Tag: statistics

Psychiatry Res. 2026 Jul 1;364:117317. doi: 10.1016/j.psychres.2026.117317. Online ahead of print.

ABSTRACT

The contribution of gut microbiota to outcomes of autism spectrum disorders (ASD) has been increasingly appreciated in recent years. With the accumulating evidence on ASD-driven alterations of the gut microbiota, heterogeneities arise across different reports. To account for variabilities in gut microbiota, clinical representations of ASD and data processing approaches, as well as limitations in sample sizes among the existing gut microbiota studies for ASD, the present multi-cohort analysis applied a standard bioinformatic and statistical pipeline on the publicly available gut metagenomic sequencing data for 674 samples, including 326 TD and 348 ASD individuals, collected from eight studies across three main geographical regions. Throughout the analysis, we identified taxonomic profiles of the gut microbiota exhibited more pronounced dysbiosis associated with ASD and between-study variations compared to functional profiles. Differentially abundant taxonomic and pathway markers were identified and validated for their consistent response to ASD across different studies. Co-occurring deficits in microbial pathways for salvaging adenosylcobalamin and S-adenosyl-L-methionine and biosynthesis of methionine in children with ASD point to a reduced microbial support for the host methionine cycle. Species from Faecalibacterium, Bacteroides, Blautia and Bifidobacterium were identified as microbial contributors to ASD-deficient microbial pathways, particularly those related to the methionine cycle. Therefore, the generalisable ASD-deficient contributors to the methionine cycle, such as Blautia wexlerae, Bacteroides stercoris and Streptococcus thermophilus, could be further investigated for their role in therapeutic applications for ASD.

PMID:42418904 | DOI:10.1016/j.psychres.2026.117317

Int J Gynecol Cancer. 2026 Jun 4;36(8):104789. doi: 10.1016/j.ijgc.2026.104789. Online ahead of print.

ABSTRACT

OBJECTIVE: Homologous recombination deficiency predicts response to platinum-based chemotherapy and poly(adenosine diphosphate-ribose) polymerase inhibitors in advanced high-grade serous ovarian carcinoma. However, the optimal timing of homologous recombination deficiency testing remains unclear for patients receiving neoadjuvant chemotherapy, as it may affect test informativity and results. We evaluated the concordance of genomic and functional homologous recombination deficiency testing before and after neoadjuvant chemotherapy in patients with high-grade serous ovarian carcinoma.

METHODS: Matched tumor samples collected before and after neoadjuvant chemotherapy from patients with high-grade serous ovarian carcinoma treated at the European Institute of Oncology (Milan, Italy, July 2018-December 2021) were analyzed. Genomic homologous recombination deficiency assessment included the Genomic Instability Score and tumor BRCA1/2 mutation testing using SOPHiA DDM Homologous Recombination Deficiency Solution. Functional homologous recombination deficiency assessment was performed through RAD51 foci formation immunofluorescence. Cohen’s kappa coefficients (κ) assessed genomic and functional homologous recombination deficiency testing concordance for matched pre- versus post-neoadjuvant chemotherapy results, and functional versus genomic homologous recombination deficiency testing concordance at all time points.

RESULTS: Samples collected before and after neoadjuvant chemotherapy from 23 patients with high-grade serous ovarian carcinoma were analyzed. Homologous recombination deficiency informativity was higher before neoadjuvant chemotherapy (87%, 20/23) than in samples collected afterward (65%, 15/23), whereas Genomic Instability Score informativity was 91% (21/23) and 78% (18/23), respectively. Concordance of the Genomic Instability Score was moderate (κ = 0.52), while homologous recombination deficiency concordance was substantial (κ = 0.67) in matched samples collected before and after neoadjuvant chemotherapy. Two of 15 matched informative samples (13%) lost Genomic Instability Score positivity after chemotherapy, but their homologous recombination deficiency test remained positive due to BRCA mutations. Functional homologous recombination deficiency assessment showed poor concordance between time points and with homologous recombination deficiency testing at each time point.

