Tag: statistics

BMC Gastroenterol. 2026 Apr 27. doi: 10.1186/s12876-026-04831-4. Online ahead of print.

ABSTRACT

Liver transplantation remains the definitive therapy for end-stage liver disease, yet Early Allograft Dysfunction (EAD) continues to challenge post-transplant outcomes. Several models have been developed to predict graft dysfunction and survival, including Olthoff’s static definition, and three kinetic prediction scores: the Model for Early Allograft Function (MEAF), the Liver Graft Assessment Following Transplantation score (L-GrAFT), and the more recent Early Allograft Failure Simplified Estimation (EASE). While these scores have been validated in Western populations, data from Eastern Europe are limited. This retrospective study aimed to externally validate and compare these recipient-centred prediction models for EAD, Early Allograft Failure (EAF), and patient/graft survival in the Romanian national transplant program.Between January 2019 and May 2025, 281 adult recipients of donation-after-brain-death grafts at Fundeni Clinical Institute met inclusion criteria. EAD (Olthoff’s definition) occurred in 79 patients (28.1%), while EAF (re-transplantation or death by POD 90) occurred in 27 patients (9.6%). The median recipient age was 52 years, with viral hepatitis representing the predominant aetiology. At 12 months, overall survival reached 86%. By Olthoff’s criteria, survival was lower in EAD vs. non-EAD, though differences were not statistically significant. Risk stratification using L-GrAFT10 and EASE identified significant survival differences across patient groups, whereas MEAF stratification failed to reach significance. Among the models, EASE demonstrated the strongest predictive accuracy for both patient and graft survival at 3 and 6 months, outperforming Olthoff’s classification. L-GrAFT10 showed the strongest association with mortality across strata, while MEAF provided robust prediction of EAD comparable to L-GrAFT10, with the advantage of relative computational simplicity.Findings confirm that established scores perform reliably within this Eastern European cohort, suggesting that regional differences in disease epidemiology do not diminish their predictive value. MEAF offered practical utility for early postoperative assessment of EAD, while EASE appeared to be the most accurate model for survival stratification. Broader multicentre studies – such as the ongoing global IMPROVEMENT study – remain necessary to optimize kinetic prediction models and guide clinical decision-making in liver transplantation.

PMID:42036635 | DOI:10.1186/s12876-026-04831-4

Eur J Dent Educ. 2026 Apr 26. doi: 10.1111/eje.70169. Online ahead of print.

ABSTRACT

PURPOSE: Effective communication and empathy are core competencies in patient-centred dental care. However, structured training in these skills is often limited in dental curricula. This study explored the association between a structured communication and body language course and dental students awareness of nonverbal communication, empathy-related attitudes, and patient-centred perspectives.

METHODS: A cross-sectional study was conducted among 390 final-year dental students at Ankara University Faculty of Dentistry. Group 1 (n = 195) had not received formal communication training, whereas Group 2 (n = 195) had completed a 39 h structured course including theoretical and practical components. Data were collected using a structured questionnaire covering sociodemographic characteristics, communication awareness, nonverbal communication practices, and empathy-related attitudes. Group differences were analysed using chi-square tests for categorical variables and independent samples t-tests for composite scores, with a p < 0.05 considered statistically significant.

RESULTS: Students who received training reported significantly higher awareness of the role of body language (p = 0.035), greater support for its inclusion in the curriculum (p = 0.037), and increased attention to instructors’ nonverbal cues (p = 0.0028). They also reported more frequent use of positive nonverbal behaviours, such as maintaining eye contact (97.4% vs. 92.0%, p = 0.042), using gestures and facial expressions (93.8% vs. 84.3%, p = 0.028), and adjusting tone of voice (90.8% vs. 80.1%, p = 0.014). Empathy-related attitudes were significantly stronger in the trained group, including better recognition of patients’ emotions (88.3% vs. 76.5%, p = 0.015), greater comfort in showing empathy (85.3% vs. 70.8%, p = 0.007), and a stronger belief that empathy can be taught (88.5% vs. 74.1%, p = 0.008). The overall mean scores for communication awareness, nonverbal communication, and empathy-related attitudes were all significantly higher in the trained group (p < 0.05).

CONCLUSIONS: Structured communication and body language training significantly enhance dental students awareness and use of nonverbal communication and strengthen empathy-related attitudes. Integrating experiential communication training into dental education may support the development of more empathetic, patient-centred clinical practice.

PMID:42036634 | DOI:10.1111/eje.70169

Acta Anaesthesiol Scand. 2026 Jul;70(6):e70235. doi: 10.1111/aas.70235.

