Tag: statistics

JSES Int. 2026 Feb 28;10(3):101676. doi: 10.1016/j.jseint.2026.101676. eCollection 2026 May.

ABSTRACT

BACKGROUND: Imaging in children with capitellar osteochondritis dissecans (COCD) is crucial for surgical decision-making but remains challenging. Novel photon-counting computed tomography (PCCT) technology enables superior resolution while reducing radiation dose. This study aims to describe interrater agreement (IRA) for COCD characteristics assessed with PCCT and to make a comparison with conventional CT.

METHODS: At a tertiary referral hospital, anonymized PCCT and conventional CT scans of COCD lesions were assessed systematically and independently by 2 experienced clinicians and 2 musculoskeletal radiologists, excluding postoperative scans. The intraclass correlation coefficient (ICC) with 95% confidence intervals was used to describe IRA among all raters.

RESULTS: In the PCCT group (n = 29), ICCs for loose body count, lesion size in the sagittal plane, presence of an empty defect, and presence of an osseous bridge were 0.75 (95% CI: 0.61-0.86), 0.68 (0.51-0.81), 0.64 (0.47-0.78), and 0.60 (0.43-0.76), respectively. ICCs of physeal status, lateral wall involvement, fragmentation, depth, and tilting had a lower bound of the 95% confidence interval below 0.4. In the conventional CT group (n = 12), ICCs for loose body count and osseous bridging were statistically significantly lower than in the PCCT group after adjustment for multiple testing (P = .009 and P = .025, respectively).

CONCLUSION: PCCT assessment of COCD demonstrates at least substantial IRA for loose body count and at least moderate IRA for lesion size and the presence of an empty defect or bony bridge. Moreover, PCCT may enable higher IRA than conventional CT.

PMID:42007424 | PMC:PMC13091507 | DOI:10.1016/j.jseint.2026.101676

JSES Int. 2026 Feb 11;10(3):101668. doi: 10.1016/j.jseint.2026.101668. eCollection 2026 May.

ABSTRACT

BACKGROUND: Proximal humerus fractures are a common challenge in patients with initial treatment ranging from nonoperative management, to open reduction and internal fixation, to arthroplasty. Initial treatment failure is not uncommon, and revision to reverse total shoulder arthroplasty (rTSA) has emerged as a viable salvage option, though long-term outcomes in these patients are variable and remain underreported. This study aimed to evaluate long-term outcomes and failure rates of rTSA after failed initial proximal humerus management (nonoperative and operative). We hypothesized that rTSA for sequelae of fracture after failed treatment would lead to durable and beneficial outcome as well as a low failure rate.

METHODS: After institutional review board approval, a retrospective review was conducted of patients who underwent rTSA for sequelae of fracture for failed treatment between 2007 and 2020, with a minimum of 24 months’ follow-up. Outcomes included American Shoulder and Elbow Surgeons (ASES), Quick Disabilities of the Arm, Shoulder, and Hand, Single Assessment Numeric Evaluation, 12-Item Short-Form Health Survey (Physical Component Summary/Mental Component Summary), pain scores, range of motion and complication/failure rates. Statistical analyses were performed using paired tests, with significance set at P < .05.

RESULTS: Sixteen shoulders (84.2%) of 15 patients were included in the final analysis. The mean follow-up was 100.8 ± 48.1 months. Significant improvements were observed in ASES (from 45.8 to 69.6; P = .002), Quick Disabilities of the Arm, Shoulder, and Hand (from 47.9 to 29.5; P = .002), daily pain visual analog scale (from 5 to 1; P = .003), and maximum pain visual analog scale (from 8 to 5; P = .01). ASES patient acceptable symptom state and minimal clinically important difference thresholds were achieved by 62.5% and 43.8% of patients, respectively. Also, patient satisfaction was high (median 8/10). External rotation (20.7 ± 18.7 vs. 34.6 ± 19.2; P = .048) and forward flexion (66.3 ± 35.7 vs. 125.7 ± 33.2; P < .001) significantly improved from pre-operatively to post-operatively. The overall complication and failure rates were low (1 case each; 6.3% each).

