Search Results (157)

Modeling bivariate count data with complex dispersion and dependence structures remains a significant challenge in statistical data analysis. This article introduces two new bivariate count distributions derived from the generalized shifted inverse trinomial distribution. The proposed models, denoted by BGIT-I and BGIT-II, are constructed using convolution and trivariate reduction methods. They provide flexible joint frameworks for modeling correlated count data while accommodating different marginal dispersion patterns. BGIT-I allows negative, near-zero, and positive dependence, whereas BGIT-II induces non-negative dependence through a common component. The proposed models have simple, tractable probability generating functions, which facilitate the derivation of probabilistic properties and motivate a probability-generating-function-based estimation approach alongside maximum-likelihood estimation. The finite-sample performance of the estimators is further examined through a Monte Carlo simulation study. The practical utility of the proposed models is illustrated using two real bivariate count data sets involving shunter accidents and patient counts in critical care and emergency room settings. The results show that the proposed BGIT models provide competitive alternatives for modeling bivariate count data with different dispersion and dependence characteristics. Full article

Driven by the low-carbon transformation in the construction industry, Moso bamboo has emerged as a promising green material. However, a critical gap exists in current structural design theories: they predominantly rely on homogeneous assumptions, failing to capture the inherent spatial variability and coupled strength–stiffness degradation of bamboo. Experimental results reveal a distinct longitudinal gradient, where the top section (5–8 m) exhibits approximately 15% higher average tensile strength and 12% higher average elastic modulus compared to the bottom section (1–3 m). This oversight severely compromises the accuracy of structural reliability evaluations. To address this, this study pioneers a high-precision digital representation method by developing a novel three-dimensional (3D) anisotropic bivariate coupled random field model. Experimental and stochastic finite element simulations demonstrate that the model accurately replicates spatial variations, maintaining relative errors for primary statistical indicators strictly below 1% while robustly capturing the bivariate coupling characteristics. Crucially, by integrating non-parametric probability box (P-box) theory, the macroscopic tensile resistance of full-scale bamboo members is rigorously bounded within a definitive statistical interval. Furthermore, the extracted Interval Skewness Ratio generally remains greater than 1.0 (averaging 1.38), providing robust quantitative proof of an asymmetric structural degradation governed by the brittle weakest-link failure mechanism. By effectively eliminating non-physical sample generation associated with traditional univariate models, this research makes a significant contribution to the field, providing a rigorous digital twin framework and theoretical foundation for the advanced non-probabilistic safety design of modern bamboo structures. Full article

This study examines how venture capital investors in Kazakhstan evaluate women-led enterprises within a frontier-emerging market context characterized by institutional transition and evolving entrepreneurial ecosystems. Addressing a gap in the literature on gendered investment behavior beyond mature markets, the research adopts an exploratory mixed-methods design combining survey data (n = 21) with open-ended qualitative responses from VC professionals. Descriptive and bivariate analyses are used to examine associations between investor characteristics and evaluation criteria, while exploratory factor analysis is employed as a heuristic tool to assess whether survey items cluster around broadly interpretable evaluative orientations shaping investment judgments. The findings suggest the presence of two indicative evaluative orientations—market orientation and impact orientation—that appear to structure how respondents in this sample prioritize dimensions such as scalability, innovation, teamwork, and social value. These orientations are interpreted as context-specific and exploratory rather than statistically generalizable. The study contributes to entrepreneurial finance and institutional theory by developing an exploratory evaluative framework that captures the coexistence of commercial and developmental considerations in venture investment decision-making within a transitional economy. The findings further highlight how gendered investment dynamics are shaped by both market criteria and institutional environments, offering implications for policymakers, investors, and scholars seeking to understand capital allocation processes in underexplored venture ecosystems. Full article

