JAMA. 2026 Mar 23. doi: 10.1001/jama.2026.4175. Online ahead of print.
NO ABSTRACT
PMID:41870422 | DOI:10.1001/jama.2026.4175
Tag: statistics
JAMA Neurol. 2026 Mar 23. doi: 10.1001/jamaneurol.2026.0359. Online ahead of print.
ABSTRACT
IMPORTANCE: Physical inactivity, hypertension, and hyperlipidemia are modifiable cardiovascular risk factors for age-related cognitive decline and dementia. It remains unknown whether exercise training combined with intensive pharmacological reduction of cardiovascular risk factors (IRVR) would have greater benefits on cognitive function than those of exercise or IRVR alone.
OBJECTIVE: To determine the effects of exercise, IRVR, and exercise combined with IRVR on cognitive function in older adults.
DESIGN, SETTING, AND PARTICIPANTS: This single-blind, multicenter randomized clinical trial with a 2 × 2 factorial design and duration of 24 months was conducted at 4 clinical sites in the US. Enrollment began on February 2, 2017; the final study visit was on January 31, 2022. After screening, older adults without dementia and with hypertension, family history of dementia, and/or self-reported subjective cognitive decline were randomized. Data were analyzed from December 2022 through October 2024.
INTERVENTIONS: Participants were randomized with a 1:1:1:1 ratio to aerobic exercise training, IRVR (lowering of systolic blood pressure to <130 mm Hg and serum low-density lipoprotein cholesterol with atorvastatin), IRVR + exercise, and usual care.
MAIN OUTCOMES AND MEASURES: The primary outcome was change in global cognitive function at 24 months from baseline, assessed with the Preclinical Alzheimer Cognitive Composite (PACC) score. Secondary outcomes were changes in the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) fluid composite score and individual test scores.
RESULTS: A total of 3290 individuals were screened, and 513 older adults (aged 60-85 years) without dementia and with hypertension, family history of dementia, and/or self-reported subjective cognitive decline were randomized. Among 513 randomized participants (mean [SD] age, 68.7 [6.0] years; 323 female participants [63.0%]), 443 completed 24-month visits, and 480 were included in the primary data analysis. For the primary outcome, there were no statistically significant interactions between intervention groups and time of visits (P = .13). At 24 months, PACC scores increased by 0.2 units in the no-exercise group (95% CI, 0.1-0.3) and by 0.3 units in the exercise group (95% CI, 0.2-0.4), with no significant group differences (0.1 units; 95% CI, -0.1 to 0.2; P = .37). PACC scores also increased by 0.3 units in the no-IRVR group (95% CI, 0.2-0.4) and by 0.2 units in the IRVR group (95% CI, 0.1-0.3), with no significant group differences (0.1 units; 95% CI, -0.3 to 0.03; P = .12). Increases in the NIHTB-CB composite score and individual test scores with exercise or IRVR showed similar results.
CONCLUSIONS AND RELEVANCE: In this multicenter randomized clinical trial among older adults with family history of dementia and/or self-reported subjective cognitive decline, exercise, IRVR, or both did not result in statistically significant differences in improvements in cognitive function over 24 months.
TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02913664.
PMID:41870419 | DOI:10.1001/jamaneurol.2026.0359
J Emerg Nurs. 2026 Mar 23:S0099-1767(26)00046-2. doi: 10.1016/j.jen.2026.02.002. Online ahead of print.
ABSTRACT
INTRODUCTION: Emergency visits for sexual assault have surged 1533.0% since 2006. Sexual assault is linked to worsened health outcomes; outcomes worsen without timely care. Sexual assault nurse examiners are specially trained to improve health care services, enhance forensic evidence collection, and amplify rates of prosecution. National standards recommend 24/7 crisis care to preserve forensic evidence and timely treatment of sexual assault patients. A southeastern teaching hospital’s part-time sexual assault nurse examiner program was audited for sexual assault nurse examiner delay length to establish recommendations.
METHODS: This gap analysis used a retrospective chart review of 150 sexual assault nurse examiner cases from 2022 to 2024 to assess care delays. The 150 patients were selected using a random number generator. Data were gathered from Epic, SharePoint, and manual chart review. Sexual assault nurse examiner delays and patients with disruptions in care were identified. Quantitative data were analyzed using descriptive statistics, whereas reasons for delays were categorized and counted. The evaluation project adhered to national protocols and received an institutional review board exemption.
RESULTS: Results showed average delays of 4.54 hours for sexual assault nurse examiner response times, with waits ranging from 0 to 30.7 hours; 6.37% of all 361 sexual assault nurse examiner cases either left or left and returned owing to sexual assault nurse examiner delays.