CONCLUSION: rTSA performed for sequelae of fracture to failed initial treatment (nonoperative or operative) of proximal humerus fractures was associated with substantial and durable improvement in pain and patient-reported function as well as restoration of range of motion, with a low rate of subsequent construct revision in this cohort. These findings support rTSA for sequelae of fracture as a suitable treatment option when initial management fails in this patient population.

PMID:42007418 | PMC:PMC13091508 | DOI:10.1016/j.jseint.2026.101668

Stat Comput. 2026;36(3):120. doi: 10.1007/s11222-026-10875-z. Epub 2026 Apr 17.

ABSTRACT

Efficient Bayesian model selection relies on the model evidence or marginal likelihood, whose computation often requires evaluating an intractable integral. The harmonic mean estimator (HME) has long been a standard method of approximating the evidence. While computationally simple, the version introduced by Newton and Raftery (1994) potentially suffers from infinite variance. To overcome this issue, Gelfand and Dey (1994) defined a standardized representation of the estimator based on an instrumental function and Robert and Wraith (2009) later proposed to use higher posterior density (HPD) indicators as instrumental functions. Following this approach, a practical method is proposed, based on an elliptical covering of the HPD region with non-overlapping ellipsoids. The resulting estimator, called the Elliptical Covering Marginal Likelihood Estimator (ECMLE), not only eliminates the infinite-variance issue of the original HME and allows exact volume computations, but is also able to be used in multimodal settings. Through several examples, we illustrate that ECMLE outperforms other recent methods such as THAMES and its improved version (Metodiev et al. 2025). Moreover, ECMLE demonstrates lower variance-a key challenge that subsequent HME variants have sought to address-and provides more stable evidence approximations, even in challenging settings.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11222-026-10875-z.

PMID:42007416 | PMC:PMC13090188 | DOI:10.1007/s11222-026-10875-z

Adv Alzheimer Dis. 2025 Jun;14(2):23-37. doi: 10.4236/aad.2025.142002. Epub 2025 Jun 30.

ABSTRACT

BACKGROUND: Alzheimer’s disease (AD) disproportionately affects Black/African American (B/AA) older adults, yet this group remains underrepresented in research. Traditional neuropsychological assessments, often developed on predominantly White populations, may not be reliable for B/AA individuals. The Loewenstein-Acevedo Scales for Semantic Interference and Learning (LASSI-L) have been shown to effectively differentiate individuals with amnestic mild cognitive impairment (aMCI) from cognitively unimpaired (CU) individuals. This study examines the relationship between LASSI-L performance and plasma p-tau₂₁₇ levels to explore early detection methods for AD in B/AA populations.

METHODS: Fifty-six older adults received clinical and cognitive evaluations and were deemed cognitively unimpaired (CU) and p-tau₂₁₇ negative (n = 35) or met criteria for amnestic mild cognitive impairment (aMCI) and p-tau₂₁₇ positive (n = 21). All participants were administered the LASSI-L to compare groups, but it was not used for group allocation to avoid circularity.

RESULTS: After adjusting for age and MMSE score, the aMCI p-tau₂₁₇+ group performed significantly worse than the CU p-tau₂₁₇– group on both free recall on List B (Free B1 Recall) and frPSI (correct responses on Cued B2). These differences remained statistically significant after covariate adjustment (p < 0.001). In addition, four other outcomes remained statistically significant following covariate adjustment: the aMCI p-tau₂₁₇+ group exhibited a higher percentage of intrusion errors (PIE) on both Cued B1 and Cued B2, along with poorer performance on maximal learning ability (Cued A2) and PSI (correct responses on Cued B1). However, after applying the Bonferroni correction, only PIE on Cued B2 remained statistically significant among these measures. Notably, performance on LASSI-L Free B1 Recall and PIE for List Cued B2 were significant predictors distinguishing aMCI p-tau₂₁₇+ from CU p-tau₂₁₇– groups, with high sensitivity (80%) and specificity (91.7%). ROC analysis of these predictors yielded an area under the curve of 0.872 (SE = 0.055; p < 0.001), with a 95% confidence interval ranging from 0.765 to 0.979.

