Tag: statistics

Pulmonology. 2026 Dec;32(1):2704379. doi: 10.1080/25310429.2026.2704379. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Accurate prognostication of malignant pleural effusion (MPE) is essential to guide management decisions and provide patients with meaningful survival estimates. LENT and PROMISE scores are widely recognised MPE-specific prognostic tools, although with limited uptake in clinical practice. More objective, serum-based indices such as the Prognostic Index for Cancer Outcomes (PICO) and Modified Glasgow Prognostic Score (mGPS) have shown robust prognostic value in oncology and may offer advantages by allowing reproducible, treatment-responsive reassessment.

METHODS: Retrospective cohort study including patients with MPE, defined by cytological and/or histopathological confirmation, between 2012-2022 at a Portuguese tertiary hospital. Demographic, clinical and biochemical data were extracted from medical records, enabling calculation of LENT, PROMISE, mGPS and PICO scores, as well as a novel serum-based index (SIMPLE).

RESULTS: 678 patients were included in the cohort. LENT and PROMISE prognostic scoring models underperformed when compared with their serum-based counterparts. PROMISE showed the lowest area under the curve [AUC = 0.735 (95% CI 0.675-0.794)], followed by LENT [AUC = 0.758 (95% CI 0.710-0.808)], PICO [AUC = 0.781 (95% CI 0.725-0.837)] and mGPS [AUC = 0.819 (95% CI 0.745-0.893)]. The most significant serum-based factors (albumin, white blood cell counts and C-reactive protein) were selected for a new prognostic model. SIMPLE showed the highest numerical discriminatory performance [AUC = 0.852 (95% CI 0.782-0.921)], statistically outperforming MPE-specific scores, while demonstrating comparable discrimination to general oncology scores.

CONCLUSION: SIMPLE is a promising, accessible prognostic tool for patients with MPE, demonstrating strong discriminatory performance and outperforming LENT and PROMISE in our sample. External validation is required before routine clinical implementation.

PMID:42480101 | DOI:10.1080/25310429.2026.2704379

Prehosp Emerg Care. 2026 Jul 21:1-12. doi: 10.1080/10903127.2026.2706747. Online ahead of print.

ABSTRACT

OBJECTIVES: Signs of life are observed during out-of-hospital cardiac arrest (OHCA) resuscitation, but their frequency, timing relative to return of spontaneous circulation (ROSC), and prognostic significance remain incompletely described. We evaluated the prevalence of signs of life during resuscitation and their association with survival.

METHODS: We performed a retrospective observational cohort study of all OHCAs treated by a single urban emergency medical services system from January 1 through December 31, 2022. Data were abstracted from prospectively maintained OHCA and airway management registries. Signs of life include respiratory effort, eye opening or tracking, body movement, and verbal response. Each sign was classified as occurring before or after initial ROSC. We used descriptive statistics, binomial confidence intervals, and unadjusted and adjusted logistic regression to evaluate associations between signs of life, OHCA etiology, and survival.

RESULTS: Among 617 treated OHCAs, 156 patients (25.3%) had at least one sign of life. Respiratory effort was most common (148 patients, 24.0%), followed by any body movement (69, 11.2%), eye opening (55, 8.9%), and any verbal response (43, 7.0%). Most documented signs occurred after ROSC, although 44 patients (7.1%) had at least one pre-ROSC sign of life. Patients with signs of life were more likely to have witnessed arrest and initial shockable rhythm and were less likely to receive intra-arrest epinephrine or prehospital advanced airway management. Survival occurred in 91 of 156 patients (58.3%) with signs of life compared with 25 of 461 patients (5.4%) without signs of life. In adjusted analysis, any sign of life was associated with survival (adjusted odds ratio [aOR] 10.3, 95% confidence interval [CI] 5.4-19.9); this relationship held when restricted to signs of life after ROSC (aOR 6.7, 95% CI 3.4-13.3). Among overdose-related OHCA, any body movement (aOR 2.44, 95% CI 1.05-5.67) and any verbal response (aOR 8.06, 95% CI 2.71-24.01) were more frequent than in the non-overdose OHCA cohort.

CONCLUSIONS: One in four treated OHCA patients displayed at least one sign of life during resuscitation. Signs of life, particularly those after ROSC, were strongly associated with survival and may provide clinically useful information during prehospital resuscitation.