ABSTRACT

BACKGROUND: Air pollution, especially particle pollution, is increasingly recognized as a potential perioperative risk factor, yet modeling environmental exposures in surgical cohorts remains methodologically underdeveloped. We demonstrate a Bayesian hierarchical framework to quantify probabilistic associations between preoperative fine particulate matter (PM_2.5) exposure and postoperative complications, highlighting its interpretability and flexibility for clinical environmental epidemiology.

METHODS: We conducted a single center, retrospective cohort study using data from 49,615 surgical patients in Utah who underwent elective surgical procedures from 2016 to 2018. Patients’ addresses were geocoded and linked to daily Census-tract level PM_2.5 estimates. The exposure variable was defined as the maximum PM_2.5 concentrations in the 7 days prior to surgery. The binary outcome was a composite of postoperative complications: pneumonia, surgical site infection, urinary tract infection, sepsis, stroke, myocardial infarction, or thromboembolic event. A hierarchical Bayesians regression model with weakly informative priors was used adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities with census tract as a group (random) effect. We present posterior estimates with credible intervals, highlight model transparency and sensitivity, and discuss contrasts with standard frequentist methods.

RESULTS: Postoperative complications were associated in a dose-dependent manner with higher concentrations of PM_2.5 exposure. We found a relative increase of 8.2% in the odds of complications (OR = 1.082) for every 10.ug/m³ increase in the highest single-day 24-h PM_2.5 exposure during the 7 days prior to surgery. For an increase in PM_2.5 from 1 to 30 ug/m³, the odds of complication rose to over 27% (95% CI: 4%-55%). The results were robust across prior choices and model specifications. We report full posterior distributions and highlight advantages of Bayesian modeling for uncertainty quantification and clinical interpretability.

CONCLUSIONS: This case study demonstrates the application of hierarchical Bayesian modeling to quantify the probabilistic associations between preoperative PM_2.5 exposure and postoperative complications, highlighting transparent risk estimation and uncertainty characterization that may inform the design of future multicenter perioperative environmental studies.

EDITORIAL COMMENT: Using Bayesian statistical analysis, the authors demonstrate a dose-dependent risk for postoperative complications in patients exposed to air polluted with fine particulate matter with a size of less than 2.5 μm.

PMID:42036603 | DOI:10.1111/aas.70235

Adv Exp Med Biol. 2026;1502:3-13. doi: 10.1007/978-981-95-6872-7_1.

ABSTRACT

The diagnostic frameworks for major depression in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and DSM-5 revision process (DSM-5-TR) have been largely defined by the significant transition from a categorical approach to a hybrid concept incorporating dimensional concepts. The main updates in the DSM-5 diagnostic framework of major depression are the addition of hopelessness as a descriptor for depressed mood, the removal of the bereavement exclusion, and the introduction of specifiers, including “with anxious distress,” “with mixed features,” and “peripartum onset.” The DSM-5-TR has newly added the depression-related diagnostic entities, including unspecified mood disorder, persistent grief disorder, suicidal behavior, nonsuicidal self-injury, and hikikomori. However, the symptom-based operation criteria for major depression remain challenging, including high clinical heterogeneity, high comorbidity, transdiagnostic nature of overlapping symptoms, and lack of integration with neurobiological markers. To overcome these limitations, the etiology-based classifications with integrating biomarkers and the digital phenotyping with ecological momentary assessments have been suggested as diagnostic practices in the level of research. The neuroinflammatory biomarkers and brain imaging have been regarded as a promising tool, but their issues regarding reproducibility and cost remain challenging in clinical applications. In addition, the digital tools with big data, wearable devices, and natural language processing may enhance the diagnostic precision, despite their issues of ethics and standardizations. Future diagnostic frameworks can be discussed in terms of personalized and biologically informed approaches in response to address the complexities of clinical practice. Integrating innovative methods with symptom-based diagnostic systems may contribute to more accurate and effective diagnostic classifications of major depression.

PMID:42036558 | DOI:10.1007/978-981-95-6872-7_1

Arch Orthop Trauma Surg. 2026 Apr 26;146(1):162. doi: 10.1007/s00402-026-06327-y.

ABSTRACT

INTRODUCTION: Revision total hip arthroplasty (THA) for acetabular bone loss is challenging. The modified Kerboull-type (KT) plate has been adopted; nonetheless, mid- to long-term clinical outcomes remain poorly understood. We evaluated survival rates and radiographic outcomes of acetabular reconstruction using the KT plate and investigated risk factors for plate breakage or re-revision.

MATERIALS AND METHODS: We retrospectively included 120 patients (130 hips) who underwent acetabular reconstruction using the KT plate (1997-2024) and evaluated perioperative outcomes, Harris Hip Score (HHS), survival rates, and key radiographic parameters.