CONCLUSION: The study highlights the utility of the LASSI-L in conjunction with plasma biomarkers, particularly p-tau₂₁₇, for early AD detection in B/AA older adults. The LASSI-L demonstrated strong sensitivity to cognitive impairment, effectively differentiating between CU and aMCI groups based on plasma p-tau₂₁₇ levels. These findings suggest that combining cognitive assessments with plasma biomarkers can enhance early diagnosis and improve timely interventions, addressing health disparities in AD diagnosis and care.

PMID:42007415 | PMC:PMC13089353 | DOI:10.4236/aad.2025.142002

J Dent Educ. 2026 Apr 20. doi: 10.1002/jdd.70243. Online ahead of print.

ABSTRACT

PURPOSE/ OBJECTIVES: The aim of this study was to evaluate the impact of race-blind admissions policies on the recruitment and enrollment of a single, university-based, pathway program.

METHODS: Programmatic data were used to conduct a retrospective cohort study of applicants to the pathway program, Saturday Academy at New York University College of Dentistry, during the period of race-conscious admissions practices (2023) and after the implementation of race-blind admissions policies (2024). Chi-squared, Fisher’s exact, and Z-tests were used to compare demographic characteristics reported by program applicants and enrollees.

RESULTS: No statistically significant differences were observed in the demographics of the applicant pool between 2023 and 2024, as it related to gender, ethnicity, race, use of federal/ state assistance programs, or first-generation college status. No statistically significant differences could be observed between Saturday Academy enrollees in 2023 and 2024 as it related to gender and use of federal/ state assistance programs. There was a 46.2% (p = 0.002) decrease in the proportion of Hispanic students and a 74.4% (p = 0.001) decrease in the proportion of Black students admitted to the program in 2024. Also in 2024, there was a 119.8% (p = 0.004) increase in the proportion of Asian American students admitted, and the proportion of students who self-identified as first-generation college students increased 27% (p = 0.03).

CONCLUSION: The effective federal ban on race-conscious admissions practices is likely to compromise the ability of pathway programs to significantly contribute to the development of a healthcare workforce that is representative of the demographics of the US population.

PMID:42003545 | DOI:10.1002/jdd.70243

Pharmacoepidemiol Drug Saf. 2026 Apr;35(4):e70381. doi: 10.1002/pds.70381.

ABSTRACT

BACKGROUND: Prescription stimulant use among the United States’ (US) older adult population is increasing, yet little is known about the cardiovascular safety profiles of the two major prescription stimulant classes, methylphenidate (MPD) and amphetamine (AMP).

OBJECTIVE: To compare the hazard of major adverse cardiovascular (CV) events between new users of prescription MPD and AMP products in US older adults.

METHODS: We employed a new user comparative safety study from a 5% random sample of fee-for-service Medicare beneficiaries. Continuously enrolled beneficiaries (Parts A/B/D) aged ≥ 66 years who initiated MPD or AMP (1/1/17-12/31/21) were included. We required a 1-year washout before the first prescription claim (index date) and excluded those with contraindications based on diagnosis codes. The primary outcome was incident modified 4-Point Major Adverse Cardiovascular Event (4-P MACE), including acute myocardial infarction, stroke or transient ischemic attack, ventricular arrhythmia, or all-cause mortality; secondary outcomes included all-cause mortality and CV events (all MACE excluding death). We used a 1-year follow up after index date that was censored at change in insurance coverage, therapeutic switch, addition of the comparator drug, or end of the study (12/31/21). Confounders included demographics, healthcare utilization indicators, comorbidities, and other medications. We used trimmed propensity scores (PS) to create stabilized inverse probability of treatment weights (IPTW) and Cox proportional hazard regression to estimate the effect of MPD vs. AMP initiation on the first occurrence of 4-P MACE.