DISCUSSION: Prolonged wait times risk negative medical, forensic, and psychological outcomes. To improve care, recommendations include expanding staffing, implementing a full-time program, streamlining processes, and achieving 24/7 sexual assault nurse examiner coverage. Delays in sexual assault nurse examiner response are 4 to 5 times standard recommendations, with only 23.33% of cases meeting the 60-minute goal.
PMID:41870417 | DOI:10.1016/j.jen.2026.02.002
Environ Sci Technol. 2026 Mar 23. doi: 10.1021/acs.est.6c01728. Online ahead of print.
ABSTRACT
Alkylated polycyclic aromatic hydrocarbons (APAHs) often possess higher toxicity than their parent compounds, yet global inventories largely overlook their direct volatilization from crude oil spills. To quantify this missing pathway, we developed a Monte Carlo framework that estimates this non-combustion source by coupling empirical spill statistics, APAH composition from 18 crude oils, and marine/terrestrial volatilization efficiencies. Across eight validated volatile species (C1-C4 naphthalenes, C1 phenanthrenes, C1-C3 fluorenes), global emissions span 3.4-73.4 kt/year (95% confidence interval), with a median of ∼17.5 kt/year. Notably, methylnaphthalenes (MeNAPs) alone account for ∼5.9% of their known global atmospheric emissions. Although global inventories for other homologues are unavailable, absolute fluxes of C2-C4 naphthalenes are comparable to or exceed MeNAPs, underscoring oil spills as a substantial, previously unquantified source of light APAHs. Sensitivity analyses highlight key uncertainties in spill volumes, crude compositions, and volatilization ratios; assumptions of parameter independence may understate extreme events. It is important to note that, due to the exclusion of dynamic meteorological suppression factors (e.g., low temperature and calm winds), these estimates represent a potential source strength. Incorporating this non-combustion pathway into inventories is therefore critical for accurate environmental risk assessments and regulatory policies.
PMID:41870409 | DOI:10.1021/acs.est.6c01728
J Nurs Manag. 2026;2026(1):e5604987. doi: 10.1155/jonm/5604987.
ABSTRACT
BACKGROUND: Occupational burnout poses a persistent threat to nurses’ mental health and the quality of patient care. Emerging evidence indicates that burnout is not a uniform phenomenon but manifests in distinct psychological patterns. Yet, how these diverse burnout experiences interact with safety-related factors is insufficiently understood. Network analysis offers a systems-level perspective to uncover interconnections among psychological and safety variables and to pinpoint potential bridge nodes for targeted interventions.
AIM: This study sought to map the network architecture linking psychological and safety-related factors among nurses across different burnout profiles, to identify profile-specific central and bridge nodes, and to examine their associations with safety behaviors.
METHODS: A total of 2092 nurses were included. This study was a secondary analysis based on a previously established dataset in which three distinct burnout profiles were identified using latent profile analysis: the High Achievement Stable Group (Class 1, 70.3%), the High Efficiency Contradictory Group (Class 2, 6.6%), and the High Pressure Adaptive Group (Class 3, 23.1%). Psychological-safety networks were estimated for both the overall sample and each subgroup using the EBICglasso model. Centrality and bridging indices were computed via expected influence and bridge expected influence, followed by network comparison tests to evaluate structural variations across profiles.
RESULTS: In the overall network, “skills” (B4) exhibited the greatest centrality, whereas “personal accomplishment” (A3) and “knowledge” (B1) consistently functioned as pivotal bridge nodes across profiles. Although bridge configurations differed slightly among classes, A3 and B1 remained the principal connectors integrating psychological and safety communities. Significant structural differences were detected between Classes 2 and 1 (M test, p < 0.001) and between Classes 3 and 1 (M test, p < 0.001; S test, p = 0.002), with pronounced discrepancies in the edge patterns surrounding A3 and B1.
CONCLUSIONS: The burnout-safety networks revealed distinct structural configurations across nurse subgroups. Identifying profile-specific bridge nodes offers practical guidance for precision interventions that enhance safety behaviors and foster occupational resilience.
PMID:41870377 | DOI:10.1155/jonm/5604987
J Exp Psychol Gen. 2026 Mar 23. doi: 10.1037/xge0001911. Online ahead of print.
