Tag: statistics

Proc Biol Sci. 2026 Mar 11;293(2066):20252137. doi: 10.1098/rspb.2025.2137.

ABSTRACT

Feedback loops govern many processes in the natural world and are ubiquitous in ecology and evolutionary biology. Despite their prevalence in theory, however, feedbacks and other forms of reciprocal causation are rarely quantified by empiricists working with observational datasets. This divide has been brought to the fore by the causal revolution in the natural sciences. When researchers aim to quantify causal effects, the bi-directional nature of feedbacks seems incompatible with standard tools, such as regression, which begin by distinguishing between ‘response’ and ‘predictor’ variables. This seems to leave empiricists in ecology and evolution with few tools, if any, to quantify bidirectional effects. First, we highlight that, when ignored, feedback can lead to bias in common statistical analyses. We then present several methods that can help researchers quantify causal effects when feedbacks are present, including models with discrete cross-lagged effects as well as continuous time models, both of which are suitable for longitudinal data. We also consider instrumental variables, which can help to disentangle bidirectional effects from cross-sectional data. Focusing on examples from ecology and evolutionary biology, our aim is to provide a general primer on the challenges and opportunities for the quantitative analysis of bidirectional causation.

PMID:41818814 | DOI:10.1098/rspb.2025.2137

Proc Biol Sci. 2026 Mar 11;293(2066):20252834. doi: 10.1098/rspb.2025.2834.

ABSTRACT

In humans and other animals, social robots can serve as effective tutors for learning new skills. Young oscines learn their song by imitating conspecific adults. In a previous study, we demonstrated that a robotic bird can be as effective as a live tutor in training a young zebra finch (Taeniopygia guttata) to imitate a song model. Here, we take this further by investigating the role of behavioural contingency in developmental song learning and in shaping the birds’ engagement with the robot. Two groups of young male finches were exposed to a robotic tutor under contingent (CON) or non-contingent (NCON) conditions. In the CON group, the robot produced a call in response to a call emitted by the bird. When the bird perched nearby, the robot oriented towards it and broadcast a song. While song imitation was slightly better in the CON group, the difference was not statistically significant. However, birds in the CON group spent more time near the robot and interacted with it more frequently compared to NCON-birds. These findings highlight the importance of behavioural contingency in social robotics and offer novel insights into the use of robotic agents in studies with non-human animals.

PMID:41818808 | DOI:10.1098/rspb.2025.2834

Psychol Health Med. 2026 Mar 12:1-17. doi: 10.1080/13548506.2026.2643801. Online ahead of print.

ABSTRACT

Climate change has emerged as a global challenge with significant impacts on individuals’ mental and emotional well-being. Among young people, particularly students in health-related fields, climate-related anxiety-commonly referred to as ‘eco-anxiety’ is becoming increasingly prevalent. Understanding the relationship between healthcare students’ climate anxiety and their levels of hope for mitigating climate change is essential for guiding educational strategies and fostering sustainable healthcare practices. This study aimed to examine the influence of healthcare students’ hope on their climate change anxiety. This descriptive and correlational study was conducted among students enrolled in five programs (Physiotherapy, Geriatric Care, First and Emergency Aid, Medical Laboratory Techniques, and Operating Room Services) within the School of Health Services at a state university, comprising a total population of 1027 students. The sample size was calculated using the G*Power program and the minimum required sample was determined as 194 students. In total, data were collected from 501 students. Data were gathered through face-to-face interviews using the Personal Information Form, the Climate Change Hope Scale (CCHS), and the Climate Change Worry Scale (CCWS). The collected data were analyzed using the SPSS 24 statistical software package. The students exhibited high levels of climate change worry (mean CCWS score = 34.49 ± 6.64) and high levels of hope for preventing climate change (mean CCHS score = 28.75 ± 7.43). The participating healthcare students exhibited high levels of both hope and worry regarding climate change, suggesting that climate change worry may function as a factor that fosters hope among young individuals.

PMID:41818789 | DOI:10.1080/13548506.2026.2643801

ATS Sch. 2026 Mar 1;7(1):44-51. doi: 10.34197/ats-scholar.2025-0029OC.

ABSTRACT

BACKGROUND: Sex-based disparities persist in procedural subspecialties, including interventional pulmonology (IP). Letters of recommendation (LORs) are critical in fellowship applications, and prior research suggests sex-based bias in LORs for female candidates.

OBJECTIVE: To evaluate gendered language and structural differences in LORs for IP fellowship candidates by applicant and letter writer sex.

METHODS: This study analyzed 461 LORs from IP fellowship applications during the 2022 and 2023 cycles. LORs were deidentified and analyzed using the Linguistic Inquiry and Word Count program, supplemented by a custom dictionary capturing agentic, communal, and family terms. Statistical analyses assessed differences by applicant and letter writer sex, practice type, and academic rank.

RESULTS: A total of 461 LORs were reviewed. No significant differences were found in LOR length by applicant or writer sex. The frequency of agentic and communal terms was similar across groups. However, female letter writers used significantly more family-related terms than male letter writers did (0.16 vs. 0.09; P = 0.002). Secondary analyses revealed no consistent meaningful differences by letter writer age, practice type, or rank.

