Tag: statistics

Eur J Gastroenterol Hepatol. 2026 May 7. doi: 10.1097/MEG.0000000000003214. Online ahead of print.

ABSTRACT

This meta-analysis aimed to systematically evaluate the efficacy (including improvement of biochemical indicators and clinical outcomes) and safety of the molecular adsorbent recirculating system (MARS) in the treatment of hepatic encephalopathy associated with liver failure. PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, Wanfang, and VIP databases were systematically searched from inception to April 2024. Predefined inclusion criteria were used to assess study quality, and statistical analyses were performed using RevMan 5.4. Seven studies were included. Results showed that MARS significantly improved hemoglobin [standard mean difference (SMD): -0.81, 95% confidence interval (CI): -1.42 to -0.19, P = 0.01], creatinine (SMD: -0.46, 95% CI: -0.68 to -0.24, P < 0.0001), and international normalized ratio (INR) (SMD: -0.22, 95% CI: -0.43 to -0.01, P = 0.004). However, effects on albumin (SMD: 0.60, 95% CI: -0.22 to 1.41, P = 0.15) and bilirubin (SMD: -0.21, 95% CI: -0.78 to 0.35, P = 0.46) were NS. No significant association was observed between MARS treatment and increased risk of bleeding (risk ratio: 1.23, 95% CI: 0.83 to 1.81, P = 0.30) or infection (risk ratio: 1.23, 95% CI: 0.97 to 1.56, P = 0.09). In conclusion, preliminary analysis suggests that MARS may help improve creatinine and INR levels in hepatic encephalopathy patients without significantly increasing bleeding or infection risks. However, because of the limited number and suboptimal quality of included studies and presence of heterogeneity, current evidence is insufficient. Rigorously designed, adequately powered, high-quality randomized controlled trials are needed to validate the precise efficacy and safety of MARS in hepatic encephalopathy treatment.

PMID:42214012 | DOI:10.1097/MEG.0000000000003214

Amyotroph Lateral Scler Frontotemporal Degener. 2026 May 29:1-7. doi: 10.1080/21678421.2026.2671162. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate how respiratory dysfunction and site of onset influences changes in sleep architecture in people with ALS (pwALS).

METHODS: We conducted a retrospective observational study, analyzing demographic data, lung function tests, and polysomnography (PSG) measures. Descriptive statistics, correlation analyses, and survival analyses were performed.

RESULTS: Our cohort had 240 pwALS, 63% male, median age at onset 59.3 (IQR 16.5) years. Median time from onset to PSG was 27.5 (IQR 25) months. Most pwALS had spinal onset (79%). Spirometry at time of PSG showed a reduced Forced Vital Capacity (FVC) (58; (IQR 26) %). We saw a significant FVC decline (3.9; (IQR 4) % per month) in the months before PSG. The sleep quality assessment in pwALS revealed a reduced total sleep time (339; (IQR 144.7) minutes), diminished sleep efficiency (62.8; (IQR 26.5)%) and increased wake after sleep onset (172; (IQR 130.2) minutes) when compared to normal values of healthy age-matched adults. The spinal onset group had a higher number of arousals. In the multivariate linear regression model adjusted for age and sex, FVC is a significant predictor for sleep efficiency (β = 3.359, p = 0.0059). Spinal onset, a slower rate of FVC decline in the months preceding PSG and a preserved FVC (≥ 70%) at the time of PSG were associated with improved survival.

CONCLUSION: We observed substantial sleep disturbances in our cohort overall with substantially increased arousals in the spinal group. FVC is a significant predictor for sleep efficiency and the decline in FVC is linked to survival.

PMID:42214007 | DOI:10.1080/21678421.2026.2671162

Phys Rev Lett. 2026 May 15;136(19):196101. doi: 10.1103/mcf7-xfrd.