ABSTRACT
According to the theory of efficient coding, sensory processing is optimized for representing the information content of natural scenes. This implies that perceptual systems are adapted to the statistical regularities of the environments they are immersed in. In color vision, relatively low sensitivity for discriminating color along blue and yellow axes has been linked to the dominance of blue-yellow color variation in natural scenes. It has been suggested that higher order visual processes, such as aesthetic preferences, could also be adapted to natural environments. Here, we manipulate the chromatic contrast of natural scenes to test whether low-, medium-, and high-level aspects of color perception can be calibrated to the color statistics of visual environments. In three experiments, we measured color discrimination, chromatic balance perception, and aesthetic judgments of colorful Mondrian patterns after adaptation to scenes with natural colors or scenes with manipulated colors. After viewing naturally colored scenes, color discrimination, perception of chromatic balance, and color preferences are biased along the blue-yellow color axis, along which there is most chromatic variance in natural scenes. Blue-yellow biases were reduced or partially inverted following adaptation to color-manipulated scenes, though the extent of the reversal in bias we observed following short-term adaptation appears to have been limited by long-term adaptation to the color statistics of natural environments. Our findings support the efficient coding theory and provide experimental support for the hypothesis that multiple attributes of human color perception adapt to the color statistics of visual environments. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
PMID:41870374 | DOI:10.1037/xge0001911
J Couns Psychol. 2026 Mar 23. doi: 10.1037/cou0000867. Online ahead of print.
ABSTRACT
The working alliance is hypothesized to be crucial for facilitating change during psychodynamic therapy. However, few studies have examined the session-by-session effects of the alliance on outcomes within this therapeutic approach. We aimed to test the effect of the client- and therapist-reported alliance on next-session problems/functioning in short-term psychodynamic therapy conducted in a university training clinic. A secondary aim was to test whether baseline personality functioning and adverse childhood experiences moderate the association between alliance and outcome. A total of 152 clients, receiving short-term psychodynamic psychotherapy from novice therapists, completed the Clinical Outcomes in Routine Evaluation-10 before each session. After each session, clients and therapists completed the Working Alliance Inventory-Short. Data were analyzed using continuous time structural equation modeling, which allows for relatively strong causal inferences despite the nonexperimental design. Improvement in the client-reported alliance significantly predicted a reduction of problems/dysfunction in the following session with a small effect size that increased to a large effect size after 7-8 sessions. The effect of problems/functioning on the client-reported alliance was also statistically significant. No associations were found between the therapist-reported alliance and outcome. The alliance effect varied considerably between therapist-client dyads and was stronger for clients reporting more adverse childhood experiences. In conclusion, the client-reported alliance was a predictor of outcome in the following session. Its effect on outcome peaked after 7-8 sessions. While this long-term effect aligns with the principles of psychodynamic therapy, it may also stem from the statistical model used. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
PMID:41870354 | DOI:10.1037/cou0000867
Cancer Biol Med. 2026 Mar 20:j.issn.2095-3941.2025.0625. doi: 10.20892/j.issn.2095-3941.2025.0625. Online ahead of print.
ABSTRACT
OBJECTIVE: This study was aimed at analyzing temporal trends in lung cancer mortality from 2013 to 2021, and projecting future trends until 2030.
METHODS: Mortality data were extracted from the China Causes of Death Surveillance Dataset, which covers 2.37 billion person-years. Age-standardized mortality rates (ASMRs) were calculated with Segi’s world standard population. Joinpoint regression was used to analyze temporal trends, and linear regression was applied to assess changes in mean age at death. A Bayesian age-period-cohort model was used to project mortality trends through 2030. Contributions of risk factors and demographic changes (population size and age structure) to mortality trends were decomposed with the population split method.
RESULTS: From 2013 to 2021, the crude lung cancer mortality rate increased by 2.3% annually, whereas the ASMR remained stable overall but showed significant 2.9% annual declines during 2015 and 2021. The ASMRs in urban areas (-2.9% per year) and eastern regions (-1.5% per year) showed significant decreasing trends throughout the entire period. The mean age at death increased across all areas, and the largest increases were observed in rural areas. Deaths among people ≥65 years of age rose by 1.6%-5.6% during the entire period. Decomposition analysis indicated that the increased death counts were driven primarily by population aging (32%-43%) and population growth (8%-31%), whereas risk factors contributed negatively (-3% to -29%). Projections suggested that the number of lung cancer deaths will reach approximately 760,200 by 2030, with continued increases in the crude mortality rate but slight declines in the ASMR.
CONCLUSIONS: The lung cancer burden in China shows marked regional disparities and challenges due to population aging. To further decrease lung cancer deaths, optimized allocation of medical resources, strengthened prevention and control of lung cancer risk factors, and integration of effective policies will be required.
PMID:41870348 | DOI:10.20892/j.issn.2095-3941.2025.0625
Anesthesiology. 2026 Mar 23. doi: 10.1097/ALN.0000000000006059. Online ahead of print.