CONCLUSION: This study found limited evidence of sex-based bias in LORs for IP fellowship candidates. The results underscore the need for continued awareness and training to promote equity in the application process.

PMID:41818786 | DOI:10.34197/ats-scholar.2025-0029OC

ATS Sch. 2026 Mar 1;7(1):52-59. doi: 10.1093/atsscholar/aapaf004.

ABSTRACT

BACKGROUND: There’s a gap in understanding how healthcare workers perceive professional development activities and goals, specifically within a Tele-ICU environment. Gaining this knowledge is crucial for optimizing educational strategies and fostering professional engagement in this specialized setting.

OBJECTIVE: This study aimed to describe the implementation of educational activities for a multidisciplinary team directly involved in patient care, as a component of the Tele-ICU project named TeleUTI Conectada.

METHOD: This is a prospective study conducted within the TeleUTI Conectada project, involving 8 Brazilian ICUs. The educational component was delivered through 3 distinct methodologies: in-person simulation, asynchronous, and synchronous online classes. The Net Promoter Score (NPS) and additional questionnaires to assess professionals’ self-perceived knowledge were applied. The participants’ performance was assessed by comparing the initial and final scores of the asynchronous classes. Variables were summarized using median (IQR) or frequency (%). The Kruskal-Wallis rank sum test was used to compare the differences between the initial and final scores of the asynchronous classes and the differences between professional performance. A P-value <.05 was considered significant for all analyses.

RESULTS: Between December 2023 and October 2024, 285 professionals were recruited to participate in educational activities. The majority of participants were female (202/285, 71%), with a median age of 36 years (31, 43). Nurses comprised the largest group of participants (161/285, 56.5%). Across all learning strategies, the course was highly rated, as indicated by the NPS and corroborated by the additional self-perception questions. The asynchronous course exhibited lower scores on both NPS and additional questionnaires, though without a statistically significant difference observed among professional groups. Participants expressed positive perceptions of the courses having met their expectations, enhanced their knowledge, and the content being applicable to their clinical practice. The median test scores comparing the initial and final scores of the asynchronous classes showed significant improvement within the respiratory therapist and nursing team.

CONCLUSION: This study described the implementation of a multidisciplinary education program within the TeleUTI Conectada project. It may offer a viable model for essential critical care training in remote areas with limited access to specialized healthcare professionals.

PMID:41818785 | DOI:10.1093/atsscholar/aapaf004

N Z Med J. 2026 Mar 13;139(1631):110-115. doi: 10.26635/6965.7313.

ABSTRACT

Achieving equity in health research requires sub-groups to have meaningful, if not equal, explanatory power, ideally through similiar sample sizes. Obtaining equal sample size, though, is often not possible. Small sub-group sizes increase the risk of false conclusions being drawn, which may reinforce inequities if results are misinterpreted (e.g., saying there is a difference between study arms when there is not and, conversely, saying there is no difference when there is). Here we provide examples of common pitfalls and potential considerations to guide researchers, reviewers and editors when analysing and interpreting sub-group data. We propose that researchers focus on presenting effect sizes and confidence intervals rather than statistical significance.

PMID:41818764 | DOI:10.26635/6965.7313

N Z Med J. 2026 Mar 13;139(1631):66-75. doi: 10.26635/6965.7187.

ABSTRACT

AIM: We aimed to describe nurse practitioner (NP) workforce characteristics, clinical practice and enablers and barriers in Aotearoa New Zealand.

METHODS: Five cross-sectional, self-reported online surveys were distributed biannually in collaboration with Nurse Practitioners New Zealand. Eligible participants were registered Aotearoa New Zealand NPs. Quantitative items covered demographics, practice activities and work environment; qualitative items captured priorities for change. Data were cleaned and reclassified to ensure comparability across survey rounds, and descriptive statistics were used to report findings. Ethics approval: Te Herenga Waka-Victoria University of Wellington, Human Ethics Committee, 2024/HE000107.

RESULTS: Of the 1,004 valid responses (52-74% of the workforce per survey), most respondents were practicing clinically (>94%). By 2022, prescribing was near-universal (98%), with most ordering laboratory (92%) and radiology (70%) investigations. Employment was concentrated in district health boards/Health New Zealand – Te Whatu Ora, with increasing representation in primary health organisations, private practice, non-governmental organisations and self-employment. Respondents reported barriers to practicing at full-scope of practice, limited succession planning and challenges to workforce sustainability.

CONCLUSION: NPs are an established part of Aotearoa New Zealand’s health workforce. However, persistent structural barriers, limited succession planning and variable support for full-scope practice continue to constrain their contribution. Strengthening integration and sustainable policy support are essential to realise the full potential of the NP role.

PMID:41818760 | DOI:10.26635/6965.7187

N Z Med J. 2026 Mar 13;139(1631):38-65. doi: 10.26635/6965.7259.