ABSTRACT

We derive exact analytical expressions for higher-order correlations of Gaussian level-set interfaces, establishing a direct link between bulk field statistics and interface geometry. This framework enables efficient reconstruction of disordered media, detailed modeling of Gaussian foams-structured, double-thresholded interfaces with tunable morphology-and analysis of memory-enhanced anisotropy reflecting directional persistence in the surface structure. These results open new possibilities for characterizing complex transport, guiding stochastic reconstructions, designing materials with desired properties, quantifying the information content of correlation functions, and modeling directional processes on irregular boundaries.

PMID:42213940 | DOI:10.1103/mcf7-xfrd

Phys Rev Lett. 2026 May 15;136(19):197301. doi: 10.1103/156q-3ngc.

ABSTRACT

Closed-loop learning is the process of repeatedly estimating a model from data generated from the model itself. It is receiving great attention due to the possibility that large neural network models may, in the future, be primarily trained with data generated by artificial neural networks themselves. We study this process for models that belong to exponential families, deriving equations of motion that govern the dynamics of the parameters. We show that maximum likelihood estimation of the parameters endows sufficient statistics with the martingale property and that as a result the process converges to absorbing states that amplify initial biases present in the data. However, we show that, for exponential families, this outcome may be prevented if, at each closed-loop retraining iteration, the data contains at least one data point generated from a ground truth model, by relying on maximum a posteriori estimation or by introducing regularization.

PMID:42213932 | DOI:10.1103/156q-3ngc

J Vet Intern Med. 2026 May 4;40(3):aalag097. doi: 10.1093/jvimsj/aalag097.

ABSTRACT

BACKGROUND: Acute infectious bronchopneumonia is widely reported in adult cattle, yet most descriptions focus on postmortem findings.

HYPOTHESIS/OBJECTIVES: To describe signalment, clinical, hematological, and ultrasonographic findings in affected cows, and to identify pathogens and clinical findings associated with outcome.

ANIMALS: Twenty-one cows from 11 farms.

METHODS: Prospective case series. All cows underwent clinical examination, thoracic ultrasonography, bronchoalveolar lavage for culture and PCR, and CBC. Thoracic ultrasonography was repeated to assess lesion dynamics after antibiotic treatment. Outcomes were classified as favorable (clinical recovery and maintained milk production) or unfavorable (death or reduced milk production leading to premature drying-off and early culling). Descriptive statistics were computed, and univariate analyses were performed to identify variables associated with outcome.

RESULTS: Mean age at inclusion was 47 months (range, 24-104). Cases occurred mainly in winter (10/21) and during the early postpartum period (10/21); 17/21 were dairy cows. Typical clinical signs associated with acute respiratory disease (coughing, wheezes, and crackles) were rarely observed. Thoracic ultrasonography revealed frequent consolidations (17/21) and pleural effusion (13/21), with lesion size decreasing over time. Mannheimia haemolytica and Pasteurella multocida were identified by PCR in bronchoalveolar lavage samples in 13/21 and 18/21 cases, respectively. Unfavorable outcomes (11/21) were associated with nasal discharge, left shift on CBC, reduced ruminal contractions, higher respiratory rate on day 0, and deeper consolidation lesions on days 0 and 5.

CONCLUSIONS AND CLINICAL IMPORTANCE: Ultrasonography is a valuable cow-side tool that supports diagnosis and provides key information on the clinical course of acute infectious bronchopneumonia in adult cows.

PMID:42207578 | DOI:10.1093/jvimsj/aalag097

JMIR Form Res. 2026 May 28;10:e89880. doi: 10.2196/89880.

ABSTRACT

BACKGROUND: Environmental factors account for 23% of global deaths and 25% of chronic diseases. In France, the Fourth National Environmental Health Plan prioritizes training health professionals in environmental health. Endocrine-disrupting chemicals (EDCs) are chemical substances that interfere with hormonal systems, contributing to a range of health effects. In 2024, the Primary Care and Environmental Health (PCEH) program at the University of Montpellier-Nîmes introduced an innovative e-learning module on EDCs for first-year family medicine residents.

