Tag: statistics

J Urban Health. 2026 Jul 31. doi: 10.1007/s11524-026-01117-8. Online ahead of print.

ABSTRACT

Extreme heat events increasingly threaten public health, particularly in rapidly urbanizing areas like Maricopa County, Arizona. This study addresses gaps in identifying communities most vulnerable to extreme heat and heat waves by creating a Heat Vulnerability Index (HVI) that integrates often-overlooked populations. Utilizing US census data, satellite imagery, chronic illness prevalence rates, and unhoused population data, this HVI assesses vulnerability across census tracts in Maricopa County’s diverse urban-rural landscape. Principal components analysis identified nine factors influencing heat vulnerability: (1) socioeconomic disadvantage; (2) isolation; (3) elderly populations; (4) chronic illness; (5) environmental risks; (6) African American race and language barriers, (7) Native American and unemployment status; (8) lack of housing and male; and (9) mobile home residents. Model validation found that heat-related mortality rate increased with heat vulnerability. Despite statistical limitations from data resolution and timeframe, this study integrates unhoused data into vulnerability assessments, emphasizing the need for equitable approaches that include underserved communities to address extreme heat vulnerability.

PMID:42536312 | DOI:10.1007/s11524-026-01117-8

Updates Surg. 2026 Jul 31. doi: 10.1007/s13304-026-02781-w. Online ahead of print.

ABSTRACT

Bethesda IV thyroid nodules remain a major diagnostic challenge because cytology cannot reliably distinguish benign from malignant follicular-patterned lesions, often leading to diagnostic surgery for ultimately benign disease. This study evaluated whether ultrasound radiomics combined with machine learning could improve preoperative risk stratification in this setting. We conducted a retrospective monocentric study including 69 surgically treated patients with Bethesda IV thyroid nodules and definitive histopathology. Ultrasound images acquired between 2019 and 2020 were manually segmented, and radiomic features were extracted using LIFEx software. After preprocessing and removal of non-informative features, the dataset was split into training (n = 48) and a held-out test set (n = 21), isolated prior to any modelling procedure. Dimensionality reduction was performed with principal component analysis analysis (20 components, 99.5% explained variance). Three supervised machine-learning models were developed and compared: K-nearest neighbors (KNN), Random Forest (RF), and Extreme Gradient Boosting (XGBoost). Internal validation was performed by leave-one-out cross-validation on the training set, with StandardScaler and PCA fitted inside each fold. Final performance was assessed once on the held-out test set. All metrics are reported with 95% confidence intervals. Model performance was assessed using cross-validation and leave-one-out cross-validation, with evaluation of accuracy, F1-score, sensitivity, specificity, and ROC-AUC. Final histology showed malignancy in 39/69 nodules (56.5%). On the held-out test set, RF (n = 50 estimators, depth = 10) achieved the best overall performance: AUC 0.735 (95% CI 0.513-0.956), sensitivity 0.714 (95% CI 0.454-0.883), specificity 0.571 (95% CI 0.250-0.842), and accuracy 0.667 (95% CI 0.454-0.828). KNN (k = 3) achieved AUC 0.602 (95% CI 0.359-0.845). XGBoost did not generalise to the test set (AUC 0.378, 95% CI 0.094-0.661). Leave-one-out cross-validation estimates were modest across all models (AUC range 0.397-0.588), with confidence intervals overlapping 0.50, reflecting the limited statistical power of the training set at n = 48. Ultrasound radiomics combined with Random Forest shows preliminary discriminative ability for distinguishing benign from malignant Bethesda IV thyroid nodules. The wide confidence intervals observed highlight the need for a larger prospective validation cohort. These findings establish a methodological framework and provide sample size benchmarks for a powered confirmatory study.

PMID:42536308 | DOI:10.1007/s13304-026-02781-w

Updates Surg. 2026 Jul 31. doi: 10.1007/s13304-026-02785-6. Online ahead of print.