CONCLUSIONS: Genomic homologous recombination deficiency tests were concordant in matched tumor samples collected before and after neoadjuvant chemotherapy for high-grade serous ovarian carcinoma, but tissue collection before chemotherapy should be prioritized due to higher informativity. Loss of informativity may result in missed opportunities for poly(adenosine diphosphate-ribose) polymerase inhibitor therapy.

PMID:42418892 | DOI:10.1016/j.ijgc.2026.104789

Nurse Educ Today. 2026 Jul 8;167:107261. doi: 10.1016/j.nedt.2026.107261. Online ahead of print.

ABSTRACT

BACKGROUND: The growing global population of older adults necessitates more nurses with positive attitudes, competence, and willingness to provide gerontological and long-term care. However, research indicates that many nursing students lack these attributes. Simulation-based learning (SBL) is proposed as a promising teaching method to address this issue. Aim This study aimed to evaluate the effectiveness of SBL in improving nursing students’ attitudes, willingness, and performance in gerontological nursing and long-term care-related competencies.

METHODS: This study is a meta-analysis of randomized controlled trials (RCTs). Embase, CNAHL, ERIC, and PubMed were the four databases that were searched. Studies that examined how SBL affects students’ attitudes, willingness, and performance with respect to gerontological-related skills were included. The Cochrane RoB 2 risk of bias assessment tools were used to evaluate the quality of the included studies.

RESULTS: The study examined eight randomized controlled trials (RCTs) involving a total of 692 participants. The results show that SBL had no significant effect on improving nursing students’ attitudes toward older adults (SMD = 0.22, 95% CI [-0.4048], P = 0.10) or their willingness to work with this population group (SMD = 0.31, 95% CI [-0.15, 0.78], P = 0.19). However, SBL had a statistically significant effect on improving students’ performance in gerontological and long-term care-related competencies (SMD = 1.48, 95% CI [0.67, 2.28], P < 0.001).

CONCLUSION: SBL effectively enhances gerontological and long-term care competency among nursing students, but its effects on attitudes and willingness remain inconclusive. Further research is needed to integrate SBL comprehensively into gerontological nursing education.

PMID:42418856 | DOI:10.1016/j.nedt.2026.107261

JMIR Form Res. 2026 Jul 8;10:e87163. doi: 10.2196/87163.

ABSTRACT

BACKGROUND: Symptom-based localization of brainstem ischemia is challenging because of the anatomical complexity of the brainstem and the nonspecific overlap of clinical syndromes. Whether large language models (LLMs) can meaningfully assist in this task remains uncertain.

OBJECTIVE: This study aimed to compare the performance of several OpenAI LLMs and neurologists in localizing diffusion-weighted imaging (DWI)-confirmed brainstem ischemic lesions based on symptom descriptions alone.

METHODS: In this retrospective single-center study, 109 patients with DWI-confirmed acute brainstem ischemia were included. Three neurologists and 6 LLMs (GPT-5, GPT-4, GPT-4.1, GPT-4o, o3, and o3-pro) predicted lesion localization using a combined anatomical-lateral end point (left or right midbrain, pons, and medulla) based on symptom descriptions alone. Overall and regional accuracy, the Cohen κ, 6-class confusion matrices, and point-biserial correlations between symptom count and correct prediction were assessed. Because all raters evaluated the same cases, paired McNemar tests with Benjamini-Hochberg correction were used for pairwise performance comparisons.

RESULTS: GPT-4 and GPT-4o achieved the highest overall accuracy (61/109, 56%; 95% CI 46.1%-65.5%). Agreement with the DWI reference standard remained limited across all raters, with the Cohen κ reaching a maximum of 0.291 for GPT-4o. Confusion matrices showed that higher performance was driven mainly by pontine cases, whereas misclassification remained frequent in mesencephalic and medullary lesions. Regional analyses outside the pons were imprecise because mesencephalic and medullary subgroups each contained only 16 cases. A higher number of documented symptoms was associated with correct prediction for GPT-4, GPT-5, GPT-o3, and 1 neurologist.

CONCLUSIONS: Although some LLMs showed higher relative accuracy than the participating neurologists, absolute performance remained limited and clinically insufficient. These findings are best interpreted as an exploratory benchmark under constrained conditions: absolute performance remained modest, agreement beyond chance was limited, and performance outside pontine lesions was inconclusive.

