Tag: statistics

J Craniofac Surg. 2026 Jul 10. doi: 10.1097/SCS.0000000000013148. Online ahead of print.

ABSTRACT

This study was performed to evaluate the maxillary sinus in patients with isolated cleft palate (ICP). A total of 87 ICP patients and 93 controls, aged 4 to 22 years, were enrolled and stratified into 4 age groups. Cone-beam computed tomography scans were utilized to assess diameters and volume of the maxillary sinus. No statistically significant differences were detected between the left and right sides, nor between male and female subjects. All measurements in ICP patients were smaller than normal. In controls, significant variations of maxillary sinus parameters were observed between adjacent age groups, with the exception of the sagittal diameter between the juvenile and adolescent groups. In ICP patients, all measurements showed significant changes from the juvenile to adolescent stages; in addition, volume and sagittal diameters on both sides showed significant changes from the adolescent to adult stages. These findings indicated the absence of sexual dimorphism and bilateral asymmetry in maxillary sinus morphology among all subjects. The maxillary sinus of ICP patients was significantly smaller than normal. In controls, the maxillary sinus increased progressively with age from preschool to adulthood. In contrast, ICP patients demonstrated relatively restricted maxillary sinus increase during the preschool and juvenile stages, followed by a continuous increase that persisted until adulthood.

PMID:42424605 | DOI:10.1097/SCS.0000000000013148

J Med Internet Res. 2026 Jul 9;28:e87280. doi: 10.2196/87280.

ABSTRACT

BACKGROUND: Patients frequently access laboratory results through patient portals, but many struggle to interpret these values and formulate relevant questions for their clinicians. Question prompt lists (QPLs) can enhance communication but are rarely tailored to individual clinical contexts.

OBJECTIVE: This study evaluated the feasibility of using large language models (LLMs) to generate patient-friendly, clinically relevant questions grounded in electronic health record (EHR) laboratory data.

METHODS: We extracted deidentified clinical profiles, including laboratory results, diagnoses, and medications, from patients with chronic conditions (eg, diabetes and chronic kidney disease). Using 9 deidentified clinical profiles from the OneFlorida Data Trust, we generated 486 questions across all rounds: 126 with GPT-4o in round 1, 120 with GPT-4o in round 2, 180 with GPT-4o in round 3, and 60 with LLaMA 3.2 in round 3. Prompt refinements were informed by clinician ratings consisting of 2 binary questions (ie, clear phrasing and clinical validity) and 3 Likert-scale questions (ie, significance for the patient’s health; clinical appropriateness, that is, the likelihood of being asked in primary care setting; and willingness to answer). Refinements were incorporated after each round. Patient participants then evaluated selected questions for understandability, perceived usefulness, and intention to use. Readability was assessed with standard indices.

RESULTS: Iterative clinician feedback improved question clarity and reduced clinically irrelevant suggestions. Across rounds, GPT-4o consistently produced more coherent and patient-friendly questions, while LLaMA 3.2 demonstrated competitive performance on Likert-scale metrics. It exhibited greater variability in clinical appropriateness as noted by clinicians. In round 3, the binary metric “clear phrasing” reached a ceiling effect for both models, while clinical validity ratings showed greater variability, particularly from one clinician. Likert-scale evaluations tended to favor LLaMA 3.2 across all 3 clinicians for clinical appropriateness (3.37-4.82 vs 3.02-4.67), significance for the patient’s health (3.38-4.28 vs 2.97-3.83), and willingness to answer (3.17-4.70 vs 2.82-4.47), with multiple comparisons reaching statistical significance after Bonferroni correction. Patient evaluation (N=134) of GPT-4o-generated questions showed that 25 of 30 questions had moderate to high understandability (average Likert score ≥3.5), and 19 of 30 questions had moderate to high usefulness (average Likert score ≥3.5).

CONCLUSIONS: This study supports the feasibility of using LLMs with structured EHR-derived laboratory data to generate contextualized QPLs, but model outputs varied in clinical appropriateness and readability. Clinician-in-the-loop review remains necessary before patient-facing use.

PMID:42424593 | DOI:10.2196/87280

Br Med Bull. 2026 Jul 3;159(1):ldag018. doi: 10.1093/bmb/ldag018.

ABSTRACT

BACKGROUND: Even after surgical repair, acute Achilles tendon rupture (ATR) may leave residual strength and function deficits. Augmenting percutaneous repair with the flexor hallucis longus (FHL) tendon may limit elongation and reinforce the repair. We report 5-year outcomes of acute ATR managed with percutaneous repair alone or with minimally invasive FHL augmentation.