Background/Objectives: Improving the prevention and management of pressure injuries requires adequate nursing knowledge. In this context, understanding the current knowledge levels of nurses is important for informing educational and organizational strategies. This study aimed to assess the pressure injury knowledge of nurses at the national level and examine differences according to their educational, professional, and informational characteristics. Methods: A national cross-sectional quantitative study was conducted in public secondary-level hospitals in the Republic of Croatia. A total of 1139 participants from 19 hospitals across all four geographical regions of Croatia participated. The PZ-PUNKT instrument was used, and an analysis was conducted using descriptive and bivariate inferential statistics. Results: Participants with bachelor’s and master’s degrees achieved higher PZ-PUKT scores than those with secondary education (p = 0.026 to < 0.001), although the effect sizes were very small (ε² = 0.008–0.017). Significant differences were observed across clinical departments (p < 0.001; ε² = 0.03–0.04), whereas no statistically significant differences were found according to the frequency of working with patients with pressure injuries (p > 0.05). Participants who reported recently attending educational activities, consulting the professional literature, or searching for information achieved higher knowledge scores across all domains (p < 0.001); however, the effect sizes remained small (ε² = 0.034–0.060; rpb = 0.133–0.214). Conclusions: Although the observed effect sizes were generally small, higher knowledge scores were observed among nurses who reported recent engagement with educational activities, the professional literature, and information-seeking behaviors. No significant differences were identified according to the frequency of working with patients with pressure injuries. These findings provide a national overview of pressure injury knowledge among Croatian nurses and may inform future educational initiatives and research. Full article

Background: Sleep quality plays an essential role in cognitive performance, memory consolidation, learning efficiency, and overall wellbeing. University students are particularly vulnerable to sleep disturbances because of academic stress, irregular sleep schedules, and lifestyle-related factors. Poor sleep quality has been associated with impaired academic performance and reduced cognitive functioning. Objective: This study aimed to evaluate the relationship between sleep patterns, sleep quality, and academic performance among female university students. Methods: A cross-sectional study was conducted among 201 female university students at Qassim University, Saudi Arabia. Data were collected using an electronic self-administered questionnaire that included demographic characteristics, sleep-related behaviors, and the Pittsburgh Sleep Quality Index (PSQI). Academic performance was assessed using self-reported Grade Point Average (GPA). Statistical analysis included descriptive statistics, Spearman correlation analysis, one-way ANOVA with Tukey post hoc analysis, Chi-square tests, and multiple linear regression analysis. Results: The mean GPA of the participants was 4.13 ± 0.60 (on a 5-point scale), while the mean PSQI score was 8.81 ± 3.26, indicating generally poor sleep quality. A significant negative correlation was observed between PSQI score and GPA (rho = −0.200, p = 0.0047). Students with good sleep quality demonstrated significantly higher GPA scores compared with students with poor sleep quality (F(2,194) = 6.31, p = 0.0022). Significant associations were also identified between sleep quality and both bedtime (p = 0.0009) and sleep duration category (p = 0.0002). However, after adjustment for other variables, the independent effect of PSQI on GPA was attenuated and did not reach statistical significance (p = 0.138). This discrepancy between the significant bivariate correlation (rho = −0.200, p = 0.005) and the non-significant multivariate result represents the most important finding of this study, suggesting that sleep quality alone does not independently predict GPA when other academic and behavioral factors are considered. Conclusion: Poor sleep quality was highly prevalent among female university students and showed a significant bivariate association with lower academic performance, though this relationship was attenuated in the multivariate model. Promoting healthy sleep behaviors may support student wellbeing and academic functioning, cognitive wellbeing, quality of life, and the advancement of Sustainable Development Goal 3 (Good Health and Well-Being). Full article

Background/Objectives: Post-COVID-19 syndrome (PCS) is frequently accompanied by pain, which may coexist with alterations in multiple health domains. However, pain in PCS has rarely been explored from a multidimensional approach combining subjective and objective measures. Objective: To describe pain in subjects with PCS using pain intensity and the pressure pain threshold (PPT), and to examine the associations between these measures and descriptive characteristics as well as health status. Methods: A cross-sectional observational study was conducted in 45 previously hospitalised adults with PCS. Pain intensity was assessed using the visual analogue scale and PPT was assessed by algometry. Health status included fatigue, dyspnoea, anxiety, depression, quality of life, functionality, frailty, physical activity, muscle quality, muscle strength, physical performance, and functional capacity. Analyses were conducted using SPSS v30.0. Results: Participants showed moderate pain intensity and variability in PPT, with a significant inverse association between both measures. Bivariate analyses showed that higher pain intensity and lower PPT were associated with worse physical, psychological, and functional outcomes. In regression analyses, pain intensity was associated with sex, length of hospital stay, PPT, and quality of life; PPT was associated with sex, pain intensity, and grip strength. Model explanatory capacity varied, and some models were not statistically significant. Conclusions: Subjects with PCS exhibited moderate pain intensity and variability in pain sensitivity, with an association between subjective and objective pain measures. Pain measures were associated with multiple health domains at the bivariate level, while regression analyses identified a limited number of associations with variable explanatory capacity. These findings support comprehensive pain assessment in PCS. Full article