PMID:42418842 | DOI:10.2196/87163

J Vet Intern Med. 2026 Jul 1;40(4):aalag135. doi: 10.1093/jvimsj/aalag135.

ABSTRACT

BACKGROUND: Cerebrospinal fluid (CSF) analysis is a critical component in the diagnosis of equine protozoal myeloencephalitis (EPM). Test results obtained may differ based on different collection sites.

HYPOTHESIS/OBJECTIVES: Compare results of EPM-specific diagnostic tests obtained from different collections sites in EPM-affected and non-EPM affected horses.

ANIMALS: Twenty control and 7 EPM-affected horses.

METHODS: Prospective observational study. CSF was collected from the lumbosacral (LS) and cranial sites (atlantooccipital or C1-2) in 27 horses and EPM-specific diagnostic tests were performed. Data were summarized by collection site and disease status. Results were compared by Wilcoxon signed rank test in the non-EPM and EPM-affected cohorts.

RESULTS: The EPM-specific diagnostic test results (anti-Sarcocystis neurona CSF antibody titer, serum/CSF titer ratios, and S. neurona antibody index [AI]) in non-EPM affected horses did not differ based on collection site. In EPM-affected horses the median [interquartile range] CSF anti-S. neurona antibody titers were higher in samples from the LS site compared with fluid collected from the cranial sites (160 [1240] vs. 80 [600]; Wald test statistic, 21.0; P = .03) and the median serum/CSF titer ratio was also lower in fluid collected from the LS site (25 [46.8] vs 50 [93.7]; Wald test statistic, 0; P = .03). Median AI values did not differ based on CSF collection site.

CONCLUSIONS AND CLINICAL IMPORTANCE: Results of EPM diagnostic tests on CSF may differ based on collection site and lead to misdiagnosis. The AI appears to be less affected by collection site than antibody titers or the serum/CSF titer ratio.

PMID:42418837 | DOI:10.1093/jvimsj/aalag135

J Vet Intern Med. 2026 Jul 1;40(4):aalag130. doi: 10.1093/jvimsj/aalag130.

ABSTRACT

BACKGROUND: Dogs with chronic inflammatory enteropathy (CIE) are common in companion animal practice. Neutrophilic inflammatory enteropathy (NIE) is a subtype of CIE that is uncommonly reported, posing a dilemma in terms of etiology, treatment, and prognosis.

HYPOTHESIS/OBJECTIVES: To describe historical, clinical, clinicopathological, imaging findings, treatment, and survival in dogs with histologically confirmed NIE.

ANIMALS: Twenty-seven client-owned dogs with NIE.

MATERIALS AND METHODS: Retrospective interrogation of the hospital database between January 2015 and January 2025 identified dogs with NIE based on histological reports. Cases were regraded using modified WSAVA guidelines and classified into the minor (mild inflammation) or major (moderate or severe inflammation) groups.

RESULTS: Twenty-seven dogs were identified, with 8 and 19 dogs in the minor and major groups, respectively. The mean age was 7.7 ± 3.5 (95% CI, 6.4-9.1) years. The most common presenting signs were diarrhea (n = 21/27; 78%), vomiting (n = 21/27; 78%), weight loss (n = 20/27; 74%), hyporexia/anorexia (n = 13/27; 48%), and melena (n = 7/27; 26%). Clinicopathological abnormalities included neutrophilia (n = 12/27, 44%), hypoalbuminemia (n = 14/27, 52%), hypoglobulinemia (n = 23/27, 85%), hypocholesterolemia (n = 11/27; 41%), total hypocalcemia (n = 11/27; 41%), and hypocobalaminemia (n = 14/24; 58%). Twenty-four (89%) dogs (6 minor and 18 major) survived to discharge, with an overall median survival time of 267 (95% CI, 0-569) days, with no statistically significant difference between the major and minor groups. Peripheral neutrophilia was associated with an increased hazard of death (4.43; 95% CI, 1.16-16.99; P = .03) on univariate analysis and a significantly shorter median survival time.

CONCLUSION AND CLINICAL IMPORTANCE: Neutrophilic inflammatory enteropathy is potentially associated with poor survival. Peripheral neutrophilia might indicate a poorer prognosis.

