Tag: statistics

J Public Health Dent. 2026 Aug 12. doi: 10.1111/jphd.70074. Online ahead of print.

ABSTRACT

PURPOSE: The Canadian Dental Care Plan aims to reduce affordability barriers to oral health care for low- and middle-income families, including children. The selection of covered services is critical to ensure that both immediate needs and long-term oral health outcomes are adequately addressed. This study identified services considered essential for children by pediatric dentists and compared them with those included in the CDCP.

METHODS: A cross-sectional survey was electronically distributed by the Canadian Association of Pediatric Dentists/Académie Canadienne de Dentisterie Pédiatrique to certified and retired pediatric dentists in Canada (n = 297). The survey collected demographic, practice, and perspectives on essential services. Data were analyzed using descriptive statistics.

RESULTS: The response rate was 35% (n = 104; 78 complete). Most respondents were women, and aged 30-39 years (33%). Participants emphasized the equal importance of primary and permanent teeth and supported comprehensive care. While perspectives generally aligned with CDCP service grids, key gaps were identified in preventive services, including oral hygiene instruction, nutritional counseling, mouth guards, space maintainers, smoking cessation counseling, and primary tooth root canals.

CONCLUSIONS: Although the CDCP aligns with many professional priorities, omissions in preventive services limit its comprehensiveness. An upstream approach could support more sustainable oral health care for children and reduce long-term burdens.

PMID:42586950 | DOI:10.1111/jphd.70074

BMJ Paediatr Open. 2026 Aug 12;10(1):e005044. doi: 10.1136/bmjpo-2026-005044.

ABSTRACT

BACKGROUND: Early-onset sepsis (EOS) is a leading cause of neonatal morbidity and mortality and contributes substantially to empirical antibiotic use in neonatal intensive care units (NICUs). In low-resource settings, limited diagnostic capacity often results in overtreatment, increasing unnecessary antibiotic exposure and its associated risks. Evidence on context-adapted EOS risk assessment pathways in sub-Saharan Africa remains scarce.

OBJECTIVE: To evaluate the impact of implementing an adapted EOS risk assessment pathway on antibiotic use and clinical outcomes among neonates admitted to NICUs in Northwest Ethiopia.

METHOD: A prospective multicentre quasi experimental pre-post-implementation study was conducted in three tertiary NICUs in Northwest Ethiopia from January to April 2026. A total of 412 neonates aged ≤72 hours and born at ≥34 weeks’ gestation with suspected EOS were included (pre-implementation, n=208; post-implementation, n=204). An adapted EOS risk assessment and antimicrobial stewardship pathway was implemented during the post-implementation phase. Differences between groups were assessed using χ², Fisher’s exact, independent t or Mann-Whitney U tests, as appropriate. Logistic regression and Cox regression were used to evaluate empirical antibiotic use and 28-day mortality, respectively. Statistical significance was declared at p<0.05.

RESULTS: Maternal and neonatal characteristics were similar between study phases. Empirical antibiotics intuition decreased from 80.8% to 55.4% (risk ratio (RR)=0.69, 95% CI 0.60 to 0.80; p<0001), prolonged antibiotics treatment (>5 days) decreased from 40.8% to 18.1% (RR=0.44, 95% CI 0.31 to 0.62; p=0.004), antibiotic discontinuation within 48 hours increased from 8.2% to 15.7% (RR=1.90, 95% CI 1.1=3.34; p=0.02). Complete blood count, C-reactive protein and blood culture testing also decreased (all p<0.001), and mean NICU safety was shorter after implementation (8.9±2.9 vs 8.1±2.5 days; p=0.002). In multivariable analysis, implementation of the EOS pathway was associated with lower odds of empirical antibiotic use (adjusted OR 0.29, 95% CI 0.19 to 0.46). No significant adverse clinical outcomes difference between study phases. 28-day mortality did not differ between groups (15.9% vs. 17.2%; p=0.7).

CONCLUSIONS: Implementation of an adapted EOS risk assessments and stewardship pathway significantly reduced unnecessary antibiotic exposure and laboratory testing without observed increase in adverse clinical outcomes. These findings support the use of structured EOS risk assessment to improve antibiotic stewardship in NICU in resource-limiting settings.

PMID:42586946 | DOI:10.1136/bmjpo-2026-005044

Mol Biol Evol. 2026 Aug 13:msag195. doi: 10.1093/molbev/msag195. Online ahead of print.