PMID:42480096 | DOI:10.1080/10903127.2026.2706747

Am J Clin Pathol. 2026 Jul 6;166(1):aqag081. doi: 10.1093/ajcp/aqag081.

ABSTRACT

OBJECTIVES: We sought to assess the real-world impact of the Genius Digital Diagnostics System (Genius Dx [Hologic, Inc]) on workload, efficiency, and turnaround time in a high-volume cervical cytology laboratory.

METHODS: The laboratory information system was retrospectively queried for all Papanicolaou test cases performed between January 1, 2023, and March 31, 2025. A total of 512 177 cases (655 468 reviews) were included. Genius Dx was implemented on August 1, 2024, and cases were classified as preimplementation or postimplementation. Daily caseload, number of reviewers, number of cases per reviewer, and accession-to-sign-out times were compared using independent-samples t tests. Diagnostic distributions were compared using ꭓ2 tests.

RESULTS: Average daily cytologist (CT) reviews were similar before and after Genius Dx (747.8 vs 758.4 cases) but required fewer CTs per day (10.4 vs 8.1; P < .001), increasing cases per CT per day from 74.5 to 94.7 (P < .001). Pathologist reviews per day increased (106.0 vs 145.3; P < .001) with fewer pathologists (4.4 vs 3.4; P < .001). Average daily CT case workload increased by 53.5% after implementation. Accession-to-sign-out times decreased for all diagnoses (P < .001). A small but statistically significant shift in diagnostic proportions was observed, with a decrease in negative results and an increase in atypical squamous cells of uncertain significance or higher (ASC-US+) findings with negligible effect size.

CONCLUSIONS: Implementation of Genius Dx substantially increased reviewer efficiency and reduced turnaround times without compromising diagnostic performance. The increased detection of ASC-US+ findings observed in this study are in line with results from the Genius Dx clinical trial and other published literature.

PMID:42480093 | DOI:10.1093/ajcp/aqag081

J Nurs Adm. 2026 Aug 1;56(8):450-454. doi: 10.1097/NNA.0000000000001765. Epub 2026 Jul 20.

ABSTRACT

OBJECTIVE: This study investigated links between incivility and intention to leave (ITL) employment among new graduate nurses (NGNs) during residency.

BACKGROUND: As an undesirable characteristic of workplace environments, incivility may predispose inexperienced nurses to leave employment.

METHODS: Surveys of NGN residents conducted 6 months after hire from 2022 through 2024 were analyzed.

RESULTS: Incivility from physicians and unit leaders significantly increased ITL scores but did not predict termination within 2 years. Long-term retention was related to having positive role models and satisfaction with work schedules.

CONCLUSIONS: Fostering supportive leadership and cultivating strong role models could improve retention and reduce early career distress among NGNs.

PMID:42480089 | DOI:10.1097/NNA.0000000000001765

J Nurs Adm. 2026 Aug 1;56(8):427-432. doi: 10.1097/NNA.0000000000001762. Epub 2026 Jul 20.

ABSTRACT

OBJECTIVE: This study sought to examine differences in nursing-sensitive patient outcomes among Magnet® hospitals, Pathway To Excellence® (PTE) hospitals, and non-American Nurses Credentialing Center’s (ANCC®) designated hospitals.

BACKGROUND: The ANCC Magnet Recognition Program® and PTE Program provide frameworks that foster nursing excellence, although limited research has examined the differences of nursing-sensitive patient outcomes among recognition programs.

MATERIALS AND METHODS: A cross-sectional comparative analysis was conducted using 2023 data from the National Database of Nursing Quality Indicators® (NDNQI).

RESULTS: Magnet hospitals reported significantly lower fall rates compared with non-ANCC hospitals (P=0.01). PTE hospitals exhibited significantly lower central line-associated bloodstream infection rates than non-ANCC hospitals (P<0.04). No statistically significant differences in catheter-associated urinary tract infection rates or hospital-acquired pressure injury prevalence were observed.

CONCLUSIONS: ANCC designations were inconsistently associated with better nurse-sensitive patient outcomes in this study. The absence of consistent differences across outcomes may reflect unbalanced sample distribution across designation groups in this sample.

PMID:42480085 | DOI:10.1097/NNA.0000000000001762

J Obstet Gynaecol. 2026 Dec;46(1):2697258. doi: 10.1080/01443615.2026.2697258. Epub 2026 Jul 21.