ABSTRACT
BACKGROUND: Cryoneurolysis provides analgesia by reversibly ablating peripheral nerves using gas-induced exceptionally low temperature. The desired therapeutic temperature is between approximately -20°C and -100°C. Warmer temperatures can induce a neuropraxia that may itself induce pain; and colder temperatures can result in permanent nerve injury. Therefore, it is imperative that the target nerve reach but not exceed the therapeutic window.
METHODS: A convenience sample of participants undergoing mastectomy (n=3) received a high-thoracic paravertebral nerve block, while subjects being treated for traumatic rib fractures (n=3) did not. All participants had ultrasound-guided cryoneurolysis of multiple intercostal nerves with a percutaneous thermocouple inserted approximately 3 mm adjacent to the cryoprobe shaft. The returning argon gas and tissue temperatures were correlated. Due to the limited sample size, the data are presented and not statistically analyzed.
RESULTS: Although in all cases (31 nerves) the returning gas was ultimately colder than -80°C, the tissue adjacent to the probe did not reach -20°C after 3 and 5 min in 71% (n=5) and 42% (n=10) of treatments, respectively. The coldest mean temperature in adjacent tissue was 60 degrees warmer than the returning gas without a nerve block, and 95 degrees warmer with a concurrent nerve block. When treating adjacent intercostal nerves, the gas temperature remained unchanged while the tissue became colder with each consecutive treatment.
CONCLUSIONS: During percutaneous cryoneurolysis, the temperature of tissue is frequently deceptively warm relative to the returning gas and tissue frequently does not reach an adequately cold temperature; prolonging gas treatment from 3 to 5 min improves the success of reaching therapeutic temperatures; the presence of a peripheral nerve block appears to lessen the chance of reaching therapeutic temperatures; and caution is warranted when treating consecutive intercostal nerves as tissue temperature may decrease with each level.
PMID:41870345 | DOI:10.1097/ALN.0000000000006059
J Pregnancy. 2026;2026(1):e2785076. doi: 10.1155/jp/2785076.
ABSTRACT
INTRODUCTION: In sub-Saharan African region, high-maternal mortality is high due to complications of labor, delivery as well as low patronage of antenatal care and skilled birth attendants (SBAs), poverty and poor health-seeking behavior. Although considerable studies exist on drivers of choice of birth locations, there is a paucity of current, nationally representative samples from various SSA countries examining factors influencing birthplace choices. This study addresses this gap by employing a recent dataset to assess the determinants of changing birth locations in SSA.
METHODS: This cross-sectional study used the most recent Demographic and Health Survey (DHS) data from 30 sub-Saharan African countries collected between 2014 and 2024, comprising 61,240 women aged 15-49. Two outcomes were examined: (i) any change in childbirth location between the two most recent births, and (ii) a shift from home to health-facility delivery. Two binary logistic regression models were fitted to identify factors associated with each outcome, with checks for multicollinearity conducted using variance inflation factors and tolerance indices. Survey design was accounted for in our regression analyses (sampling weights and clustering).
RESULTS: Overall, 13.59% (n = 8320) of women changed their childbirth location between their two most recent births, and more than half of these women (54.35%) shifted from home to a healthcare facility. The highest change is observed in Uganda where 20.36% (95% CI; 19.07-21.66) changed their location of childbirth, and the lowest is observed in Burkina Faso where only 5.24% (95% CI; 2.99-7.48) changed their location of childbirth. The probability of changing birth location from home to a healthcare facility increased with the level of education, with those with higher education having a higher likelihood of changing from home to a facility (AOR = 2.76, 95% CI: 1.53-4.97) compared with those with no education. The odds of changing birth location from home to a healthcare facility increase with wealth status, particularly for women in the richest category (AOR = 2.31, 95% CI: 1.79-2.97) relative to those in the poorest category. Women in rural areas are 34% less likely to change from home to a facility compared with those in urban areas (AOR = 0.66, 95% CI: 0.57-0.76).
CONCLUSION: Our study highlights significant disparities in changes in childbirth locations across SSA countries, driven primarily by education, wealth, and rural-urban residence. Although countries like Malawi and Zimbabwe demonstrate successful strategies for promoting facility-based deliveries, others like Chad and Burkina Faso face persistent barriers. Addressing these disparities requires targeted interventions, including expanding rural healthcare infrastructure and implementing pro-poor healthcare policies. Future research and program designs should prioritize longitudinal assessments of these determinants to tailor interventions for specific country contexts.
PMID:41870343 | DOI:10.1155/jp/2785076