OBJECTIVE: This study aimed to evaluate the impact of the PCEH e-learning module on participants’ satisfaction, knowledge, and self-reported behaviors regarding EDCs in household environments.

METHODS: This monocentric, matched before-and-after cohort study included all first-year family medicine residents at the University of Montpellier-Nîmes. The module, developed collaboratively by clinicians and educators, integrated interactive images, artificial intelligence-generated virtual rooms, short educational videos, games, and flash cards. Participants were assessed using pretraining and posttraining questionnaires administered immediately before and after the module. These questionnaires evaluated satisfaction (using a 5-point Likert scale), knowledge (using binary “yes” or “no” questions), and behaviors (using a 5-point Likert scale). Statistical analyses included the McNemar test for paired categorical variables and paired 2-tailed t tests for continuous variables, with a significance threshold set at a P value of less than .05.

RESULTS: This study aimed to evaluate the impact of an e-learning module on knowledge and behaviors related to endocrine disruptors. Our findings show significant improvements across all measured domains. Of 148 eligible residents, 78 (52.7%) completed both assessments over a 17-day period. Overall satisfaction was high (mean 4.0/5, SD 0.9), with positive ratings for the e-learning format (mean 4.1/5, SD 1.0) and module duration (mean 4.2/5, SD 1.0). Knowledge improved significantly, with a mean 55.56 (SD 13.54) increase in correct identification of EDCs across all substances (P<.001). Self-reported behaviors improved by an average of 2.13 points (95% CI 1.71-2.56) on the 5-point scale (P<.001), exceeding those reported in previous PCEH modules. Secondary outcomes showed high posttraining identification of at-risk populations and exposure locations, although recognition of some substances (eg, alkylphenols and phenoxyethanol) remained low.

CONCLUSIONS: This innovative e-learning module significantly improved residents’ knowledge and preventive behaviors related to EDCs. These findings support the integration of environmental health training into medical curricula and highlight the potential of scalable e-learning interventions to strengthen preventive competencies in primary care.

PMID:42207575 | DOI:10.2196/89880

Clin Exp Rheumatol. 2026 May 28. doi: 10.55563/clinexprheumatol/g80tlj. Online ahead of print.

ABSTRACT

OBJECTIVES: To estimate the epidemiology of Behçet’s syndrome (BS) in Sardinia using a combined administrative and clinical data latent class analysis (LCA).

METHODS: Cases with a diagnosis of BS were retrieved from 2006-2016 in the Hospital Discharge Records (HDRs), 2006-2016 Rare Diseases Regional Register (RDRR), and 2014-2016 in the Specialist Outpatient Database (SOD). Medical records from regional rheumatology clinics were reviewed and classified by the International Criteria for Behçet’s Disease (ICBD) and International Study Group (ISG) criteria. Statistical analysis involved cross-referencing databases and applying LCA to estimate the probability of a BS diagnosis. Prevalence and incidence of BS in Sardinia were calculated, as well as the sensitivity and specificity of each database source.

RESULTS: Administrative databases analysis retrieved 271 unique cases. A medical record review of 133 patients identified 116 BS cases, of which 107 matched administrative records and 9 were new. After excluding two deaths, 280 cases were considered for analysis (164 administrative-only, 107 mixed, 9 clinical-only). Using ICBD, the LCA confirmed 193 (68.9%) as BS cases (68.3% female, mean age 47). This yielded a 2016 Sardinian BS prevalence of 11.7 per 100,000 inhabitants (15.7) for women and 7.6 for men), with annual incidence rates ranging from 0.24 to 0.48 per 100,000 inhabitants (2014-2016). Prevalence and incidence were lower using the ISG criteria. Database sensitivity varies from 40.6% to 70.5%, while specificity ranges from 16.3% to 99.0%.

CONCLUSIONS: BS in Sardinia is a rare disease. Relying on a single data source to estimate.

