Tag: statistics

JAMA Netw Open. 2026 Apr 1;9(4):e267416. doi: 10.1001/jamanetworkopen.2026.7416.

ABSTRACT

IMPORTANCE: The lack of a comprehensive population-level study evaluating the association of marginalization markers with concussion presentation limits opportunities for health care system improvements.

OBJECTIVE: To describe the association of socioeconomic measures of disparity with location of concussion presentation and follow-up rates.

DESIGN, SETTING, AND PARTICIPANTS: This population-based cohort study used linked administrative databases to assess patients with International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Canada (ICD-10-CA) concussion diagnosis codes at emergency department (ED) or outpatient clinics in Ontario, Canada, from April 1, 2010, to March 31, 2023. Data analysis was performed from March 1, 2025, to February 8, 2026.

EXPOSURES: Patient-level exposures were age, sex, immigrant status, presence of family physician, and rurality. Neighborhood-level exposures were income quintile, Ontario Marginalization (ON-Marg) Material Resource Index (access to basic material needs, such as percentage of unemployment), Household and Dwelling Index (accommodation type, such as percentage living alone), and Racialized and Newcomer Populations Index (such as percentage of recent immigrants or those who identify as a visible minority group) within 4 different age groups (<18, 18-39, 40-64, and ≥65 years).

MAIN OUTCOMES AND MEASURES: Location of initial visit (ED vs outpatient, including urgent care, walk-in, primary care, and specialty clinic) and presence of outpatient follow-up visit at 30 days or less.

RESULTS: Overall, 674 629 patients were evaluated (356 842 [52.9%] female; mean [SD] age, 32.8 [22.0] years). Marginalization measures were higher for patients first presenting to EDs vs outpatient via the ON-Marg Material Resources Index (57 043 [20.4%] vs 56 856 [14.4%]; difference, 6.2 [95% CI, 6.0-6.3] percentage points), rurality (47 356 [16.9%] vs 35 521 [9.0%]; difference, 7.9 [95% CI, 7.8-8.1] percentage points), and presence of a family physician (264 179 [94.4%] vs 388 346 [98.3%]; difference, -3.9 [95% CI, -3.8 to -4.0] percentage points). In modeling, having a family physician was associated with first seeking care in EDs (18-39 years: odds ratio [OR], 4.71; 95% CI, 4.41-5.03), as was living in rural areas (18-39 years: OR, 1.56; 95% CI, 1.51-1.62). Follow-up rates at 30 days or earlier were lower for patients first seen in EDs (24 307 [8.7%]) vs outpatient (110 821 [28.1%]). In regression analysis assessing variables associated with follow-up, first being seen in EDs (aged 65 years: OR, 0.21; 95% CI, 0.19-0.22), not possessing a family physician (aged ≥65 years: OR, 0.29; 95% CI, 0.19-0.46), and being in the most marginalized quintile for ON-Marg Material Resources (aged ≥65 years: OR, 0.74; 95% CI, 0.65-0.84) were all significantly associated with not completing a follow-up visit.

CONCLUSIONS AND RELEVANCE: In this cohort study of patients with concussion treated in Ontario, Canada, those with higher marginalization markers were more likely to first seek care in EDs and have lower follow-up rates. These findings emphasize the importance of expanding health care system-wide resources, including primary care access and telemedicine, and enhancing resources for ED clinicians to optimize concussion care.

PMID:42018325 | DOI:10.1001/jamanetworkopen.2026.7416

JAMA Psychiatry. 2026 Apr 22. doi: 10.1001/jamapsychiatry.2026.0428. Online ahead of print.

ABSTRACT

IMPORTANCE: LB-102 (N-methyl amisulpride) is a novel benzamide under investigation for the treatment of schizophrenia.

OBJECTIVE: To evaluate the efficacy and safety of LB-102 in acute schizophrenia.

DESIGN, SETTING, AND PARTICIPANTS: This US-based, multicenter, double-blind, placebo-controlled, phase 2 randomized clinical trial (NOVA1) conducted from December 2023 to August 2024 comprised an inpatient screening period (≤14 days), 28-day inpatient treatment period, 5-day inpatient stabilization period, and outpatient safety follow-up visit approximately 2 weeks after the treatment period end. Eligible participants were adults (aged 18-55 years) with schizophrenia who required hospitalization or continued hospitalization for an acute exacerbation of psychotic symptoms and had a Positive and Negative Syndrome Scale (PANSS) total score of 80 to 120, PANSS Positive Symptoms subscale item score of 4 or greater on 2 or more key items, and a Clinical Global Impressions-Severity of Illness scale (CGI-S) score of 4 or greater at screening and baseline.