ABSTRACT

BACKGROUND: Ineffective uterine contractions contribute to labour dystocia and are a leading indication for primary caesarean delivery. Although oxytocin is the standard therapy for augmentation, prolonged exposure may result in receptor desensitisation and reduced effectiveness. Calcium is essential for myometrial contraction; however, systemic calcium homeostasis is tightly regulated, and it is unclear whether oral calcium supplementation can meaningfully influence uterine activity. This study aimed to evaluate the effect of oral calcium carbonate on uterine contractility.

METHODS: We conducted a single-centre randomised controlled pilot trial at a tertiary care teaching hospital (ClinicalTrials.gov: NCT07056062). Term patients with singleton foetus in cephalic presentation and an intrauterine pressure catheter in place were randomised 1:1 to receive a single 2,000 mg oral dose of calcium carbonate or no intervention. Uterine activity was measured using Montevideo units (MVUs) at baseline and at 30-minute intervals for two hours. Secondary outcomes included contraction frequency, peak contraction pressure, labour duration, mode of delivery, oxytocin dose, and postpartum haemorrhage. Oxytocin infusion rates were held constant during the observation period.

RESULTS: Eighty-nine patients were analysed (45 control; 44 intervention) with similar baseline characteristics. No statistically significant difference in baseline MVUs was observed between groups (p = 0.1825). Although absolute MVUs were higher in the intervention group at 30 minutes (p = 0.0500), this difference was not sustained at subsequent time points and was absent in change-from-baseline analyses, suggesting no clinically meaningful treatment effect. No statistically significant differences were identified in secondary outcomes.

CONCLUSIONS: Oral calcium carbonate did not result in a statistically significant improvement in uterine contractility or clinical outcomes. These findings likely reflect the limited physiologic effect of oral calcium on serum calcium levels. Oral calcium carbonate appears unlikely to be an effective intervention for labour augmentation; future research should focus on strategies with more controllable mechanisms.

PMID:42480078 | DOI:10.1080/01443615.2026.2697258

Nat Prod Res. 2026 Jul 21:1-16. doi: 10.1080/14786419.2026.2705308. Online ahead of print.

ABSTRACT

This pioneering study reports the phytoconstituents of aerial organs of the vulnerable Stereospermum colais. These parts have been historically overlooked compared to root and bark exploitation in Ayurveda. This approach eliminates destructive root harvesting while staying within WHO elemental limits for multi-herb Ayurvedic formulations. The study proved leaves as the richest source of antioxidant phenolics and flavonoids, particularly rutin. The abscised petals stand out, containing a high level of the biomarker lignan cycloolivil (15.3 mg/g-DW), thus ideal for zero-impact, sustainable harvesting. Meanwhile, green stems are the best source of lapachol (1558 μg/g-DW in acetone). These highly significant profiles expand our understanding of the S. colais beyond previously identified compounds from roots and bark. This minimises expenses while maintaining tree health and bioactive yields for Ayurvedic applications. This study unlocks sustainable, eco-friendly sourcing for Ayurvedic and modern medicines, easing pressure on wild populations with non-destructive harvesting that can readily scale for commercial use.

PMID:42480068 | DOI:10.1080/14786419.2026.2705308

JMIR Res Protoc. 2026 Jul 21;15:e89405. doi: 10.2196/89405.

ABSTRACT

BACKGROUND: Outdoor play supports children’s physical, social, and cognitive development; yet, opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centers are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and those without disabilities.

OBJECTIVE: The Sending Preschoolers Outside (SPROUT) and SPROUT-able studies aim to examine the impact of one of Canada’s first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10-59 months, with and those without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (eg, not outdoor-focused) ELCC settings. Secondary objectives are to (1) examine educator job satisfaction, health, well-being, and attitudes toward teaching outdoors for children with and those without disabilities; (2) examine caregiver beliefs and attitudes toward children’s participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and those without disabilities (ie, the SPROUT-able substudy) in an outdoor-focused ELCC program.

METHODS: This prospective longitudinal open cohort study follows children, caregivers, and educators over 3 years. Participants are recruited from 1 outdoor-focused (experimental) and 3 conventional (usual care) ELCC centers in Ontario, Canada; all sites are licensed. Assessments occur every 6 months and include direct measures of children (eg, anthropometry, motor skills, and accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs usual care).

RESULTS: As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental and 43 control). Of these, 70 children who enrolled at study initiation have completed baseline and T1 and T2 assessments (43 experimental and 27 usual care), while 18 children enrolled at the 6-month time point (T1; 13 experimental and 5 usual care) have completed T1 and T2 (with a missing baseline assessment). A total of 19 children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able substudy: 4 with a formal diagnosis, 3 with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker.