ABSTRACT

A catecholamine-induced hypertensive crisis in patients with pheochromocytoma has recently been defined as systolic/diastolic blood pressure ≥ 180/120 mmHg. However, the consequences of observing blood pressure values above these thresholds during laparoscopic adrenalectomy have never been evaluated. The aim of this study was to identify factors associated with intraoperative catecholamine-induced hypertensive crisis (main objective) and postoperative cardiovascular complications (secondary objective). A multi-institutional retrospective cohort study from 01/01/2000 to 12/31/2016 was performed in eight university hospitals to identify independent factors associated with catecholamine-induced hypertensive crisis while adjusting for the clustering of patients within hospitals (generalized linear mixed model for hierarchical analysis). Logistic regression analysis was used to analyze postoperative cardiovascular complications on day 30. A total of 1056 patients underwent adrenalectomy for pheochromocytoma, of whom 894 were included in the final analysis. During adrenalectomy, 122 patients (13.6%) presented with at least one episode of a catecholamine-induced hypertensive crisis. Cardiovascular complications were observed in 32 patients (3.6%) on the 30th postoperative day. Tumor diameter (OR 1.011, 95%CI 1.001-1.021; p = 0.035) and any biological profile with high adrenaline (OR 1.602, 95%CI 1.051-2.441; p = 0.028) were significantly associated with the occurrence of intraoperative catecholamine-induced hypertensive crisis. The occurrence of intraoperative catecholamine-induced hypertensive crisis (OR 2.4, 95%CI 1.603-3.707; p = 0.033) remained significantly associated with cardiovascular complications at 30 days postoperatively. Catecholamine-induced hypertensive crisis is a relevant criterion for evaluation during laparoscopic adrenalectomy for pheochromocytoma because it is associated with an increased incidence of postoperative cardiovascular complications.

PMID:42536306 | DOI:10.1007/s13304-026-02785-6

Front Oncol. 2026 Jul 16;16:1779553. doi: 10.3389/fonc.2026.1779553. eCollection 2026.

ABSTRACT

AIM: This study investigates the link between proliferation markers (PCNA, p16, Ki-67) and histopathological factors, exploring their prognostic value in breast cancer patients.

MATERIALS AND METHODS: We analyzed female breast cancer patients who underwent surgery. Data collected included demographics, clinical parameters (hemogram, Ca 15.3, menopause status, etc.), family cancer history, pathology, treatments (neoadjuvant, surgical, oncological), tumor staging, lymph node status, receptor status (ER, PR, cerb-b2), and survival. Paraffin blocks were retrospectively analyzed for PCNA, p16, and Ki-67 expression via immunohistochemical staining.

RESULTS: PCNA scores showed no association with demographic or clinical features, though a statistically significant inter-marker correlation with p16 was found (both markers increased together). P16 scores were not linked to other parameters aside from Ki-67 (also demonstrating positive correlation). Higher Ki-67 index was associated with decreased ER and PR expression and, importantly, decreased survival. Although a significant correlation was observed between PCNA and p16 expression levels, neither marker demonstrated independent prognostic significance with respect to overall survival.

CONCLUSIONS: Although PCNA and p16 expression levels were inter-correlated, neither marker showed an independent association with clinicopathological variables or overall survival in our cohort. In contrast, the Ki-67 index was significantly associated with hormone receptor status, pathological stage, and shorter overall survival, and remains the most informative proliferation marker for prognostic stratification in breast cancer. Further prospective studies with standardized scoring and multivariate analysis are warranted to clarify the prognostic value of PCNA and p16.

PMID:42534781 | PMC:PMC13422137 | DOI:10.3389/fonc.2026.1779553

Front Psychol. 2026 Jul 16;17:1901610. doi: 10.3389/fpsyg.2026.1901610. eCollection 2026.