RESULTS: Mean age at surgery and follow-up duration were 69.0 ± 10.4 years and 107.4 ± 71.7 months, respectively. Mean blood loss and operative time were 630.2 mL and 284.3 min, respectively. HHS improved from 56.2 to 86.4. Fractures (5.3%) and dislocations (3.0%) were observed. Ten-year survival rates were 95.6% for re-revision and 93.0% for plate breakage. Failure and head migration occurred in 11 (8.5%) and 6 (4.6%) hips, respectively. Multivariate analysis identified younger age, use of morselized bone chips alone, and postoperative head migration as independent predictors of failure. In revision THA cases with ≥ 5-year follow-up and Paprosky classification type 3 A or 3B defects, age, Knight classification, and head migration differed significantly between hips with and without failure. Hips with plate breakage requiring re-revision showed greater horizontal head migration than those managed nonoperatively.

CONCLUSIONS: KT plate-based acetabular reconstruction achieved excellent mid- to long-term outcomes, with a 10-year survival rate exceeding 95% and significant functional improvement. Younger age, bone chip grafting alone, and femoral head migration were associated with failure. Even when plate breakage occurred, re-revision was avoided if bulk bone grafts provided sufficient mechanical support and head migration remained minimal. Surgical outcomes were better in the later period than in the early period due to improved learning, surgical techniques, and grafting strategies.

PMID:42036554 | DOI:10.1007/s00402-026-06327-y

Plant Reprod. 2026 Apr 27;39(2):3. doi: 10.1007/s00497-026-00536-6.

ABSTRACT

Heteranthery is widespread among angiosperms and is classically linked to nectarless flowers that offer pollen as a reward, where the division of labour in the androecium helps to decrease the consumption of viable pollen grains. However, heteranthery also occurs in lineages with non-pollen-rewarding flowers. This is the case of some neotropical species of Malpighiaceae, which depend on oil-collecting bees for pollination, and offer floral oils. This study analyzes the androecium of Mamedea pulchella to assess the presence of division of labour and whether such specialization functions primarily in pollinator attraction rather than pollen economy. Anther traits from flowers of different populations were measured and analyzed statistically, complemented by anatomical and histochemical studies. Fertile stamens show significantly bigger anther area while sterile stamens bear antherodes with a significantly larger glandular connective. Occasional abortive anthers in usually fertile stamens and fertile anthers in usually sterile stamens were observed. Histochemical reactions indicate that connective glands secrete mainly terpenes. Differences between anthers and antherodes are consistent across populations, suggesting that heteranthery is a stable condition in M. pulchella, with a clear division of labour: anthers of large stamens supply pollen for fertilization whereas antherodes of smaller stamens act as osmophores, emitting scents that attract and guide oil-collecting bees to the elaiophores. This case highlights a potential alternative role for heteranthery in oil-rewarding flowers, where stamen specialization may contribute to pollinator attraction rather than solely mitigating the “pollen dilemma”, suggesting that heteranthery can evolve through multiple functional pathways in pollination systems.

PMID:42036546 | DOI:10.1007/s00497-026-00536-6

Ther Innov Regul Sci. 2026 Apr 27. doi: 10.1007/s43441-026-00973-5. Online ahead of print.

ABSTRACT

BACKGROUND: Sub-Saharan Africa carries 25.0% of the global disease burden but hosts only 2.0% of clinical trials worldwide. A key measure to address this challenge is shortening review timelines and enhancing the capacity of protocol reviewers in regulatory authorities. This study, triggered by the Tanzania medicines and medical devices authority and stakeholders, aimed to assess the competency of assessors in reviewing clinical trial applications and to conduct an intervention involving didactic and hands-on training.

METHODS: A descriptive cross-sectional study was conducted from February 2021 to June 2021 using an online survey targeting 128 participants from medicines regulatory authorities, regional ethical committees, institutional review boards, and research institutions. A 70-hour (7 credit) course was developed and implemented in 30 clinical trial assessors.

RESULTS: The survey had a 70.3% response rate, with 58.9% male participants. Over half of the participants held a master’s degree. The study revealed that 94.0% needed training in clinical assessment, 92.2% in quality assessment, and 92.6% in statistical assessment for clinical trial protocols. Following pre- and post-training evaluation, one sample t-test indicated a statistically significant difference in the mean scores, 18.96, CI (13.15-24.76), indicating an improvement in the knowledge of the participants.

CONCLUSION: The study identified significant gaps in the competency of clinical trial applications assessors and ethical reviewers in Tanzania according to the African vaccine regulatory forum guidelines for review of clinical trial protocols. The targeted training improved the capacity of 30 assessors, yet further targeted and stratified capacity-building trainings are recommended to enhance regulatory capacity.