INTERVENTIONS: Participants were randomized (3:3:3:1) to oral once-daily placebo, LB-102 50 mg, 75 mg, or 100 mg.

MAIN OUTCOMES AND MEASURES: The primary end point was change from baseline to week 4 in PANSS total score (Hochberg multiplicity correction for LB-102 50 mg and 75 mg vs placebo). Secondary efficacy end points included changes from baseline to week 4 in CGI-S score, CGI-S response, PANSS subscale scores, PANSS Marder factor scores, and 20% or greater PANSS response. Safety and tolerability end points included treatment-emergent adverse effects (TEAEs).

RESULTS: A total of 359 participants (mean [SD] age, 39.1 [9.3] years; 290 male [80.8%]; mean baseline PANSS total score = approximately 94 across groups) were randomized and included in the safety and intention-to-treat populations (placebo, n = 108; 50 mg, n = 107; 75 mg, n = 108; 100 mg, n = 36). The trial met the primary end point: LB-102 50 mg and 75 mg, were statistically superior to placebo in change from baseline to week 4 in PANSS total score (mean [SE], placebo, -9.3 [1.08]; 50 mg, -14.3 [1.10], P < .001; Hedges g = 0.61; 75 mg, -14.0 [1.11], P = .002; Hedges g = 0.41); LB-102 100 mg, also showed significance (mean [SE], -16.1 [1.91]; nominal P = .002; Hedges g = 0.83). TEAEs were reported in 60 participants (56%) in the placebo group, 74 (69%) in the group receiving 50 mg, 62 (57%) in the group receiving 75 mg, and 27 (75%) in the group receiving 100 mg. Ten participants reported TEAEs leading to withdrawal (placebo, n = 2; 50 mg, n = 2; 75 mg, n = 3; 100 mg, n = 3) with 5 serious TEAEs (placebo, n = 2 [including 1 death]; each LB-102 arm, n = 1).

CONCLUSIONS AND RELEVANCE: This randomized clinical trial provided rigorous evidence demonstrating the efficacy and safety of LB-102 for the treatment of adults with acute schizophrenia.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT06179108.

PMID:42018313 | DOI:10.1001/jamapsychiatry.2026.0428

JAMA. 2026 Apr 22. doi: 10.1001/jama.2026.5157. Online ahead of print.

NO ABSTRACT

PMID:42018312 | DOI:10.1001/jama.2026.5157

J Phys Chem A. 2026 Apr 22. doi: 10.1021/acs.jpca.5c07760. Online ahead of print.

ABSTRACT

Analyzing the conformational dynamics of short peptides from molecular dynamics (MD) simulations remains challenging. The high dimensionality of torsional space and the periodic nature of dihedral angles complicate statistical analysis and dimensionality reduction. This work presents an integrated computational workflow that combines all-atom MD simulations with a multistage analytical framework to characterize torsional reorganization patterns. Our approach introduces an angular-displacement representation χ that resolves periodic discontinuities by focusing on frame-to-frame torsional changes rather than absolute configurations. This transformation yields variables suitable for linear analysis and acts as a high-pass filter, emphasizing rapid reorganization events over slow conformational drift. We analyze these transformed coordinates using spatiotemporal principal component analysis (PCA) to identify collective torsional patterns. To evaluate how different coordinate choices preserve dynamical information, we quantitatively compare raw dihedral angles, sine-cosine embedding, and the displacement representation χ using the VAMP score. This comparison reveals their complementary nature: sine-cosine coordinates capture slow conformational variability, while χ highlights rapid torsional reorganizations. Subspace convergence analysis confirms the stability of the reduced PCA representation within the simulation time scale. We apply the methodology to the DENV-2 peptide (CGYGLC) as a representative short system. Our approach identifies hierarchical patterns of torsional flexibility─characterized by a flexible central core and region-specific dynamics─and reconstructs short-term structural evolution with angular errors below 25% and RMSD values of 1.0-2.1 Å. The main contributions are (i) a geometry-aware angular-displacement representation that respects the periodic nature of torsional variables; (ii) a spectral characterization of the displacement transformation; (iii) a quantitative comparison of observable representations using the VAMP score; and (iv) a demonstration of short-horizon structural prediction from reduced dynamical subspaces. The workflow provides a computationally efficient framework for analyzing torsional reorganization dynamics in peptide simulations.