RESULTS: We identified 2526 Medicare beneficiaries initiating MPD (N = 1340, mean [SD] age = 76.7 [7.4] years, 54.3% female sex) or AMP (N = 1186, mean [SD] age = 72.3 [5.4] years, 60.6% female sex). After PS trimming and applying IPTW, the groups were well-balanced based on absolute standardized mean differences. During 2021.6 person-years follow up (MPD [1009.9 years] vs. AMP [1011.8 years]), 339 4-P MACE events occurred (MPD [N = 280] vs. AMP [N = 59]), of which 225 were deaths (MPD [N = 192] vs. AMP [N = 33]), and 114 were CV events (MPD [N = 88] vs. AMP [N = 26]). In the primary analysis, MPD vs. AMP initiation was associated with an increased risk of 4-P MACE (HR = 1.73, 95% CI [1.36, 2.19]). The secondary analysis showed a statistically significant increased risk of all-cause mortality (HR = 2.20, 95% CI [1.62, 3.00]), but not adverse CV events (HR = 1.14, 95% CI [0.77, 1.67]).

CONCLUSIONS: Initiation of MPD vs. AMP among older adults was associated with an increase in the hazard of 4-P MACE. Secondary analysis suggested that this increase was driven by all-cause mortality as opposed to adverse CV events.

PMID:42003446 | DOI:10.1002/pds.70381

Ann Med. 2026 Dec;58(1):2654251. doi: 10.1080/07853890.2026.2654251. Epub 2026 Apr 20.

ABSTRACT

BACKGROUND: Oxidative stress is central to type 2 diabetes mellitus (T2DM) and Parkinson’s disease (PD). However, the utility of biomarkers for lipid peroxidation (F2-isoprostanes) and DNA damage (8-OHdG) in the comorbidity of PD and T2DM remains unclear.

METHODS: We conducted a systematic review and meta-analysis of 54 unique studies of human subjects aged ≥ 50 years (n = 7,521: 3,522 with T2DM, 722 with PD, and 3,277 controls), measuring biomarkers in serum, plasma, or leukocytes. Mixed-effects models quantified standardized differences (Hedges’ g) across subgroups.

RESULTS: In T2DM, F2-isoprostanes (g = 1.60, 95% CI: 0.95-2.25) and 8-OHdG (g = 2.64, 95% CI: 2.13-3.14) were markedly elevated (p < 0.001). Stronger effects were observed in younger cohorts and serum/plasma samples, with complications like nephropathy exhibiting extreme oxidative stress (g = 5.24). In PD, 8-OHdG was moderately elevated (g = 0.78, 95% CI: 0.18-1.39; p = 0.011), particularly in randomized controlled trials and plasma samples, whereas F2-isoprostanes were not significantly elevated (g = 0.47, 95% CI: -0.43-1.38). High heterogeneity in T2DM (I² > 90%) reflected methodological variability.

CONCLUSION: Distinct profiles – both markers elevated in T2DM but only 8-OHdG in PD – underscore 8-OHdG’s potential in PD-T2DM comorbidity. Future research should focus on standardized assays, multi-compartmental or multi-modal sampling, and longitudinal studies to clarify mechanisms and therapeutic targets.

PMID:42003321 | DOI:10.1080/07853890.2026.2654251

J Mol Recognit. 2026 May;39(3):e70033. doi: 10.1002/jmr.70033.

ABSTRACT

Biocompatibility of a biosensor can be achieved by grafting polymer brushes onto a solid surface. These brushes must be able to attract specific analytes or repel unwanted entities. This is obtained with weak polyelectrolyte polymer brushes that shrink or swell depending on external stimuli. In this study, the conformation of polyacrylic acid (PAA) and polyethylene oxide (PEO) polymer brushes was characterized as a function of pH and ionic strength using Atomic Force Microscopy (AFM) in spectroscopic mode. Instead of colloidal tips classically used to measure the mechanical behavior of the brush, force curves were performed with conventional tips for better sensitivity to the interaction between ions and polymer, which is responsible for their conformation. Since force mapping experiments generate thousands of curves, a statistical representation was employed to define the general trend of the curves and facilitate their interpretation. As expected, the neutral PEO is not affected by changes in solution pH and salinity. In contrast, PAA exhibits behaviors depending on the ions present in the solution and increasing salinity; the brush shrinks at low pH with H₃O⁺ ions and swells with the addition of Na⁺ and K⁺ ions. The originality of the study also lies in the implementation of an Artificial Intelligence (AI) clustering model applied to force curves to specifically study a 50% PAA/50% PEO mixed polymer brush. This AI model makes it possible to distinguish areas of the surface where only one type of polymer has been grafted and to identify its nature according to its force curve.