ABSTRACT

Teacher caring is a crucial relational resource for student development in higher education, yet the process by which it connects to students’ perceived course-related learning gains remains underexplored. Drawing on caring theory, social cognitive theory, learning engagement theory, and a supportive relationship perspective, this study tested a sequential mediation model. This model posits that teacher caring is associated with perceived course-related learning gains through academic self-efficacy and learning engagement. A cross-sectional, anonymous online questionnaire survey was administered to Chinese undergraduate students. Out of 632 returned questionnaires, 562 valid responses remained after data cleaning, resulting in a valid response rate of 88.9%. The results showed that teacher caring was positively associated with academic self-efficacy, learning engagement, and perceived course-related learning gains. The CFA measurement model demonstrated a good fit, and composite score path analyses using standardized scores supported the proposed model. Bootstrap mediation tests indicated that both academic self-efficacy and learning engagement partially mediated the association between teacher caring and perceived course-related learning gains, and they also formed a significant sequential indirect path. These results remained stable even after controlling for gender, year of study, major category, region, and university identifier. The findings suggest that teacher caring should be understood not merely as emotional warmth or general support, but as a relational resource linked to students’ confidence in learning and active engagement in coursework. Because the study relied on cross-sectional self-report data, the results should be interpreted as statistical associations consistent with the proposed relational-motivational pathway rather than as evidence of causal ordering.

PMID:42534778 | PMC:PMC13422389 | DOI:10.3389/fpsyg.2026.1901610

Air Qual Atmos Health. 2026;19(8):168. doi: 10.1007/s11869-026-02060-y. Epub 2026 Jul 29.

ABSTRACT

Particulate Matter (PM_2.5) exposure contributes to the global disease burden, yet its monitoring remains sparse and uneven, with limited ground sensor infrastructure. Road-traffic proxy indicators can provide indirect estimates of PM_2.5 where measurements are limited but require context-specific validation. We evaluated three PM_2.5 road-traffic-related proxies: (i) population-Weighted Road Network Density (wRND), (ii) Euclidean (straight line) distance from highways (EH), and (iii) Euclidean distance from main roads (EM). We validated these proxies using high-resolution outdoor filtered PM_2.5 personal exposure measurements collected over 1 year from 343 postpartum participants in The Gambia, Kenya, and Mozambique. Proxy-PM_2.5 associations were assessed using Spearman correlation, and predictive utility was tested using country-specific and global Random Forest (RF) models (3-fold cross-validation), reporting R², RMSE, and feature importance. Spatial mapping showed heterogeneous proxy-PM_2.5 relationships across and within sites, with elevated PM_2.5 occurring in both low- and high-proxy contexts. wRND-PM_2.5 correlations were weak overall and statistically significant only in Mozambique (r = 0.351; p = 0.005), with non-significant associations in Kenya (r = – 0.041; p = 0.673) and The Gambia (r = – 0.020; p = 0.909). EH-PM_2.5 correlations were positive in The Gambia (r = 0.335; p = 0.053) and Mozambique (r = 0.292; p = 0.020) but negative and significant in Kenya (r = – 0.224; p = 0.018). Single-variable RF models performed poorly across all countries (R² < 0.45) and the Global model (R² = 0.42). Combining proxies improved performance in Kenya (R² = 0.52; RMSE = 31.7 µg/m³) and Mozambique (R² = 0.60; RMSE = 8.9 µg/m³), Global R² = 0.46; RMSE = 29.1 µg/m³), although in The Gambia, the combined model (R² = 0.53; RMSE = 37.6 µg/m³) did not exceed the best single-proxy model. Road-network proxies provided limited but context-dependent signals of personal PM₂.₅ exposure. Their performance varied substantially across countries, indicating that road-based indicators should not be used as stand-alone exposure measures in heterogeneous sub-Saharan African settings. Instead, they are most defensible as locally validated components of hybrid exposure models that also incorporate meteorology, land use, biomass burning, household energy, and other non-traffic sources.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11869-026-02060-y.

PMID:42534776 | PMC:PMC13421249 | DOI:10.1007/s11869-026-02060-y

Front Allergy. 2026 Jul 16;7:1911930. doi: 10.3389/falgy.2026.1911930. eCollection 2026.

