcomes.

CONCLUSIONS: Effective adult vaccination strategies were multifactorial. Service quality improvement, priority population focus, and community-based recruitment were the strongest predictors of higher uptake. Findings support the WHO BeSD model’s Practical Issues domain: reducing friction outperformed persuasion alone. GRADE certainty remained LOW to MODERATE, emphasizing the need for higher-quality, equity-focused research.

REGISTRATION: This systematic review was registered at Open Science Framework: 10.17605/OSF.IO/SM7YD.

PMID:42430872 | DOI:10.1016/j.vaccine.2026.128910

Am J Emerg Med. 2026 Jun 29;109:133-140. doi: 10.1016/j.ajem.2026.06.041. Online ahead of print.

ABSTRACT

OBJECTIVE: This study focuses on characterizing the voices that are amplified through peer reviewed publication and how they relate to one another. This study aims to 1) identify patterns of author collaboration and representation, 2) assess how this varies among different journals, 3) examine the relationship between author collaboration and quantitative publication.

METHODS: This is a bibliometric analysis using descriptive statistics and network analysis, examining all publications in four influential emergency medicine journals from January 2015 through December 2024. Authors and journals were assessed on quantity of publications, patterns of co-authorship, and network characteristics of individual and aggregate journals.

RESULTS: There is a sharp right-skew of authorship – most authors have only a single article published in ten years. The most prolific authors in emergency medicine demonstrate significantly more publications than their peers. Journals show a propensity to publish multiple articles from a small number of authors, but there is variation among journals as to how many unique authors appeared during the timeframe studied. There was a gender disparity identified among the top authors, most of whom were men.

CONCLUSION: Bibliometric analysis is able to demonstrate academic influence while also casting light on the role of journals in peer-reviewed publication patterns. Publication is a vital component of academic success and tangible evidence of professional influence. How authors collaborate and journals select manuscripts is impactful, and unfortunately this study demonstrates inequity among the most visible authors in the most impactful journals.

PMID:42430864 | DOI:10.1016/j.ajem.2026.06.041

Ultrasonics. 2026 Jun 9;168:108192. doi: 10.1016/j.ultras.2026.108192. Online ahead of print.

ABSTRACT

The strengthening of steel structures with carbon fiber reinforced polymer (CFRP) composites has gained wide acceptance in civil engineering, yet interfacial bonding defects such as inclusion, delamination, and porosity can severely degrade structural performance. Conventional ultrasonic testing often suffers from noise contamination and limited feature extraction, restricting the reliability of defect identification. To address this issue, this study integrates phased array ultrasonic testing (PAUT) with encoder-assisted acquisition and advanced signal processing. Wavelet packet transform (WPT) was applied to denoise and decompose A-scan signals, from which eight statistical energy-based features were extracted to construct discriminative feature vectors. These vectors were then used to train and compare three backpropagation artificial neural network (BP-ANN) variants. The BP-ANN trained with the conjugate gradient algorithm achieved the highest overall accuracy of 95.83% among the three investigated optimization strategies. The results indicate that WPT-based feature engineering improves the discriminative capability of ultrasonic features under controlled laboratory conditions, while encoder-assisted acquisition improves the consistency of PAUT signal collection. The proposed framework provides a feasible approach for intelligent classification of interfacial defects in CFRP-steel hybrid structures and may serve as a reference for future studies involving real manufacturing defects and practical engineering scenarios.

PMID:42430857 | DOI:10.1016/j.ultras.2026.108192

Mar Environ Res. 2026 Jul 10;221:108248. doi: 10.1016/j.marenvres.2026.108248. Online ahead of print.