PMID:42018286 | DOI:10.1021/acs.jpca.5c07760

Lang Speech Hear Serv Sch. 2026 Apr 22:1-11. doi: 10.1044/2026_LSHSS-25-00167. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to investigate how speech-language pathologists (SLPs) implement language comprehension curriculums (LCCs) in elementary school settings, particularly for students with language and literacy difficulties. It addressed questions related to current usage, perceived barriers, misconceptions, and factors influencing adoption of LCCs, with the goal of informing future strategies for improving language and reading comprehension outcomes.

METHOD: A survey study was conducted with 83 participants, including 77 certified SLPs and six clinical fellows, recruited through professional networks and online platforms. The survey, administered via Qualtrics, included both quantitative and qualitative items assessing awareness, usage, barriers, and attitudes toward LCCs. Content analysis and descriptive statistics were used to analyze responses, and data were visualized using R.

RESULTS: Findings revealed limited awareness and use of LCCs among SLPs, with significant barriers including lack of training, time constraints, and systemic challenges. SLPs’ misconceptions and their role in implementation were also identified. Despite these challenges, participants expressed interest in future research and recognized the potential benefits of LCCs for managing caseloads and supporting students with language and literacy difficulties.

CONCLUSIONS: The study highlights a critical gap in the implementation of LCCs by SLPs and underscores the need for future quantitative studies and targeted professional development and systemic support in this area. Results support the need for further research that investigates the effectiveness of SLPs using LCCs in individualized and small-group settings, particularly for students with suspected, or diagnosed, language and literacy disabilities.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.31975221.

PMID:42018276 | DOI:10.1044/2026_LSHSS-25-00167

Percept Mot Skills. 2026 Apr 22:315125261446365. doi: 10.1177/00315125261446365. Online ahead of print.

ABSTRACT

This study aimed to investigate the criterion validity and reliability of the International Physical Activity Questionnaire – Short Form (IPAQ-SF) for estimating sedentary behavior (SB) across different time contexts (weekdays, weekends, and total weekly time) and using different accelerometer cut-off points. A total of 80 university students (73.7% women; mean age 26.0 ± 6.2 years) from a public higher education institution in Bahia, Brazil, participated in this methodological validation study. Sedentary time was objectively measured using an ActiGraph wGT3X-BT accelerometer over seven consecutive days, applying two cut-off points (<100 and <150 counts per minute). Self-reported sitting time was obtained using the IPAQ-SF, and test-retest reliability was assessed in a subsample of 20 participants after 14 days using the intraclass correlation coefficient (ICC). Criterion validity was examined using Spearman’s correlation and Bland-Altman analysis. The IPAQ-SF demonstrated moderate to almost perfect reliability (ICC = 0.622-0.856). Criterion validity was weak but statistically significant when using the <150 cpm cut-off for weekdays and total weekly sedentary time. Bland-Altman analysis indicated that the IPAQ-SF underestimated sitting time by 56% (≈214 min/day) at <100 cpm and overestimated it by 17.8% (≈117 min/day) at <150 cpm. Correlations were stronger for weekdays than weekends. In conclusion, the IPAQ-SF showed excellent reproducibility but limited criterion validity, highlighting the need for cautious interpretation of self-reported sedentary behavior in population-based studies.

PMID:42018274 | DOI:10.1177/00315125261446365

J Ultrasound. 2026 Apr 22. doi: 10.1007/s40477-026-01152-w. Online ahead of print.

ABSTRACT

OBJECTIVE: Type 2 diabetes causes changes in the structure and functions of the major salivary glands. The aim of this study is to evaluate the dimensional measurements, echogenicity, and fractal dimension (FD) of bilateral major salivary glands in patients with type 2 diabetes mellitus (DM) on ultrasonography (US) and compare them with healthy individuals.

METHODS: The study included US images of 36 patients with type 2 DM and 36 healthy individuals. The superoinferior (SI), anteroposterior (AP), and mediolateral (ML) dimensions of the major salivary glands were measured, echogenicity was classified, and FD was calculated. Dimensional measurements, FD, and echogenicity comparisons between groups were analyzed.