ABSTRACT

We investigate the predictability of evolution in terms of the phylogenetic placement of new lineages. This leads us to develop a class of coalescent models that relax neutrality by allowing the rate of coalescence to vary as a continuous heritable trait. In this setting, each lineage has a relative propensity to coalesce, with coalescent odds ratios defined from the product of pairwise propensities. Estimated coalescent odds provide a statistic that captures variation in lineage growth and are informative about the strength of natural selection acting on individual lineages. A number of practical statistical methods are then developed: techniques to adjust for biased and non-uniform sampling; procedures to automatically calibrate hyperparameters governing the evolution of coalescent propensity; and, methods for clustering phylogenies into sets that delineate clades according to coalescent propensity. Simulations show sensitivity of these methods to detecting small selective effects acting on rare variants, and strong robustness to imbalanced sampling. We demonstrate these methods using two datasets reflecting microbial populations evolving under strong selection. First, we examine a large set of Neisseria gonorrhoeae genomes, and show that lineages with high coalescent odds feature a unique antibiotic resistance pattern which presaged its subsequent expansion. We then re-analyse SARS-CoV-2 data in combination with independent estimates of reproduction numbers corresponding to major variants of concern 2020-2023. This indicates that coalescent odds can function as an excellent tree-based proxy for relative fitness of major SARS-CoV-2 lineages.

PMID:42586937 | DOI:10.1093/molbev/msag195

Jpn J Nurs Sci. 2026 Oct;23(4):e70070. doi: 10.1111/jjns.70070.

ABSTRACT

AIM: This study aimed to investigate these aspects in female community-dwelling cancer survivors.

METHODS: This secondary analysis of a community-based cancer survey was conducted in Tokyo, Japan. Emotional well-being (EWB) and functional well-being (FWB) were measured using two subdomains of the Functional Assessment of Cancer Therapy-General. The sample comprised 163 survivors of breast and gynecological cancers. We used descriptive statistics and multivariate regression analyses to explore the association between the challenges and EWB and FWB.

RESULTS: All participants were women, of whom 118 and 45 were breast and gynecological cancer survivors, respectively. The most frequent challenges experienced but not addressed (referred to as “unaddressed challenges”) were “anxieties about progression and prognosis”, followed by “balancing hobbies and treatments”, and “depressed mood”. Although initial analyses suggested that the presence of challenges related to “depressed mood” and “balancing hobbies and treatments” was associated with lower EWB, these associations did not maintain statistical significance after adjusting for multiple testing. Conversely, excluding challenges related to “fertility preservation,” all unaddressed challenges related to diagnosis and medical treatment and finances remained robustly associated with lower scores in EWB and FWB. Among unaddressed challenges related to balancing daily life and treatment, “balancing housework and treatment” and “balancing hobbies and treatments” remained associated with lower scores in EWB and FWB.

CONCLUSIONS: Female community-dwelling survivors of breast and gynecological cancers face various unaddressed challenges that diminish EWB and FWB. Early identification and targeted public health interventions are required to address survivors’ daily life challenges and improve well-being.

PMID:42586935 | DOI:10.1111/jjns.70070

J Obstet Gynaecol Res. 2026 Aug;52(8):e70445. doi: 10.1111/jog.70445.

ABSTRACT

BACKGROUND: Induction of labor is increasingly used across diverse obstetric indications, yet uncertainty persists regarding its impact on neonatal outcomes compared with expectant management across gestational ages. This scoping review aimed to map the scope, characteristics, and findings of randomized controlled trial (RCT) evidence comparing induction of labor with expectant management in singleton pregnancies, with particular emphasis on neonatal outcomes.

METHODS: PubMed, Scopus, and Web of Science were searched in March 2025. Eligible studies were parallel-group RCTs comparing induction of labor with expectant management involving at least 24 h of planned delay in singleton pregnancies. Trials addressing any gestational age or clinical indication were included. Findings were synthesized descriptively by clinical indication.

RESULTS: Fifty RCTs published between 1987 and 2023 were included. Indications comprised post-term pregnancy, prelabor rupture of membranes, hypertensive disorders, suspected macrosomia, elective induction at term, and preterm medical conditions. Neonatal outcomes were heterogeneously reported, most commonly NICU admission and perinatal mortality. Across indications, trials generally showed similar or improved neonatal outcomes with induction compared with expectant management in term and post-term settings, alongside comparable or reduced cesarean delivery rates. In hypertensive and preterm conditions, neonatal outcomes varied by gestational age, with higher NICU admissions reflecting prematurity.

CONCLUSIONS: This scoping review maps RCT evidence suggesting that induction is not associated with worse neonatal outcomes across most indications. Effects are context-specific and gestational age-dependent, with important trade-offs in preterm settings. Substantial heterogeneity and evidence gaps highlight the need for standardized outcomes and further research.

PMID:42586930 | DOI:10.1111/jog.70445

Trends Cogn Sci. 2026 Aug 13:S1364-6613(26)00161-0. doi: 10.1016/j.tics.2026.07.003. Online ahead of print.