CONCLUSIONS: By combining a holistic and comparative approach with a focus on children with and those without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator well-being, and community health.

PMID:42480064 | DOI:10.2196/89405

JMIR Mhealth Uhealth. 2026 Jul 21;14:e90422. doi: 10.2196/90422.

ABSTRACT

BACKGROUND: Structured exercise is a key component of cardiac rehabilitation (CR) for patients with heart failure (HF), but access to center-based cardiac rehabilitation (CBCR) is often limited. Mobile health (mHealth) platforms enable remote, virtual, or hybrid cardiac rehabilitation (RVH-CR) delivery.

OBJECTIVE: This study aimed to evaluate the effectiveness and safety of structured, exercise-focused RVH-CR supported by mHealth compared with usual care or CBCR in patients with heart failure with reduced ejection fraction (HFrEF) or in HF populations predominantly comprising patients with HFrEF.

METHODS: We searched PubMed, Web of Science, MEDLINE via Ovid, Cochrane CENTRAL, and CINAHL Complete from inception to April 27, 2026. Randomized controlled trials comparing mHealth-supported RVH-CR with usual care or CBCR were included. The primary outcome was exercise capacity, assessed by peak oxygen uptake (VO2 peak) and 6-minute walk distance (6MWD). Secondary outcomes included health-related quality of life and safety. Data were pooled using random-effects meta-analysis stratified by comparator. Risk of bias was assessed with the Cochrane Risk of Bias Tool version 2, and evidence certainty was evaluated using GRADE (Grading of Recommendations Assessment, Development, and Evaluation).

RESULTS: Eight randomized controlled trials with 1368 patients were included. In the CBCR comparison, mHealth-supported RVH-CR showed a statistically significant greater improvement in VO2 peak than CBCR (mean difference [MD] 0.82, 95% CI 0.06-1.57; P=.03), although this finding was based on a limited number of trials. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD (MD 22.99, 95% CI 1.15-44.82; P=.04). Single-trial estimates suggested improvements in VO2 peak (MD 2.50, 95% CI 0.88-4.12) and Minnesota Living with Heart Failure Questionnaire scores (standardized MD -0.57, 95% CI -0.98 to -0.17; P<.01) versus usual care. The certainty of evidence ranged from low to moderate. No intervention-related deaths or serious adverse events were reported, but sparse events and short follow-up limited conclusions regarding safety.

CONCLUSIONS: The effects of structured RVH-CR supported by mHealth differed according to comparator type, but the certainty of evidence ranged from low to moderate. Compared with usual care, mHealth-supported RVH-CR was associated with improved 6MWD. Compared with CBCR, mHealth-supported RVH-CR showed a significantly greater improvement in VO2 peak in a limited number of trials, but superiority, equivalence, or noninferiority to CBCR cannot be concluded. Because usual care and CBCR are clinically distinct comparators, no single overall effect across comparator types should be inferred. Future studies should assess long-term outcomes and standardize structured exercise protocols across RVH-CR models.

PMID:42480049 | DOI:10.2196/90422

Brief Bioinform. 2026 Jul 3;27(4):bbag390. doi: 10.1093/bib/bbag390.

ABSTRACT

Variant-set association analysis is a powerful strategy for genetic studies of whole-genome sequence (WGS) data, especially for rare variants. By aggregating variant signals, variant-set analysis can improve statistical power, result interpretability, and study replicability. Motivated by the evidence that 3D genome architecture plays a critical role in regulating gene transcription, several works have incorporated 3D genome architecture into gene-based association tests and demonstrated great promise. In this work, we extend the idea of 3D-genome guided test from gene-centric to gene-agnostic, whole-genome testing by introducing an Hi-C informed kernel association test (i.e. HiC-KAT). We present a principled procedure that converts Hi-C contact confidence into borrowing weights and integrates these weights into genetic similarity kernels so that higher-confidence interacting loci contribute more to the association test of the target variant set. We use a controlling parameter to adaptively determine the appropriate degree of information borrowing from its interacting loci during association testing. We assess the performance of HiC-KAT using simulations and illustrate its advantage in detecting rare-variant sets using WGS data from the ARIC study in the Trans-Omics for Precision Medicine program.

PMID:42480046 | DOI:10.1093/bib/bbag390