ABSTRACT

The Indo-Pacific finless porpoise (Neophocaena phocaenoides), a coastal cetacean species widely distributed from the Taiwan Strait to the Persian Gulf, is an iconic species that may represent an overall status indicator of marine ecosystems. However, growing anthropogenic pressures have led to declines in the population of this species in many regions such as Hong Kong waters, highlighting the need for complementary monitoring approaches. In this study, we applied two environmental DNA (eDNA) analysis methods, species-specific quantitative PCR (qPCR) and cetacean-targeting metabarcoding using μCeta primers, to detect Indo-Pacific finless porpoise eDNA around the Soko Islands, Hong Kong. First, we empirically validated the performance of the qPCR primers previously designed in another study. Then, in March 2025, water samples were collected from surface and bottom water layers at 20 locations in the Soko Islands area, a known habitat of Indo-Pacific finless porpoises in Hong Kong. The qPCR analysis detected finless porpoise eDNA in eight out of 40 samples, but all eDNA concentrations were below the limit of quantification. μCeta metabarcoding detected finless porpoise eDNA in seven out of 40 samples. The qPCR and μCeta metabarcoding approaches showed comparable detection rates for Indo-Pacific finless porpoises. Interestingly, the μCeta metabarcoding method detected a transient cetacean species, the false killer whale (Pseudorca crassidens), at a single location. Both methods showed consistent detection rates between surface and bottom water layers, with no statistically significant difference. Overall, the two eDNA analysis methods successfully detected finless porpoise eDNA around the Soko Islands, demonstrating the potential of these approaches for monitoring Indo-Pacific finless porpoises and other cetaceans in this region. Taken together, our findings provide a basis for an eDNA-based cetacean monitoring framework in Hong Kong waters.

PMID:42430845 | DOI:10.1016/j.marenvres.2026.108248

Psychiatry Res. 2026 Jul 4;364:117312. doi: 10.1016/j.psychres.2026.117312. Online ahead of print.

ABSTRACT

BACKGROUND: Schizophrenia is a disabling mental disorder. Quality of life (QoL) reflects patients’ social-psychological prognosis in mental health services. Sleep and physical activity relate to symptoms and prognosis closely, but their interplay and link to QoL are unclear. This study aimed to explore their impact on schizophrenia patients’ QoL.

METHODS: The samples for this study were derived from Shanghai Community-based Severe Mental Disorders cohort. QoL was assessed using the World Health Organization Quality of Life Assessment Scale Short Form (WHOQOL-BREF); sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI); physical activity was assessed using the International Physical Activity Questionnaire Short Form. The statistical analysis was conducted using SPSS 24 and R 4.4.1. We used linear regressions to assess the impact of sleep quality, analysis of variance for PA, and analysis of variance and post-hoc tests for the interaction effect.

RESULTS: The final sample consisted of 5210 cases, with an average age of 59.0 years. Among them, 2,778 were female (53.3%). The patient scored the lowest on the dimension of social relationships (M = 12.864, SD = 2.254) regarding their QoL. Improvement in sleep and an increase in physical activity (all p < 0.001) both contribute to QoL of patients. For the environmental health (F = 5.013, p = 0.007, η_p² = 0.002) dimension, the two have a mutual compensatory effect.

CONCLUSIONS: This study emphasizes the significance of sleep and physical activity for the recovery of patients with schizophrenia, particularly highlighting the crucial role of improving sleep.

PMID:42430832 | DOI:10.1016/j.psychres.2026.117312

J Surg Res. 2026 Jul 10;326:212-218. doi: 10.1016/j.jss.2026.06.029. Online ahead of print.

ABSTRACT

INTRODUCTION: The incidence and pattern of blunt traumatic injury are believed to correlate with what bioengineers termed imparted energy (IE), which combines the change in velocity (Δv) and the principal direction of force. In this study, our objective was to evaluate the incidence and pattern of cervical spine injury (CSI) following falls, stratified by fall height. We hypothesized that the incidence of CSI would not correlate with fall height, as the vertical IE vector of a fall does not translate into the horizontal IE relevant to cervical spine motion.