ABSTRACT

Understanding human decision-making processes in everyday life is a central, yet rarely addressed, challenge in psychology. Either real-life complexity is reduced by isolating specific aspects of decision-making in highly constrained experimental settings, yielding insights into specific cognitive mechanisms under idealized conditions, or decision-making is studied in real-life contexts, using high-level descriptions of behavior that do not afford fine-grained, process-level insights. Bridging this gap poses a challenge of both measurement and inference. Recent advances in high-resolution tracking technologies provide novel solutions to many measurement challenges but are rarely integrated with formal psychological theory. In this article, we review tracking technologies and statistical tools, proposing a cognitive-computational framework that uses high-resolution spatiotemporal data to investigate the mechanisms of real-life decision-making in a theory-driven manner.

PMID:42586903 | DOI:10.1016/j.tics.2026.07.003

Clin Lymphoma Myeloma Leuk. 2026 Jul 18:S2152-2650(26)00214-4. doi: 10.1016/j.clml.2026.07.009. Online ahead of print.

ABSTRACT

BACKGROUND: Chimeric antigen receptor (CAR) T-cell therapies offer substantial survival benefits for relapsed and/or refractory multiple myeloma (RRMM). However, access remains limited across the US. We examined geographic variation in MM burden and key drivers of CAR T access disparities to inform targeted strategies to close these gaps.

PATIENTS AND METHODS: Patients with MM and CAR T recipients from January 2021-August 2024 were identified from the Komodo Patient-Level Analytics and Insights Derivative claims database. MM prevalence at the ZIP-3 level came from the US Cancer Statistics database. Drive-times to the nearest authorized treatment center (ATC) for patients with MM and to ATCs for CAR T recipients were calculated and compared nationally and by region.

RESULTS: There were 106,593 prevalent patients over the study period. The South had the second highest MM burden (66.1/100,000 people) but the lowest proportion of patients within 1 hour of an ATC (55.7%). CAR T recipients in the South also traveled the longest to their ATC (median, 1.5 hours). Multivariable analysis with socio-economic and demographic covariates indicated that ≥ 2 hour potential drive-time to nearest ATC versus < 1 hour (adjusted odds ratio [or] = 0.43; 95% confidence interval (CI), 0.27-0.69), household income < $50k versus ≥ $100k (or = 0.19; 95% CI, 0.05-0.69), and residence in nonmetropolitan areas versus metropolitan (or = 0.41; 95% CI, 0.28-0.60) were significantly associated with reduced odds of CAR T use.

CONCLUSIONS: There were substantial geographic and socioeconomic disparities in CAR T access, with long drive‑times, lower household income, and non‑metro residence limiting uptake and underscoring the need for targeted ATC expansion.

PMID:42586901 | DOI:10.1016/j.clml.2026.07.009

Appl Nurs Res. 2026 Jul 30:152133. doi: 10.1016/j.apnr.2026.152133. Online ahead of print.

ABSTRACT

BACKGROUND: AI-driven virtual standardized patients (VSPs) integrated within virtual reality (VR) environments offer structured opportunities for safe communication practice in nursing education; however, empirical evidence regarding their preliminary feasibility and educational effects remains limited, particularly in domain-specific clinical contexts such as preoperative nursing care.

METHODS: This mixed-methods pilot study pursued two objectives: (1) to develop a VR simulation integrating an AI-driven VSP (AI-VSP) for preoperative nursing communication, and (2) to pilot-test its preliminary feasibility and exploratory pre-post effects. Ten third-year nursing students completed a single 50-minute preoperative care simulation using the VIRTI platform (Meta Quest 3). Quantitative data on satisfaction, self-confidence, simulation design perceptions, and immersion were collected using four validated instruments and analysed using paired-samples t-tests with effect sizes and 95% confidence intervals. Qualitative data were collected via semi-structured interviews and analysed using inductive thematic analysis.

RESULTS: All four outcome variables showed statistically significant pre-post differences (all p ≤ .004), with large effect sizes (Cohen’s d = 1.10-1.75). Qualitative themes indicated realistic conversational learning experiences and perceived clinical relevance, while identifying technical limitations in nonverbal feedback and scenario-level construct alignment as areas for refinement.

CONCLUSION: These preliminary findings suggest that AI-VSP-based VR simulation may offer a feasible and structured pre-clinical learning environment for preoperative nursing communication competency development. Future work should prioritise multimodal feedback enhancement and controlled comparative designs to evaluate educational effectiveness more rigorously.

PMID:42586890 | DOI:10.1016/j.apnr.2026.152133

Clin Ther. 2026 Aug 12:S0149-2918(26)00265-1. doi: 10.1016/j.clinthera.2026.07.004. Online ahead of print.