PMID:42207566 | DOI:10.55563/clinexprheumatol/g80tlj

Clin Exp Rheumatol. 2026 May 21. doi: 10.55563/clinexprheumatol/mf8noj. Online ahead of print.

ABSTRACT

OBJECTIVES: Rheumatoid arthritis (RA) is a complex autoimmune disease with a strong genetic component. The STAT4 rs7574865 (G>T) variant has been associated with RA in various populations, but data from North Africa remain limited. This study aimed to investigate the association of rs7574865 with RA susceptibility in Moroccan patients.

METHODS: A case-control study was conducted including 87 Moroccan patients with severe RA and 69 healthy controls. Genotyping of rs7574865 was performed using TaqMan assays. Serum levels of anti-CCP2 and IgM-RF were measured by ELISA. Associations between genotypes, alleles, demographic, clinical, and serological features were analysed.

RESULTS: The GT genotype was more frequent in patients than in controls, and the T allele showed higher prevalence in the RA group. A significant genotypic association with RA risk was observed, while the TT genotype was absent in both groups. No associations were detected with demographic or general clinical characteristics. However, a significant clinical association was observed with anti-CCP2 status. The GT genotype also showed a noticeable trend in RF-positive and anti-CCP2-negative patients compared with controls, though differences between serological subgroups within patients were not statistically significant.

CONCLUSIONS: These findings provide the first evidence from Morocco that the STAT4 rs7574865 variant may contribute to RA susceptibility. While its effect appears moderate, the study highlights the importance of including North African populations in genetic studies of RA.

PMID:42207556 | DOI:10.55563/clinexprheumatol/mf8noj

JAMA Otolaryngol Head Neck Surg. 2026 May 28. doi: 10.1001/jamaoto.2026.1050. Online ahead of print.

ABSTRACT

IMPORTANCE: Age-related hearing loss is a major modifiable risk factor for dementia, yet the neural mechanisms linking auditory dysfunction to brain aging and cognitive decline remain unclear. In particular, it is unknown whether peripheral hearing loss, central auditory processing deficits, or hearing aid use best predict neurodegenerative change in older adults.

OBJECTIVE: To determine whether hearing thresholds, speech-in-noise ability, and hearing aid use are associated with longitudinal cortical atrophy and cognitive trajectories in cognitively normal older adults.

DESIGN, SETTING, AND PARTICIPANTS: This population-based, longitudinal cohort study with baseline and 3-year follow-up assessments was conducted among community-dwelling older adults in Australia. Participants were selected from the Aspirin in Reducing Events in the Elderly trial and categorized as having normal hearing, unaided hearing loss, or using hearing aids based on audiometry and self-reported hearing aid use. Structural magnetic resonance imaging, auditory, and cognitive data were collected between 2012 and 2017. Data were analyzed from August to October 2025.

EXPOSURES: Peripheral hearing loss assessed using better-ear 4-frequency average thresholds, central auditory processing assessed using binaural speech-in-noise performance, and hearing aid use and duration of use.

MAIN OUTCOMES AND MEASURES: Longitudinal change in cortical thickness and regional brain volumes derived from T1-weighted magnetic resonance imaging, focusing on auditory and Alzheimer disease-vulnerable regions. Global cognition was assessed using the Modified Mini-Mental State Examination.

RESULTS: A total of 312 adults (mean [SD] age, 73.5 [3.3] years; 167 [54%] female) without dementia at baseline were included. At baseline, hearing loss groups showed poorer audiometric and speech-in-noise performance but did not differ in global cognition. Over 3 years, widespread age-related cortical atrophy was observed, and poorer baseline speech-in-noise performance was associated with faster cortical thinning in inferior parietal (β = -0.002; 95% CI, -0.003 to 0.001), precuneus (β = -0.001; 95% CI, -0.002 to 0.000), middle temporal cortex (β = -0.001; 95% CI, -0.002 to -0.001), and superior temporal sulcus regions (β = -0.001; 95% CI, -0.002 to 0.000), independent of hearing thresholds and hearing aid use. There was not a statistically significant association between hearing loss/hearing aid use and longitudinal neurostructural change or cognitive decline.