PMID:42418836 | DOI:10.1093/jvimsj/aalag130

JMIR Form Res. 2026 Jul 8;10:e94949. doi: 10.2196/94949.

ABSTRACT

BACKGROUND: Ecological momentary assessment (EMA) enables repeated, real-time measurement of emotional states, behaviors, and contextual exposures in individuals’ daily lives. Although EMA has been increasingly used in health and behavioral research, evidence regarding the feasibility, compliance, and acceptability of smartphone-based EMA among older adults in Asian settings remains limited.

OBJECTIVE: This study aimed to evaluate the feasibility, EMA compliance, usability, and acceptability of a 14-day smartphone-based EMA protocol among community-dwelling older adults in Singapore.

METHODS: The data came from the Ecological Momentary Assessment in Ageing study, a smartphone-based EMA study designed to assess mental well-being, lifestyle behaviors, and perceived neighborhood environment among older adults. Adults aged 65 years or older in Singapore were enrolled and asked to complete 5 EMA prompts per day over 14 consecutive days using a smartphone app. Each EMA prompt remained available for up to 5 hours after delivery. EMA prompts assessed momentary mental well-being, sleep, physical activity, screen time, and perceived neighborhood environment. Feasibility indicators included recruitment and retention rates. EMA compliance was assessed as the proportion of completed EMA prompts out of all scheduled prompts. Usability and acceptability were assessed using a poststudy survey.

RESULTS: Between June 2025 and December 2025, a total of 186 individuals initially expressed interest in the study, of whom 139 (74.7%) scheduled an appointment, and 132 (95%) of the latter attended the appointment. Of those who attended, 98.5% (130/132) were enrolled. Participants had a mean age of 70.1 (SD 4.04) years; 65.4% (85/130) were female, 90.8% (118/130) were Chinese, and 65.4% (85/130) had postsecondary or university-level education. All enrolled participants completed the 14-day EMA protocol, resulting in 100% (130/130) retention. Across all participants, 99% (9007/9100) of the scheduled EMA prompts were completed. The poststudy usability survey was completed by 96.9% (126/130) of the participants. Among those who completed the poststudy usability survey, 88.1% (111/126) agreed or strongly agreed that the app was easy to use, 84.1% (106/126) agreed or strongly agreed that most people would learn to use it quickly, and 87.3% (110/126) preferred the app over face-to-face interviews. Overall, 91.3% (115/126) reported being satisfied or strongly satisfied with the app, and 100% (126/126) indicated willingness to be contacted for future research.

CONCLUSIONS: A 14-day smartphone-based EMA protocol was highly feasible and acceptable among community-dwelling older adults in Singapore, with high retention and compliance and favorable usability ratings. These findings support the use of EMA methodologies in aging research within Asian contexts and suggest that older adults can successfully engage with repeated smartphone-based assessments when protocols are appropriately designed and supported.

PMID:42418824 | DOI:10.2196/94949

Clin Exp Dent Res. 2026 Aug;12(4):e70403. doi: 10.1002/cre2.70403.

ABSTRACT

OBJECTIVES: This systematic review aims to assess the effectiveness of varnishes for the remineralization of white spot lesions in primary teeth.

METHODS: A database search was conducted in MEDLINE and the Cochrane Library to screen for articles relevant to the topic of the review. Risks of bias in randomized studies were assessed using the ROB2 tool and GRADE evidence levels.

RESULTS: Seven studies met all inclusion criteria and were included. Differences in varnish composition and characteristics can affect the anticaries properties. Bioactive additives had a statistically significant reduction in ICDAS scores.

CONCLUSIONS: Intensive application of remineralizing varnishes demonstrated a significant effect on the remineralization and control of carious lesion activity. New-generation fluoride appear to be more effective than conventional sodium fluoride varnishes.

PMID:42418809 | DOI:10.1002/cre2.70403

J Magn Reson Imaging. 2026 Jul 8. doi: 10.1002/jmri.70444. Online ahead of print.

ABSTRACT

BACKGROUND: Environmental conditions established at facility design, construction, updates, and/or procurement of specialized equipment are the foundation of safe MR practice. Establishing an institutional MR safety program must take into consideration the conditions of the MR environment, and staff training should be tailored to its features.