ABSTRACT

PURPOSE: Clopidogrel is a cornerstone of antiplatelet therapy after lower-limb endovascular intervention in patients with peripheral arterial disease (PAD), yet interindividual variability in treatment response may influence clinical outcomes. To our knowledge, this is the first systematic review and meta-analysis to combine an updated quantitative synthesis of functional clopidogrel resistance with a dedicated qualitative appraisal of CYP2C19 genetic determinants, while explicitly separating analyses based on raw event data from exploratory analyses using published effect estimates and applying conservative small-sample sensitivity methods. We evaluated the association between functional clopidogrel resistance and clinically relevant limb outcomes-target lesion/target vessel revascularization (TLR/TVR) and major adverse limb events (MALE)-with all-cause mortality as a secondary exploratory outcome.

METHODS: The review was conducted according to PRISMA 2020 and registered in PROSPERO (CRD42026129845). MEDLINE (PubMed), EMBASE, Web of Science, and Google Scholar were searched from inception to May 17, 2026. Functional resistance was defined as high on-treatment platelet reactivity (HTPR) assessed by platelet function testing, and genetic determinants as CYP2C19 loss-of-function alleles or metabolizer status associated with impaired clopidogrel response. Random-effects meta-analyses using restricted maximum likelihood (REML) were performed, with Hartung-Knapp-Sidik-Jonkman (HKSJ) sensitivity analyses and prediction intervals to quantify statistical uncertainty in sparse data. Genetic studies were synthesized qualitatively.

FINDINGS: Ten studies met the inclusion criteria; 6 functional studies contributed to the quantitative analyses. In the primary analysis based on 3 studies with raw event data, HTPR was associated with an approximately 3.7-fold increase in TLR/TVR risk (odd ratios [OR] 3.68; 95% confidence interval [CI] 1.56-8.68; P = 0.003; I² = 59%). An exploratory analysis of 5 studies with published effect estimates was directionally consistent (OR 4.46; 95% CI 1.09-18.31; I² = 87%). HKSJ sensitivity analyses preserved the direction of effect but produced substantially wider confidence intervals crossing the null, indicating increased statistical uncertainty. HTPR was not significantly associated with all-cause mortality (OR 1.49; 95% CI 0.92-2.42).

IMPLICATIONS: Functional clopidogrel resistance may be associated with an approximately 3- to 4-fold higher risk of repeat revascularization after lower-limb endovascular intervention; however, the small number of studies, substantial heterogeneity, and conservative sensitivity analyses warrant cautious interpretation. Larger prospective studies and randomized trials are needed before platelet-function-guided or genotype-guided antiplatelet strategies can be recommended.

PROSPERO REGISTRATION: CRD42026129845.

PMID:42586868 | DOI:10.1016/j.clinthera.2026.07.004

Nurs Crit Care. 2026 Sep;31(5):e70637. doi: 10.1111/nicc.70637.

ABSTRACT

BACKGROUND: Continuous renal replacement therapy (CRRT) is the preferred renal replacement therapy for critically ill patients with acute kidney injury; however, unplanned treatment discontinuation remains a major challenge that compromises treatment efficacy and patient outcomes.

AIMS: To investigate the risk factors and temporal trends associated with unplanned CRRT discontinuation using descriptive time-series analysis and to identify evidence-based nursing interventions.

STUDY DESIGN: This retrospective cohort study was conducted at a tertiary hospital in China between January and December 2025. Univariate analysis and binary logistic regression were used to identify factors independently associated with unplanned discontinuation. Descriptive time-series analysis with 7-day moving average smoothing was applied to evaluate temporal patterns throughout the study period.

RESULTS: Unplanned discontinuation occurred in 77 of 3128 CRRT sessions (2.46%). After adjustment, anticoagulation regimen, treatment duration (p < 0.001) and net ultrafiltration rate (p = 0.032) were identified as independent predictors of unplanned discontinuation. Compared with no anticoagulation, nafamostat mesylate was associated with lower odds of unplanned CRRT discontinuation (p = 0.013), whereas sodium citrate was associated with higher odds (p = 0.004), likely reflecting centre-specific implementation factors related to low citrate utilization. Descriptive time-series analysis showed temporal fluctuations in unplanned discontinuation rates, with an apparent peak in November. Elevated circuit pressure was the leading cause of unplanned discontinuation.

CONCLUSIONS: Unplanned CRRT discontinuation was associated with anticoagulation regimen, treatment duration and ultrafiltration rate. Standardized anticoagulation protocols, staff training, safe ultrafiltration practices and enhanced circuit pressure surveillance may reduce unplanned discontinuation and improve patient outcomes.

RELEVANCE TO CLINICAL PRACTICE: These findings provide nurses with evidence-based strategies, including locally informed monitoring protocols, standardized anticoagulation checklists and circuit pressure early warning indicators, to reduce unplanned CRRT discontinuation.

PMID:42586802 | DOI:10.1111/nicc.70637