RESULTS: Dimensions of SI, AP, and ML were found statistically higher in the patient group than in the control group (p < 0.05). In the parotid gland, the isoechoic type was significantly more common in the patient group (p < 0.05). Although no statistically significant relationship was observed, in the submandibular and sublingual glands, isoechoic type was more frequent in the patient group. FD values were found to be higher in the patient group compared with the control group for all glands and a statistically significant relationship was observed in the sublingual gland (p < 0.05).

CONCLUSION: Type 2 DM is a disease that changes the salivary gland structure, but to confirm these results, new studies are needed in which disease severity/HbA1c levels, drug doses and disease duration are known and can be associated with clinical data.

PMID:42018273 | DOI:10.1007/s40477-026-01152-w

Insights Imaging. 2026 Apr 22;17(1):111. doi: 10.1186/s13244-026-02261-0.

ABSTRACT

OBJECTIVE: To assess the performance of a deep learning-based computer-aided detection (DL-CAD) algorithm for prostate lesion detection and classification on biparametric (bp)MRI.

MATERIALS AND METHODS: This retrospective, single-center study included men undergoing 3-T MRI of the prostate for suspected prostate cancer (PCa) between July and September of 2022. Using the radiology report as the reference standard, detection performance for high-risk lesions (defined as PI-RADS ≥ 3, 4, 5) by the DL-CAD was evaluated per-patient using sensitivity, specificity, PPV, NPV and AUC; and per-lesion using sensitivity and PPV. Kappa statistics was used to assess per-patient detection and per-lesion classification of PI-RADS ≥ 3 lesions. Clinical and imaging factors associated with discordance between DL-CAD and radiology reports were assessed using Mann-Whitney, Chi-square, and Fisher’s exact tests.

RESULTS: 442 adult males (mean age 65 ± 9 years) were assessed. Per-patient sensitivity, specificity, PPV, and NPV for detection of PI-RADS ≥ 4 and 5 lesions were 65.3%/81.2%/62.7%/82.9% and 82.1%/93.8%/65.7%/97.3%, respectively. Per-patient performance for identifying PI-RADS ≥ 3/4/5 lesions was fair-to-excellent: AUC = 0.67 (0.62-0.71)/0.75 (0.71-0.80)/0.92 (0.89-0.96). For detection of PI-RADS ≥ 4 and 5, per-lesion sensitivity was 60.4% and 78.3%, while PPV was 55.0% and 60.3%. Per-patient agreement between DL-CAD and the reference increased with higher PI-RADS scores (kappa = 0.26 (0.18-0.35)/0.46 (0.37-0.55)/0.68 (0.59-0.78)). Agreement on classification of PI-RADS ≥ 3 lesions was moderate (kappa = 0.56 (0.45-0.68)).

CONCLUSION: A pre-trained DL-CAD showed good-to-excellent per-patient performance for the detection of PI-RADS ≥ 4 lesions and moderate performance of PI-RADS ≥ 3 lesion classification. Future prospective studies validating the DL algorithm with histopathologic correlation are warranted.

CRITICAL RELEVANCE STATEMENT: A deep learning computer-aided detection (DL-CAD) algorithm showed good-to-excellent per-patient performance for detection of PI-RADS ≥ 4 lesions, moderate performance of PI-RADS ≥ 3 lesion classification and high negative predictive value, which can be applied in the clinic with knowledge of its limitations.

KEY POINTS: Clinical validation of deep learning computer-aided detection (DL-CAD) models for the detection and classification of prostate lesions on MRI is urgently needed. A pre-trained DL-CAD algorithm showed fair-to-excellent per-patient performance for detection of prostate lesions on biparametric MRI, with moderate performance for PI-RADS ≥ 3 lesion classification. Identification of false negatives and false positives of prostate cancer detection DL-CAD algorithms is important for future improvement and clinical deployment. A DL-CAD-based prostate cancer detection algorithm with high NPV may reduce interpretation time.

PMID:42018265 | DOI:10.1186/s13244-026-02261-0

Int Ophthalmol. 2026 Apr 22;46(1):209. doi: 10.1007/s10792-026-04081-z.