METHODS: We queried the trauma registry at our level I trauma center for all patients admitted with fall-related injury between 2013 and 2018. CSI was identified using International Classification of Diseases, Ninth Revision, codes 805, 806, 839, or 952. For eligible patients, we extracted clinical and radiographic data from registry and inpatient chart review. A single author (N.K) reviewed computed tomography scans of patients with CSI to confirm the diagnosis. We classified patients into 3 fall-height groups: ground-level fall (GLF); low fall (LF), <20 feet; and high fall (HF), ≥20 feet. We also classified CSI anatomically into an upper (C1-C3) and lower (C4-C7) injuries. Descriptive summary statistics were performed, and a regression model was used to identify independent risk factors for CSI. A P value < 0.05 was considered statistically significant.

RESULTS: During the study period, 4759 patients suffered from a fall. This included 1571 GLF patients, 2518 LF patients, and 670 HF patients. The overall incidence of CSI was 4.9%, 8.9% among GLF patients, 2.5% among LF patients, and 4.3% among HF patients. Fall height was not a significant risk factor for CSI (odd ratio [OR], 0.59; 95% confidence interval [CI], 0.47-0.75. However, age (OR, 1.03; CI, 1.02-1.04) and male gender (OR, 1.7; CI, 1.3-2.3) were significant risk factors. Additionally, older patients more frequently sustained upper (C1-C3) CSI, whereas younger patients more commonly sustained lower (C4-C7) CSI.

CONCLUSIONS: The overall incidence of CSI after a fall was 4.9%. There was no correlation between fall height and the incidence of CSI. This finding may be explained by the mismatch between the vertical vector of fall-related IE and the horizontal direction of cervical spine motion. Future studies will continue to explore the incidence and injury pattern of CSI across other trauma mechanisms.

PMID:42430831 | DOI:10.1016/j.jss.2026.06.029

J Neurosurg. 2026 Jul 10:1-10. doi: 10.3171/2026.1.JNS251897. Online ahead of print.

ABSTRACT

OBJECTIVE: Maximal safe resection of intra-axial brain tumors near the motor cortex is aided by intraoperative motor mapping. Here, the authors compared outcomes in patients undergoing either low-frequency bipolar stimulation (LFBS) or high-frequency monopolar stimulation (HFMS) for cortical and/or subcortical motor mapping during brain tumor resection.

METHODS: A retrospective analysis of patients undergoing an asleep craniotomy with motor mapping or an awake craniotomy with motor and speech mapping with a single surgeon was performed. Three cohorts were compared: 1) asleep LFBS (AsLFBS), 2) awake LFBS (AwLFBS; motor + speech mapping), and 3) asleep HFMS. HFMS mapping was not used for awake craniotomies.

RESULTS: A total of 284 patients who underwent 300 craniotomies with motor mapping were identified. No significant differences in permanent neurological deficits (p = 0.377) or extent of resection (EOR) of nonenhancing tumors (p = 0.453) were identified between LFBS or HFMS motor mapping cases. Both EOR (92.7% vs 83.5%, p = 0.035) and permanent neurological deficits (7.6% vs 3.3%) occurred more frequently in enhancing tumors with LFBS, although the latter was not statistically significant. HFMS was associated with higher rates of subcortical motor pathway identification (p = 0.001) and fewer total intraoperative seizures (p = 0.003) compared with LFBS. Previous resection (HR 0.46, p = 0.003) and a higher cortical threshold (HR 0.95, p = 0.023) were significantly associated with longer survival, while preoperative aphasia (HR 2.24, p = 0.022), hospital length of stay (HR 1.1, p = 0.005), an insular-based tumor (HR 3.5, p = 0.021), and a histological diagnosis of glioblastoma (HR 2.9, p = 0.001) were negative predictors. Interestingly, overall FLAIR EOR was significantly associated with a marginally decreased overall survival (HR 1.01, p = 0.011).

CONCLUSIONS: No significant differences in postoperative neurological deficits were found between LFBS and HFMS paradigms. HFMS may identify subcortical motor fibers more reliably while resulting in significantly fewer intraoperative seizures. Although LFBS was associated with greater EOR of contrast-enhancing tumors, it may also be associated with higher rates of postoperative deficits, perhaps reflecting less reliable identification of subcortical motor fibers.

PMID:42430806 | DOI:10.3171/2026.1.JNS251897