PURPOSE/HYPOTHESIS: To identify the concordance on conditions for a safe MR environment among a variety of widely known national guidance documents.

STUDY TYPE: Analysis of guidance documents.

POPULATION/SUBJECTS/PHANTOM/SPECIMEN/ANIMAL MODEL: Not applicable.

FIELD STRENGTH/SEQUENCE: Not specific to field strength.

ASSESSMENT: Information was extracted from national MR safety guidance documents about the expected conditions in a safe MR environment, and categorized among (1) facility design, (2) MR equipment selection, and (3) peripheral equipment. Commonalities and differences were identified.

STATISTICAL TESTS: Descriptive statistics.

RESULTS: Six publicly available national guidance documents for MR safety were obtained, from countries with relatively high density of MR systems (between 9 and 38 MR systems per million inhabitants): Australia, New Zealand, Sweden, Switzerland, UK, and USA. Full or partial concordance was observed among many measures related to facility design (21/25 conditions), MR equipment features (7/9 conditions), and peripheral equipment (10/13 conditions).

DATA CONCLUSION: This work identified the common and divergent recommendations on facilities and equipment from a variety of guidance documents from national sources. Highlighting common (and uncommon) features recommended by guidance can help users identify weaknesses in their MR environment. This could inform jurisdictions/countries without official guidance and serve in the development of future guidance documents or MR safety training materials.

EVIDENCE LEVEL: 5.

TECHNICAL EFFICACY: 1.

PMID:42418802 | DOI:10.1002/jmri.70444

J Cardiovasc Electrophysiol. 2026 Jul 8. doi: 10.1111/jce.70437. Online ahead of print.

ABSTRACT

BACKGROUND: Multiple randomized controlled trials (RCTs) have compared the efficacy of pulmonary vein isolation adjunct (PVI+) techniques with PVI alone in patients with persistent atrial fibrillation (AF). However, these comparisons have been limited by a small sample size or conflicting results. It remains unclear if there is any benefit offered by these PVI+ techniques.

OBJECTIVES: We conducted a systematic review and meta-analysis of RCTs and compared the efficacy of different PVI+ techniques with PVI alone. We hypothesized that as compared with PVI alone, the PVI+ techniques have a superior efficacy in freedom from atrial arrhythmias.

METHODS: A systematic search of MEDLINE and EMBASE was conducted. The outcomes of interest included freedom from atrial arrhythmias, freedom from AF, procedure time, fluoroscopy time, ablation time and procedural complications. For dichotomous outcomes, Mantel-Haenszel risk ratios (RR) with 95% CIs were calculated using random-effects model. For the continuous outcomes standardized mean differences (SMD) were calculated. Subgroup analyses were conducted for various PVI + techniques including posterior wall isolation, linear lines, complex fractionated atrial electrograms, and low voltage area ablation.

RESULTS: A total of 18 RCTs comprising 3459 patients (PVI + = 1956, PVI alone=1503) were included. There was no statistically significant difference between the two arms in the freedom from atrial arrhythmias (RR 1.10; 95% CI [1.00-1.22]; p = 0.06; I² = 56%), and freedom from AF (RR 1.12; 95% CI [0.99-1.25]; p = 0.06; I² = 63%). PVI+ techniques were associated with a statistically significant increase in procedure time (SMD 1.46; 95% CI [0.76-2.15]; p < 0.0001; I² = 96%), fluoroscopy time (SMD 0.45; 95% CI [0.06-0.84]; p = 0.02; I² = 91%), and ablation time (SMD 1.32; 95% CI [0.74-1.90]; p < 0.00001; I² = 95%). There was no statistically significant difference in the pooled total complications between PVI + vs. PVI alone (RR 1.61; 95% CI [0.99-2.62]; p = 0.05; I² = 26%).

CONCLUSIONS: This meta-analysis of 18 RCTs shows that there is no difference in the freedom from atrial arrhythmias with various PVI + techniques vs. PVI alone in patients with persistent AF. Further large RCTs are needed to determine the ideal ablation strategy for these patients.

PMID:42418771 | DOI:10.1111/jce.70437