ABSTRACT

INTRODUCTION: Chronic rhinosinusitis (CRS) is a prevalent inflammatory disease of the upper airways, frequently characterized by recurrence and impaired quality of life. Persistent inflammation and bacterial biofilms contribute to disease chronicity. Topical plant-derived therapies may offer a preventive strategy in long-term CRS management. This study evaluated the effectiveness of a Pistacia lentiscus-based nasal medical device in reducing the impact of CRS recurrence on patients’ daily life.

METHODS: In this retrospective, observational, single- center case-control study, 100 adult patients with chronic rhinosinusitis (CRS) and recurrent disease were identified and included from clinical records. Patients were stratified according to prior exposure to nasal drops containing ultra-fractionated Pistacia lentiscus oil in addition to isotonic saline nasal irrigation, or to isotonic saline nasal irrigation alone, according to routine clinical practice. All patients had undergone a 12-month follow-up regimen with assessments available at baseline, 30 days, and 12 months. The primary outcome was symptom severity measured using the Sino-Nasal Outcome Test (SNOT-22). Secondary outcomes included nasal cytology parameters, biofilm presence, nasal discharge, bacterial elements, supranuclear stria, and ciliary motility.

RESULTS: Of the 100 identified subjects, 92 were included in the final analysis due to loss to follow-up. In the exposed group, SNOT-22 scores showed a 40.6% reduction after the first month, compared with a 7.8% reduction observed in the control group (p < 0.001). Only patients exposed to Pistacia lentiscus oil demonstrated statistically significant reductions over time in nasal discharge (p < 0.005), biofilm presence (p < 0.005), and bacterial elements (p < 0.05), while no significant changes were observed in the control group for these parameters. Ciliary motility remained unchanged in both groups across the study period.

DISCUSSION: Overall, within the limits of this retrospective case-control design, patients exposed to Pistacia lentiscus oil in addition to standard saline irrigation showed greater improvement in patient-reported symptoms and selected cytological markers compared with patients treated with saline irrigation alone.

PMID:42534765 | PMC:PMC13422398 | DOI:10.3389/falgy.2026.1911930

Health Equity. 2026 Jun 8;10:24731242261455433. doi: 10.1177/24731242261455433. eCollection 2026 Jan-Dec.

ABSTRACT

INTRODUCTION: Disparities in medical education are documented across the training continuum, yet little is known about how racial and socioeconomic factors shape disciplinary actions during residency.

METHODS: We conducted a cross-sectional anonymous survey of resident physicians affiliated with the Committee of Interns and Residents. The survey captured demographic characteristics and experiences with negative feedback, remediation, and discipline. We used descriptive statistics and logistic regression.

RESULTS: We analyzed 1,755 validated responses (9.2% completion). Compared with White participants, Black participants had higher odds of being asked to meet with program leadership (unadjusted odds ratio [OR] = 1.93, 95% confidence interval [CI]: 1.32-2.82), and this association strengthened after adjustment for gender, specialty type, and early-life socioeconomic indicators (adjusted OR [AOR] = 2.24, 95% CI: 1.48-3.38). Black participants were nearly three times as likely to report ever being on remediation (OR = 2.93, 95% CI: 1.51-5.72), although adjusted models were limited by small event counts. When disciplinary outcomes were combined, Black participants were 55% more likely than White participants to experience any disciplinary action in unadjusted analyses (OR = 1.55, 95% CI: 1.10-2.19), and this association strengthened after adjustment (AOR = 1.76, 95% CI: 1.21-2.57). Hispanic and Asian participants did not demonstrate higher odds of disciplinary action compared with White participants.

CONCLUSION: Racial and socioeconomic inequities in residency discipline challenge assumptions that discipline reflects merit alone. Programs should implement transparent, uniform disciplinary processes and create supportive training environments for all trainees.

PMID:42534758 | PMC:PMC13421930 | DOI:10.1177/24731242261455433

Cureus. 2026 Jun 30;18(6):e111807. doi: 10.7759/cureus.111807. eCollection 2026 Jun.