PMID:42003221 | DOI:10.1002/jmr.70033

Acta Otolaryngol. 2026 Apr 19:1-7. doi: 10.1080/00016489.2026.2659356. Online ahead of print.

ABSTRACT

BACKGROUND: Chronic suppurative otitis media (CSOM) is characterized by recurrent otorrhea and tympanic membrane perforation. The selection of surgical technique and suitable time for myringoplasty remain variable and unclear.

OBJECTIVES: This study aimed to compare the feasibility and effectiveness of the CSOM patients with dry and wet ears using endoscopic inlay and underlay myringoplasty.

METHODS: Sixty-four patients with CSOM who underwent endoscopic underlay or inlay myringoplasty were studied retrospectively. Cartilage-perichondrium grafts were used to repair tympanic membrane perforations. Pure-tone audiometry was performed at pre- and post-operation assessing hearing outcomes.

RESULTS: Successful closure of performed tympanic membrane with operations was achieved in all patients. Hearing improvement was observed in both the dry ear group and the wet ear group, with no statistically significant difference between the two groups (p > 0.05). Furthermore, there was no statistically significant difference in hearing improvement in the two groups by inlay and underlay technique. However, the operative time in wet ear group was statistically significant shorter in inlay myringoplasty group than in the underlay myringoplasty group (p < 0.001).

CONCLUSIONS: The closure rates of tympanic membrane perforation and post-operative hearing improvement were not affected in the wet ears. Endoscopic inlay myringoplasty might be a suitable option for patients with wet ears, offering shorter operative times, minimal trauma to middle ear structures.

PMID:42003062 | DOI:10.1080/00016489.2026.2659356

High Alt Med Biol. 2026 Apr 19:15578682261444634. doi: 10.1177/15578682261444634. Online ahead of print.

ABSTRACT

Brillhart, Aaron, Molly Enenbach, Javier Seufferheld, Bernabé Abramor, Peter Callas, Rodrigo Duplessis, Ian Guertin, Theodore A Hartridge, Roxana Pronce, Ana Saravia, and Scott E. McIntosh. Medical screening of climbers who later develop high-altitude pulmonary edema on Aconcagua. High Alt Med Biol. 00:00-00, 2026.

INTRODUCTION: On Aconcagua (6,961 m), high-altitude pulmonary edema (HAPE) is the most frequent reason for medical evacuation. This study aimed to compare medical screening data of climbers who developed HAPE with those who did not and to identify trends to aid in illness prevention and climber safety.

METHODS: De-identified medical screening data of Aconcagua climbers from 2024 to 25 were retrospectively reviewed, comparing climbers who developed HAPE with those who did not.

RESULTS: Fifty-three of 2,336 climbers developed HAPE (2.3%). Asymptomatic climbers screened at 4,300 m who later developed HAPE had lower mean oxygen saturation than controls (80% vs. 85%, p < 0.001) and higher mean heart rate (96 vs. 87 bpm, p < 0.001). Nonsignificant trends were noted with guided status (74% vs. 61%, p = 0.06), and prophylactic acetazolamide use (34% vs. 21%, unadjusted: p = 0.02, odds ratio [OR] 1.92, adjusted: p = 0.08, OR 1.74).

CONCLUSIONS: On Aconcagua, certain vital sign parameters, including oxygen saturation below 80% and tachycardia during asymptomatic screening at 4,300 m, could raise concern for later developing HAPE. Future research could clarify any association between HAPE, certain climber groups such as guided clients, ascent rate, and medication use. Gradual ascent should continue to be emphasized to facilitate acclimatization and prevent life-threatening altitude illness such as HAPE.

PMID:42002892 | DOI:10.1177/15578682261444634