SOURCES OF DATA: A prospective comparative cohort of 53 patients (27 percutaneous repair alone, 26 with FHL augmentation) with a minimum 5 years follow-up. Objective and subjective outcomes were collected.

AREAS OF AGREEMENT: At 5 years, both procedures gave equivalent results on all patient-reported outcome measures. FHL augmentation reduced tendon elongation (lower Achilles tendon Resting Angle) and produced statistically significantly greater isometric strength and smaller calf circumference difference.

AREAS OF CONTROVERSY: Structural and strength differences were small, of doubtful clinical relevance, and did not improve patient-reported function. FHL augmentation is more demanding, longer, costlier, and required inpatient admission, whereas percutaneous repair was a day-case procedure under local anesthesia. A significant between-group age difference is an important confounder.

GROWING POINTS: Structural indices frequently dissociate from patient-reported function after ATR. Within the Italian National Health Service, the added resource use of FHL augmentation is hard to justify when no validated measure detects a clinically meaningful 5-year difference.

AREAS TIMELY FOR DEVELOPING RESEARCH: Adequately powered randomized trials with pre-specified age stratification are needed to establish whether particular subgroups, such as older patients or those with more degenerate tendons, derive a clinically relevant benefit from FHL augmentation.

PMID:42424592 | DOI:10.1093/bmb/ldag018

Am J Public Health. 2026 Jul 9:e1-e11. doi: 10.2105/AJPH.2026.308516. Online ahead of print.

ABSTRACT

Objectives. To gain a more comprehensive understanding of the morbidity associated with pedestrian risk in Chicago, Illinois, by probabilistically matching the data of injured pedestrians in standardized police traffic crash reports to their associated emergency department (ED) visit record. Methods. Between 2018 and 2022, we extracted information on pedestrians injured by vehicles as recorded by the Chicago Police Department pedestrians seen at a city ED for injuries sustained by a vehicle. Among matched records, we used descriptive statistics to describe temporal, geographic, and demographic patterns in ED-attended pedestrian injury. We used multivariable regression modeling to calculate incidence rates of ED-attended pedestrian injury across Chicago communities of varying economic hardship. Results. Among 2631 ED patients matched to a police department crash record, 73.9% were initially recorded by police with nonincapacitating injuries or less at the crash scene. Five of the 6 communities with the highest combination of crash frequency and injury severity were among the 40% most economically disadvantaged communities. Conclusions. Incorporation of ED data highlighted pedestrian injuries that would have been missed with police crash data alone, which disproportionately affects economically vulnerable neighborhoods. Public Health Implications. Regular incorporation of pedestrian-injury data from local EDs could help jurisdictions better understand broader public health implications and disparities in pedestrian risk and identify additional opportunities for intervention. (Am J Public Health. Published online ahead of print July 9, 2026:e1-e10. https://doi.org/10.2105/AJPH.2026.308516).

PMID:42424579 | DOI:10.2105/AJPH.2026.308516

J Med Internet Res. 2026 Jul 9;28:e89065. doi: 10.2196/89065.

ABSTRACT

Places have a significant impact on health. Thus, examining place-based structural and social determinants can help inform effective public health interventions. HealthAtlas.ucsf.edu provides a single online platform to explore multiple domains of place-based data. The initial California-only version of Health Atlas was launched in April 2020, and a national version was launched in October 2024. An artificial intelligence-assisted search function was integrated in January 2026. Health Atlas includes data on over 200 variables across 5 topical domains: demographics, socioeconomic, neighborhood, environment, and health and health care. The data were either (1) obtained from the American Community Survey, CDC PLACES, and other public sources or (2) obtained through collaboration with research partners. Users can visualize and aggregate data for 7 geographic levels: census tract, zip code tabulation area, county, congressional district, core-based statistical area, public use microdata area, and state. Most variables are available across all 50 states in the United States, the District of Columbia, and Puerto Rico. Users can explore Health Atlas to better understand the relationship between selected variables via maps, histograms, scatterplots, and summary plots. Users can select custom areas to suit specific needs. Customizable datasets can be downloaded for further use. Health Atlas provides freely available, user-friendly data and tools to support researchers, community organizations, government entities, and other public health professionals. We envision that Health Atlas will contribute to evidence-based, community-based initiatives; impactful health equity research; and effective public health programs.

PMID:42424556 | DOI:10.2196/89065

Aesthet Surg J. 2026 Jul 9:sjag142. doi: 10.1093/asj/sjag142. Online ahead of print.