ABSTRACT

Objective The gingival sulcus and biological width are key anatomical structures involved in maintaining periodontal health and guiding prosthodontic treatment planning. Although their clinical importance has been well established, data describing these parameters in Moroccan populations remain limited. This study aimed to evaluate the mean gingival sulcus depth and biological width among young Moroccan adults and to provide baseline descriptive data for future periodontal assessment and treatment planning. Methods A descriptive cross-sectional study was conducted involving 133 dental students (72 males and 61 females), aged 21 to 23 years, at the Dental Consultation and Treatment Center (CCTD) of Ibn Rochd University Hospital, affiliated with the Faculty of Dental Medicine of Casablanca (FMDC), Casablanca, Morocco. Each participant underwent standardized clinical and radiographic examinations of one anterior and one posterior tooth. Sulcus depth was measured using a calibrated periodontal probe, while biological width was assessed using periapical radiographs. A single calibrated examiner performed all measurements following a standardized protocol. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA), and mean values were compared using Student’s t-test. Results The mean sulcus depth was 1.11 mm for anterior teeth and 2.17 mm for posterior teeth, with a statistically significant difference (p < 0.0001). The mean biological width was 2.05 mm, consistent with classical reference values reported in the literature. No statistically significant sex-related differences were observed for either parameter. Sulcus depth was significantly greater in posterior teeth than in anterior teeth (p < 0.0001), and biological width differed significantly between anterior and posterior sites (p = 0.003). Conclusions The findings are consistent with previously reported values in the literature and confirm the relative stability of biological width in healthy periodontal tissues. These findings provide descriptive anatomical data that may contribute to biologically informed prosthodontic treatment planning. Further studies incorporating additional periodontal parameters and more diverse populations are recommended to improve external validity.

PMID:42534746 | PMC:PMC13422043 | DOI:10.7759/cureus.111807

Front Psychiatry. 2026 Jul 16;17:1851981. doi: 10.3389/fpsyt.2026.1851981. eCollection 2026.

ABSTRACT

OBJECTIVE: To explore the chain mediating effects of resilience and self-efficacy on the association between social support and quality of life (QoL) among patients with severe stroke.

METHODS: This cross-sectional study enrolled 272 inpatients between June 2023 and June 2025. Validated instruments were used to assess social support (SSRS), resilience (CD-RISC), self-efficacy (GSES), and quality of life (QoL) (SS-QOL). PROCESS Model 6 with 5,000 bias-corrected bootstrap samples was used to test sequential mediation while adjusting for key covariates.

RESULTS: Mean scores indicated moderate levels of social support, resilience, self-efficacy, and QoL. Quality of life scores were significantly higher among patients aged <60 years compared to those aged ≥60 years (54.62 ± 14.07 vs. 49.34 ± 13.12), among patients with higher education levels (college or above: 54.73 ± 14.27 vs. primary school or below: 47.26 ± 11.38), among patients covered by Employee Health Insurance compared to self-funded patients (53.26 ± 13.42 vs. 42.36 ± 11.25), and among patients with lower NIHSS scores (10-14 points: 56.38 ± 13.45 vs. 15-24 points: 46.44 ± 12.41). All comparisons were statistically significant at P < 0.05. All main variables were positively correlated. The direct association between social support and QoL was significant (adjusted unstandardized β = 0.88, 95% CI [0.790, 0.975]), accounting for 53.5% of the total association. The three indirect associations were: (1) SSRS – CD-RISC – SS-QOL: β = 0.255, 95% CI [0.192, 0.329]; (2) SSRS – GSES – SS-QOL: β = 0.126, 95% CI [0.020, 0.208]; and (3) SSRS – CD-RISC – GSES – SS-QOL: β = 0.385, 95% CI [0.289, 0.510],supporting the hypothesized chain mediation model.

CONCLUSION: Social support was strongly associated with QoL, both directly and indirectly through resilience and self-efficacy and their sequential pathways. These findings highlight potential intervention targets, although causal inferences are limited by the study’s cross-sectional design. Strengthening social support and related psychological resources may improve rehabilitation outcomes in patients with severe strokes.

PMID:42534726 | PMC:PMC13421905 | DOI:10.3389/fpsyt.2026.1851981