PMID:42036537 | DOI:10.1007/s43441-026-00973-5

Bull Math Biol. 2026 Apr 27;88(5):83. doi: 10.1007/s11538-026-01640-4.

ABSTRACT

We address the problem of localizing the source of infection in an undirected, tree-structured network under a susceptible-infected outbreak model. The infection propagates with independent random time increments (i.e., edge-delays) between neighboring nodes, while only the infection times of a subset of nodes can be observed. We show that a reduced set of observers may be sufficient, in the statistical sense, to localize the source and characterize its identifiability via the joint Laplace transform of the observers’ infection times. Using the explicit form of these transforms in terms of the edge-delay probability distributions, we propose scale-invariant estimators of the source. We evaluate their performance on synthetic trees and on a river network, demonstrating accurate localization under diverse edge-delay models.

PMID:42036518 | DOI:10.1007/s11538-026-01640-4

Eur J Pediatr. 2026 Apr 27;185(5):303. doi: 10.1007/s00431-026-06964-w.

ABSTRACT

Finnish guidelines recommend antimicrobial treatment for acute otitis media (AOM), with both amoxicillin and amoxicillin-clavulanate as equally acceptable first-line treatment options. This study aimed to investigate in what proportion different antimicrobial agents are prescribed for children with AOM. Our hypothesis was that amoxicillin is the most frequently prescribed antimicrobial agent. This register-based cohort study included all children less than 16 years of age with a diagnosis of AOM in two Finnish hospitals in 2023. Data on children’s demographics, AOM symptoms, findings and treatment were collected individually from the patient charts. The primary outcome was the proportion of children who were prescribed amoxicillin, amoxicillin-clavulanate, or other antimicrobial agents for the treatment of AOM. The antimicrobial treatment choices and durations were compared between Turku and Vaasa and reported as percentage differences with 95% confidence intervals. A total of 1,240 children in Turku and 393 children in Vaasa were included in this study. Among these, 80.9% (1,003/1,240) and 80.7% (317/393) were prescribed amoxicillin for the treatment of AOM in Turku and Vaasa, respectively. Amoxicillin-clavulanate was the second most used antimicrobial treatment, prescribed to 10.1% (125/1,240) and 8.7% (34/393) of the children in Turku and Vaasa, respectively. Most of the children with AOM were prescribed a short 5-day course of treatment.

CONCLUSION: A short 5-day course of amoxicillin was the most frequently prescribed antimicrobial treatment for children with AOM. The adherence to AOM guidelines appears to be high in the two hospitals studied.

WHAT IS KNOWN: • Amoxicillin and amoxicillin-clavulanate are recommended as first-line treatments for acute otitis media in Finland. • National data on real-world antibiotic choices have been limited.

WHAT IS NEW: • Amoxicillin was the most frequently prescribed antibiotic in the two Finnish hospitals studied. • The most common treatment duration was a short 5-day course of treatment.

PMID:42036512 | DOI:10.1007/s00431-026-06964-w

Pediatr Nephrol. 2026 Apr 27. doi: 10.1007/s00467-026-07290-x. Online ahead of print.

ABSTRACT

BACKGROUND: Few studies have compared the long-term survival of children by their first modality of kidney replacement therapy (KRT). This study aimed to compare the mortality outcomes of children starting dialysis as their first KRT modality to those who received a pre-emptive kidney transplant (PKT).

METHODS: Historical cohort analyses of UK children starting KRT between 1997-2020 were undertaken, using data from the UK Renal Registry linked to Hospital Episodes Statistics. Crude and multivariable Cox proportional hazards regression analyses were performed to compare mortality amongst children with complete records who received (i) haemodialysis (HD) and (ii) peritoneal dialysis (PD) for ≥ 3 months with those receiving PKT, stratified by the time-period of KRT initiation. Mortality estimates were adjusted for sociodemographic, time-period, primary kidney disease and comorbidity-related covariates.

RESULTS: 242 deaths were recorded amongst 2440 children included in complete-case analyses. Adjusted mortality amongst children was highest (HR 3.70, 95% CI: 1.41-9.74), when compared to PKT) for those starting HD in 1997-2008. Evidence for a difference in mortality amongst children receiving HD (compared to PKT) was weak in later time-periods (2009-14, 2015-20). Mortality did not differ amongst children receiving PD first compared to those who had been pre-emptively transplanted.

CONCLUSIONS: Whilst adjusted mortality was highest for children starting HD at KRT onset in the earliest time-period, there were no differences in long-term survival amongst those starting dialysis (HD or PD) to those pre-emptively transplanted in more recent years.

PMID:42036508 | DOI:10.1007/s00467-026-07290-x