ABSTRACT

PURPOSE: To evaluate the efficacy and safety of toric foldable intraocular lens (IOL) for high astigmatism correction in eyes with prior penetrating keratoplasty (PK).

METHODS: Clinical data were retrospectively collected at baseline and 12 months postoperatively from pseudophakic patients with high astigmatism (> 2 D), and previous PK, who underwent implantation of customized foldable toric IOLs using the piggyback technique. Uncorrected and best-corrected visual acuity (UCVA, BCVA), manifest refraction, keratometry, refractive and topographic cylinder, endothelial cell count (ECC), and complications were assessed. To account for inter-eye correlation, analyses were performed using generalized estimating equations (GEE), and estimated differences (est.) with 95% confidence intervals (CI) were reported.

RESULTS: Fourteen eyes of 11 patients (2 women, 9 men; mean age 62 ± 21 years) were included. The mean interval between PK and piggyback implantation was 24.18 years. Uncorrected and best-corrected visual acuity improved at 12 months (UCVA: est. – 0.69 logMAR; 95% CI, – 0.84 to – 0.54; p < 0.001; BCVA: est. – 0.20 logMAR; 95% CI, – 0.29 to – 0.11; p < 0.001). Total refractive astigmatism was reduced (est. – 4.09 diopters; 95% CI, – 5.20 to – 2.99; p < 0.001), whereas topographic astigmatism remained unchanged (est. – 0.03 diopters; 95% CI, – 0.21 to 0.16; p = 0.76). Endothelial cell count did not show a statistically significant change over time (est. – 67.8 cells/mm²; 95% CI, – 139.6 to 4.0; p = 0.07). One eye experienced recurrent IOL rotation (80°), requiring explant and replacement.

CONCLUSIONS: The favorable refractive outcomes and safety profile support the use of the piggyback technique with a customized toric foldable IOL for correcting high astigmatism in pseudophakic eyes that have undergone PK many years before. Larger sample size and prospective study are needed.

PMID:42018245 | DOI:10.1007/s10792-026-04081-z

Breast Cancer Res Treat. 2026 Apr 22;217(2):27. doi: 10.1007/s10549-026-07967-9.

ABSTRACT

PURPOSE: Detecting malignancy before gender-affirming chest masculinization surgery (GACMS) can alter surgical planning and prevent reoperation, yet a lack of standardized preoperative breast imaging guidelines has resulted in inconsistent, surgeon-dependent practices and potential missed diagnoses. Limited data evaluating the efficacy of pre-GACMS imaging further contributes to this gap. This study aimed to characterize patterns, indications, and outcomes of preoperative breast imaging before GACMS, and to assess the impact of preoperative imaging on cancer detection, surgical decision-making, and timing to surgery.

METHODS: A single-institution, retrospective review of adults who underwent GACMS between January 2017-September 2024 was conducted. Descriptive statistics summarize preoperative imaging frequency, indications, modalities, outcomes, and postoperative pathology. Alterations in surgical management based on preoperative versus postoperative cancer detection, as well as an institution-wide screening algorithm, are described.

RESULTS: Of 368 patients, 91.8% (n = 338) were under 40 (mean 27.2, range 18-63). Preoperative breast imaging was recommended in 11.7% (n = 43) and performed in 11.1% (n = 41). Modalities included screening mammography (70.7%, n = 29), diagnostic mammography (29.3%, n = 12), MRI (9.8%, n = 4), and ultrasound (7.3%, n = 3). Indications included age (41.9%, n = 18), family history (30.2%, n = 13), physical exam finding (23.3%, n = 10), and BRCA2 mutation (2.3%, n = 1). Imaging revealed irregular findings in 17.1% (n = 7), with malignancy confirmed in 2 patients (4.9% of imaged; 0.5% overall). One patient who did not receive preoperative imaging was found to have invasive ductal carcinoma on postoperative pathology, resulting in 0.8% (n = 3) overall breast cancer diagnoses perioperatively. Preoperative detection altered surgical planning. Median time to surgery did not significantly differ between imaged and non-imaged patients (3.1 vs. 3.7 months, p = 0.2).

CONCLUSION: Preoperative breast cancer imaging before GACMS identified malignancies that significantly influenced surgical planning, preventing additional procedures postoperatively. Implementing a decision-making algorithm could guide and standardize breast imaging before GACMS.

PMID:42018242 | DOI:10.1007/s10549-026-07967-9