Background/Objectives: To analyse postoperative pain trajectories after anterior cruciate ligament (ACL) reconstruction using data from a digital rehabilitation system, and to determine (i) whether combined ligament injuries are perceived as more painful than isolated ACL tears, (ii) which patient characteristics are associated with clinically relevant pain (visual analogue scale [VAS] > 5), and (iii) whether higher early pain is associated with later discontinuation of digital monitoring. Methods: This retrospective cohort study used routine data recorded by a validated sensor-based home rehabilitation system in patients after ACL reconstruction. This approach has previously been used to analyse functional recovery trajectories. All patients with ACL-related indications who performed at least one postoperative test were included and classified into four groups: isolated ACL rupture, ACL + meniscus, ACL + collateral ligament, and ACL + collateral ligament + meniscus. Pain during exercises and tests was recorded on a 0–10 VAS. High pain was defined as VAS > 5. Group comparison between indication types, anthropometric and activity-related variables and the proportion of high-pain events were performed using chi-square tests. Early pain (first postoperative month) was analysed in relation to the presence of later tests (≥3 months) to explore associations with discontinuation of digital monitoring. Results: Combined ligament injuries showed a significantly higher proportion of high-pain events during rehabilitation compared with isolated ACL ruptures (5.8% vs. 2.4%, overall p < 0.001). In particular, combined ligament injuries with ACL + collateral ligament rupture were associated with a greater share of VAS > 5 ratings in the early rehabilitation phases. No relevant association was observed between sex or BMI category and the occurrence of high pain, while age group showed an overall association without a consistent directional pattern. Sport activity level showed a strong relationship with high pain (p < 0.001). Early pain demonstrated a small but statistically significant negative correlation with later test participation (r = −0.15, approximately 2% of variance, p = 0.0076); however, this association was attenuated and no longer statistically significant when analysed using mixed-effects models accounting for within-patient clustering, indicating that patients with higher early pain tended to discontinue digital monitoring. Conclusions: Digital routine data after ACL reconstruction suggest that (i) combined ACL–collateral ligament injuries are perceived as more painful than isolated ACL tears, (ii) high postoperative pain is more closely related to activity level and injury pattern than to sex or BMI, while age group shows an overall but non-directional association, and (iii) higher early pain shows a weak bivariate correlation with digital disengagement that was not confirmed in mixed-effects models. Pain is therefore an exploratory marker warranting further investigation, rather than a confirmed independent predictor of adherence in app-based rehabilitation. Full article

Helicobacter pylori (H. pylori) antimicrobial resistance is a key driver of eradication failure in children and adults. Recognizing factors associated with H. pylori antimicrobial resistance may help identify individuals at risk for treatment failure and tailor management. We conducted a retrospective cohort study of patients with H. pylori-positive gastric biopsy culture and available antimicrobial susceptibility data at a large pediatric tertiary care center between 2020 and 2025. Descriptive statistics and logistic regression models were used to assess associations among demographic characteristics, prior treatment history, and antimicrobial resistance. Of 174 patients (56.1% male, median 14 years), 50.3% were resistant to at least one antimicrobial. Resistance rates included metronidazole (28.3%), clarithromycin (18.5%), rifampin (12.7%), fluoroquinolones (11.6%), amoxicillin (4%), and tetracycline (0.6%). The multidrug resistance rate was 17.3%. Prior H. pylori treatment was the most consistent predictor of antimicrobial resistance on both bivariate and multivariable analyses. Race was independently associated with metronidazole resistance, with Black patients exhibiting the highest rates and significantly greater odds compared to White patients. Hispanic ethnicity was also independently associated with increased odds of metronidazole resistance. Careful consideration of prior treatment history, race, and ethnicity is warranted when managing pediatric H. pylori infection, given their association with increased antimicrobial resistance. Full article