ABSTRACT

AIM: We aimed to examine the experiences of Pacific nurses in Aotearoa New Zealand who provide informal language assistance to Pacific patients with limited English proficiency (LEP).

METHODS: A cross-sectional online survey was distributed to 229 alumni of the Aniva Leadership Programme. The survey included quantitative and qualitative questions about interpreting experiences. Descriptive statistics and logistic regression were used for quantitative analysis; framework analysis was applied to free-text responses.

RESULTS: The response rate was 69% (n=159). Of respondents, 80% spoke a Pacific language and 85% of these had been asked to interpret in clinical settings, most commonly by patients, families and colleagues. While 75% felt confident interpreting, many reported difficulties with technical terminology. Nurses observed improved patient trust, understanding and engagement when using Pacific languages. However, interpreting often conflicted with core duties, raised ethical concerns and was not formally recognised or supported.

CONCLUSION: Pacific nurses routinely provide informal interpreting, significantly enhancing patient care. Yet this work is uncompensated, untrained and exposes nurses to professional risks. Health systems must reduce reliance on informal interpreting by investing in professional services, offering interpreter training for bilingual staff and formally recognising the cultural and linguistic labour of Pacific nurses to support equitable care.

PMID:41818759 | DOI:10.26635/6965.7259

N Z Med J. 2026 Mar 13;139(1631):28-37. doi: 10.26635/6965.7213.

ABSTRACT

AIM: We aimed to describe demographics and rates of diagnoses of blood-borne viruses and other sexually transmitted infections (STBBI) in sex workers attending an outreach clinic in Auckland.

METHODS: Sex workers attending an outreach clinic in Auckland from 31 December 2018 to 31 December 2020 were eligible for inclusion. Gonorrhoea and chlamydia rates in sex workers were compared to rates in two comparator groups: attendees to general sexual health clinics and a population-based sample.

RESULTS: Three hundred and fifty-six sex workers were eligible for inclusion. The majority were cisgender-gender females (93.5%, n=333). Test positive rates for chlamydia (5.1%) and gonorrhoea (3.9%) in cisgender-female sex workers were lower than for females attending general sexual health clinics. Chlamydia and gonorrhoea rates were higher in transgender-female sex workers than in cisgender-female sex workers, but the numbers were small (n=14). Of the 159 sex worker participants tested for hepatitis C antibody, 25 were antibody positive (15.7%).

CONCLUSIONS: Cisgender-female sex workers had lower rates of diagnosis of chlamydia and gonorrhoea than females attending general sexual health clinics. STBBI testing in sex workers should routinely include assessment and testing for hepatitis C. The data indicate that sex workers should continue to be a priority population in the STBBI strategy.

PMID:41818758 | DOI:10.26635/6965.7213

Obstet Gynecol. 2026 Mar 12. doi: 10.1097/AOG.0000000000006233. Online ahead of print.

ABSTRACT

OBJECTIVE: To describe the clinical profile, management, and potential preventability of maternal deaths from venous thromboembolism (VTE) based on data from the French maternal mortality surveillance system.

METHODS: We conducted a retrospective descriptive study of all maternal deaths that resulted from a VTE event in France from 2007 to 2018. Deaths were identified through the nationwide permanent enhanced maternal mortality surveillance system-ENCMM (Enquête Nationale Confidentielle sur les Morts Maternelles [French National Confidential Enquiry into Maternal Deaths]). Women were considered for two groups based on the time of VTE onset, antepartum or postpartum. Maternal characteristics, clinical features, and preventability factors were described for these two groups.

RESULTS: During the 12-year study period, 99 women died from VTE, and the corresponding maternal mortality ratio remained stable, at around 1.0 per 100,000 live births. Analyses were conducted on 80 maternal deaths that resulted from antepartum (n=37, 46.2%) and postpartum (n=43, 53.8%) VTE with available data from confidential inquiry. Risk factors were found in 67.6% (25/37) of antepartum cases and 93.0% (40/43) of postpartum cases. Most women (62.5%) only had moderate risk factors, most often multiple (two or more, 66.7%). Among women who died from postpartum VTE, 37.2% (16/43) had acquired risk factors resulting from obstetric conditions (postpartum hemorrhage or preeclampsia). Overall, 46.2% of VTE-related maternal deaths were considered preventable and this proportion did not significantly change over time. According to national guidelines, thromboprophylaxis was indicated in 30 of 80 (37.5%) women who died from antepartum and postpartum VTE (two in the antepartum period, 5.4%; 28 in the postpartum period, 65.1%). Of these women, 13 (43.3%) did not receive thromboprophylaxis and eight (26.7%) received an inappropriate dose or duration of thromboprophylaxis.

CONCLUSION: Nearly half of VTE-related maternal deaths were preventable. Women who died had a high prevalence of cumulative moderate VTE risk factors as well as acquired factors related to obstetric complications. This underlines the importance of repeated assessment along pregnancy to integrate the evolutionary nature of VTE risk in the obstetric population and improve the quality of care.

PMID:41818752 | DOI:10.1097/AOG.0000000000006233