ABSTRACT

BACKGROUND: The décolleté is susceptible to intrinsic aging, photoaging, and mechanical stress (breast movement and weight), resulting in progressive thinning, laxity, and wrinkle formation. Although injectable fillers are increasingly used to improve décolleté appearance, controlled clinical data evaluating effectiveness and effects on breast imaging are limited.

OBJECTIVES: To evaluate the safety and effectiveness of diluted calcium hydroxylapatite carboxymethylcellulose (CaHA-CMC; Radiesse®), prepared at a 1:2 ratio with sterile saline, for treating moderate-to-severe décolleté wrinkles.

METHODS: Eligible females were randomized to immediate or delayed treatment. Patients assigned to immediate treatment received up to three diluted Radiesse sessions, with optional retreatment. Patients assigned to delayed treatment remained untreated through Week 24 (primary endpoint) and subsequently received the same treatment regimen without retreatment. Effectiveness was assessed by blinded evaluators using the Merz Assessment Scale (MAS) Décolleté Wrinkles – At Rest. Safety evaluations included adverse events, patient-reported treatment responses, and retrospective review of post-treatment radiographic breast imaging.

RESULTS: The Week 24 estimated responder rate (≥1-point improvement on the MAS Décolleté Wrinkles – At Rest) was 71.2% [95% CI: 61.4%, 79.4%] among treated patients compared with 6.3% [95% CI: 1.5%, 22.9%] among untreated controls, demonstrating a statistically significant between-group difference. Treatment was well tolerated, with predominantly transient, mild-to-moderate injection-site reactions. No interference attributable to diluted Radiesse was observed on post-treatment breast imaging.

CONCLUSIONS: Diluted Radiesse provided clinically meaningful improvement in décolleté wrinkles with a favorable safety profile and no observed impact on breast imaging, supporting its use as a nonpermanent injectable option for décolleté rejuvenation.

PMID:42424535 | DOI:10.1093/asj/sjag142

Eur J Cardiovasc Nurs. 2026 Jul 9:zvag160. doi: 10.1093/eurjcn/zvag160. Online ahead of print.

ABSTRACT

AIM: Serious games are increasingly used in nursing education as an innovative teaching method. However, evidence regarding the impact of this approach on nursing students’ cardiopulmonary resuscitation knowledge has not yet been reviewed. The aim of this systematic review and meta-analysis was to evaluate the effects of serious games on nursing students’ cardiopulmonary resuscitation knowledge.

METHODS AND RESULTS: This study is of meta-analysis type. In this study, a literature search was conducted in accordance with the PRISMA statement using six databases for studies published up to January 20, 2025. Data were analyzed using CMA statistical software.

RESULTS: Five studies conducted in four different countries with a total of 379 nursing students were included in the analysis. Three of these studies were randomized controlled and two were quasi-experimental. Heterogeneity was observed across studies due to the diversity of serious games, platforms used, and gamification elements.

CONCLUSION: Findings indicate that serious games provide positive effects in improving nursing students’ cardiopulmonary resuscitation knowledge. However, given the methodological limitations of existing studies, further research evaluating the effectiveness of serious games with more robust designs is needed.

REGISTRATION: A protocol was registered on the PROSPERO (CRD420251111467).

PMID:42424523 | DOI:10.1093/eurjcn/zvag160

JMIR Med Educ. 2026 Jul 9;12:e90563. doi: 10.2196/90563.

ABSTRACT

BACKGROUND: Digital educational resources, including asynchronous video-based materials and simulation models, are increasingly used in undergraduate medical education to support procedural skills training. Although both approaches have demonstrated educational value, there is limited qualitative evidence on how the pedagogical integration of these approaches is experienced in real-world clinical training environments, particularly during time-constrained surgical internships.

OBJECTIVE: This study aimed to explore medical students’ and an instructor’s experiences with an integrated suturing skills module combining asynchronous instructional videos and simulation-based practice during a surgical internship.

METHODS: An interpretive qualitative study was conducted with sixth-year medical students during a surgical internship at a medical school in Chile. The intervention consisted of a suturing simulation module supported by asynchronous instructional videos. Data were collected through 2 focus groups with 20 students and a semistructured interview with 1 instructor after completion of the module. All sessions were audio-recorded, transcribed verbatim, and pseudonymized. Data were analyzed using reflexive thematic analysis following an inductive approach. The Technological Pedagogical Content Knowledge framework was used as a sensitizing lens during the interpretive phase. Ethics approval was obtained prior to data collection, and all participants provided informed consent.