CONCLUSIONS AND RELEVANCE: In this cohort study of cognitively normal older adults, central auditory processing impairment, not peripheral hearing loss or hearing aid use, was associated with accelerated cortical thinning in speech-processing networks. Speech-in-noise performance may represent an early behavioral marker of neural vulnerability preceding measurable cognitive decline.

PMID:42207546 | DOI:10.1001/jamaoto.2026.1050

JAMA Netw Open. 2026 May 1;9(5):e2615020. doi: 10.1001/jamanetworkopen.2026.15020.

ABSTRACT

IMPORTANCE: The after visit summary (AVS) is believed to be a critical mechanism for postvisit communication, and health systems are widely adopting digital AVS systems to comply with federal regulations. However, little is known regarding the physician time cost of writing the AVS and whether patients routinely engage with the digital AVS.

OBJECTIVE: To assess patterns of patient digital AVS engagement following ambulatory care visits and the associated physician time cost.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study analyzed ambulatory care visits that occurred between June 1, 2018, and May 31, 2023, at a large, urban, academic health care system with multiple hospitals and outpatient clinics. All ambulatory visits by adults between the study period that were captured in the institutional electronic health record system were included. Data were analyzed in May 2025.

MAIN OUTCOMES AND MEASURES: The primary outcome was engagement with the digital AVS through the patient portal following an ambulatory visit. Secondary measures included patient demographic factors, visit variables (including clinic specialty [primary care, urgent care, medical specialties, surgical specialties] and visit type [video, nonvideo]), and physician-specific behaviors (including time spent writing patient instructions, using composition tools, and physically printing the AVS).

RESULTS: A total of 6 262 623 ambulatory care visits were analyzed. Most visits were made by female patients (3 890 100 [62.1%]), and 51.0% of all patients were aged 55 years or older. Digital AVS engagement increased from 20.8% in 2018 to 37.6% in 2023. Physicians spent a median (IQR) duration of 1.38 (0.52-3.28) minutes per visit writing patient instructions, despite the AVS not being viewed in 62.4% of encounters. AVS composition varied by physician specialty, with surgeons using a greater percentage of templated text (63.6% of AVS text) and medical specialists entering more text manually (50.7% of AVS text). Patient engagement varied by demographic factors, with higher engagement among married vs single patients (AME, 6.6 [95% CI, 6.1-7.1] percentage points) and retired vs employed patients (AME, 5.1 [95% CI, 4.5-5.6] percentage points). Lower engagement with the digital AVS was found among males vs females (AME, -3.1 [95% CI, -3.7 to -2.5] percentage points), non-English speakers vs English speakers (AME, -15.0 [95% CI, -15.9 to -14.2] percentage points), and those with Medicare (AME, -3.3 [95% CI, -4.2 to -2.5] percentage points) or public insurance (AME, -3.6 [95% CI, -4.4 to -2.9] percentage points) compared with private insurance. Physician behavior was also associated with digital AVS engagement, with presence vs nonpresence of physician-written patient instructions associated with higher engagement (40.5% vs 34.3%) and printed vs nonprinted AVS associated with lower engagement (31.6% vs 38.8%). Compared with primary care, medical and surgical specialties were associated with lower digital AVS engagement (medical: AME, -4.3 [95% CI, -5.3 to -3.2] percentage points; surgical: AME, -2.9 [95% CI, -4.1 to -1.7] percentage points), while urgent care showed no significant difference (AME, -0.6 [95% CI, -2.2 to +1.0] percentage points).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of ambulatory visits, digital AVS engagement increased but remained low and was associated with a high time investment for physicians. This inefficiency in postvisit communication emphasizes the need to reconsider such communication, particularly with unmarried males, non-English-speaking populations, and publicly insured populations, and in specialty care settings.

PMID:42207516 | DOI:10.1001/jamanetworkopen.2026.15020