RESULTS: Participants described asynchronous videos as facilitating prior preparation by allowing flexible, self-paced review of procedural steps, which supported students’ perceived readiness for hands-on practice. The integration of video-based resources with simulation-based training was perceived as enabling more focused engagement during supervised sessions, shifting attention from procedural recall to technical execution. Participants also reported perceived increases in confidence when approaching early clinical tasks. However, logistical constraints, including limited time for individualized feedback and challenges related to the physical learning environment, were identified. Some participants also expressed ongoing uncertainty regarding specific techniques despite prior video exposure.

CONCLUSIONS: The integration of asynchronous instructional videos with simulation-based practice was perceived as a coherent educational strategy that supported students’ preparation for procedural training within a demanding clinical context. The findings highlight the potential of asynchronous resources to function as preparatory scaffolding that may enable more efficient use of supervised training time. This study contributes to the qualitative understanding of how integrated digital and simulation-based approaches are experienced in surgical internships, supporting their consideration in curriculum design while emphasizing the need for careful implementation and contextual adaptation.

PMID:42424512 | DOI:10.2196/90563

J Med Entomol. 2026 Jul 1;63(4):tjag114. doi: 10.1093/jme/tjag114.

ABSTRACT

Vector-borne diseases represent a growing public health issue nationwide. Nebraska reports a sustained burden of mosquito-borne diseases and expanding tick-borne disease risk. This study aims to assess retrospective surveillance data for vector abundance, vector infection rates, and human vector-borne disease reports to examine the relationship between vector factors and human risk. Vector abundance and pathogen infection rates were mapped alongside the presence and incidence of key vector-borne diseases. Mosquito surveillance and mosquito-borne disease data were available from 2012 to 2024, while tick surveillance and tick-borne disease data were available from 2021 to 2024. Statistical models and comparative tests were used to explore associations between vector factors and disease reports. In the full 2012-2024 dataset, only Culex tarsalis abundance was associated with human WNV case counts. In a contemporary subset (2021-2024), Culex pipiens pooled infection rate showed a significant negative association with human cases, although this relationship was not observed in the full dataset. Tick surveillance indicates established populations of vector tick species in distinct regions of the state, with pathogen detections generally aligning with areas where human cases have been reported. However, there was no positive association between tick infection rates and the presence of human cases. Differences in the level of human case reporting and data availability affected interpretation of long-term trends and limited strong conclusions regarding direct relationships between vector factors and human disease. Continued integration of entomological surveillance with human case information may help clarify patterns of vector-borne disease risk and inform efforts to address current and emerging threats in Nebraska.

PMID:42424506 | DOI:10.1093/jme/tjag114

Eur J Public Health. 2026 Jun 10;36(4):ckag101. doi: 10.1093/eurpub/ckag101.

ABSTRACT

Circadian disruption resulting from night shift work has been associated with cardiometabolic diseases, but the underlying biological pathways remain insufficiently understood. We analyzed data from the EPHOR-NIGHT cohort, including questionnaires, clinical assessments [body mass index (BMI), blood pressure (BP), waist/hip circumference], and plasma metabolites in blood samples (N = 860; day shift workers n = 362, night shift workers = 498) from Sweden, Spain, and Denmark. We applied multivariable linear regression to examine differences in cardiometabolic risk factors and metabolite levels between shift workers and examined associations between metabolites and cardiometabolic risk factors. Night shift work was associated with higher mean systolic BP (β = 1.89, 95%CI 0.00, 3.79 mmHg), higher mean BMI (β = 1.14, 95%CI 0.44, 1.84 kg/m2), and higher odds of hypertension (OR = 1.38, 95%CI 1.00, 1.89) and overweight/obesity (OR = 1.37, 95%CI 1.02, 1.82), compared to day shift work. Associations were stronger among women in sex-stratified analyses. Night shift workers had metabolic alterations, with lower fractions of polyunsaturated fatty acids, higher fractions of mono-unsaturated and saturated fatty acids, and higher levels of amino acids isoleucine, valine, and phenylalanine. These changes remained after multiple adjustments, including diet. Effects were more pronounced for those working more consecutive night shifts, more night shifts per week, and for permanent night schedules versus rotating shifts. The night shift-related metabolites were associated with higher BMI and higher blood pressure. Night shift work was associated with specific metabolic alterations linked to increased cardiometabolic risk. Our results suggest that reducing night shift intensity and consecutive nights may help mitigate these adverse effects.

PMID:42424502 | DOI:10.1093/eurpub/ckag101