Background: Burn injuries remain a major health problem in low- and middle-income countries. Contemporary data from Jordan are scarce, and the last report from Jordan University Hospital (JUH) was published more than four decades ago. This study describes the epidemiology, characteristics, management, and outcomes of burn admissions to JUH during 2016–2020 and compares them with historical and regional data. Methods: We conducted a retrospective cohort study of all consecutive patients admitted to the JUH burn unit with acute burn injury between 1 January 2016 and 31 December 2020. Demographic and clinical variables were abstracted from electronic and paper records using a standardised case-report form. Descriptive statistics summarised injury patterns, while bivariate tests and multivariable linear regression were used to identify factors associated with hospital length of stay (LOS). Results: A total of 575 patients were included (50.3% male; median age 19 years). Children constituted 43.5% of admissions. Median TBSA was 7%, and partial-thickness burns predominated (73.9%). Scalds were the leading aetiology (60.7%), followed by flame burns (19.5%). Most injuries occurred at home (92.5%). The median LOS was 6 days, and 2.1% of patients died. Burn degree, aetiology, TBSA, surgical grafting, and adverse clinical events were independently associated with longer LOS, whereas escharectomy shortened hospitalisation. Conclusions: Domestic scald injuries in children remain the dominant burn pattern in Jordan, although mortality has fallen markedly compared with the 1980 JUH cohort. Prevention efforts should prioritise household safety and child supervision, while continued investment in specialised burn care is likely to further improve outcomes. Full article

Background: Stunting remains a major public health problem among ethnic minority children in mountainous areas of Vietnam. Picky eating has been suggested as a potential behavioral risk factor for poor child growth, but evidence from vulnerable rural populations remains limited. This study examined the association between picky eating and stunting among ethnic minority children aged 12–35 months in Vietnam. Methods: This cross-sectional study was conducted from October to November 2025 in two communes of Phu Tho province, formerly part of Lac Son District, Hoa Binh Province, Vietnam. A total of 341 children aged 12–35 months and their caregivers were included. Data were collected using structured interviewer-administered questionnaires on feeding practices and child characteristics. Picky eating was assessed based on caregiver-reported behaviors. Anthropometric measurements were performed according to standard procedures, and height-for-age Z-scores were calculated using the WHO Child Growth Standards. Zinc status was assessed in a subsample of children. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with stunting. Adjusted odds ratios (AORs) with 95% confidence intervals (95% CIs) were reported. Results: The prevalence of picky eating was 39.6%, while 24.9% of children were stunted. Zinc deficiency was identified in 41.9% of children with available blood samples. In multivariable analysis, picky eating was significantly associated with increased odds of stunting (AOR = 3.63; 95% CI: 1.71–7.70). Snacking before main meals was also independently associated with stunting (AOR = 1.81; 95% CI: 1.01–3.24). In contrast, zinc deficiency was associated with stunting in crude analysis but was not statistically significant after adjustment. Other factors, including child age, sex, caregiver identity, and timing of complementary feeding, were not independently associated with stunting. Conclusions: Picky eating was common and was independently associated with stunting among ethnic minority children in this mountainous setting. These findings suggest that behavioral feeding practices, particularly picky eating and pre-meal snacking, warrant attention in nutritional programs targeting this population; however, longitudinal studies are needed to confirm the direction of this relationship. Full article

Informal public transportation remains the backbone of urban mobility in many developing cities. While these systems offer flexible and affordable services, they are often associated with safety issues, unreliability, congestion, and environmental impacts. Consequently, transitioning travelers toward formal public transportation is a key objective for sustainable transport planning. This study investigates travelers’ willingness to shift from their current travel modes to a proposed Metro system in Alexandria, Egypt. The analysis uses stated preference data collected through interviews that presented respondents with multiple service scenarios. A correlated random parameters bivariate probit model with heterogeneity in means is estimated to capture interdependence between responses. The results reveal strong and statistically significant cross-equation error correlations, confirming that decisions are not independent and supporting the use of a joint modeling approach. Empirical results indicate that willingness to shift is influenced by socio-demographic characteristics, trip attributes, and current travel conditions. Female travelers are more sensitive to waiting time, while low-income and older individuals are less likely to shift across scenarios. Physical accessibility, especially walkability to and from stations, emerges as the most influential factor in encouraging adoption. These findings provide policymakers with actionable insights for designing inclusive, accessible, and sustainable public transportation systems. Full article

Background/Objectives: Thyroid cancer (TC) is among the most common endocrine malignancies, with incidence rates increasing worldwide. However, careful inferential analysis based on refined data is needed to provide a sharper clinical and epidemiological description of this serious condition in a biologically and technologically evolving society. This study presents an exploratory statistical analysis of data from 1470 patients who underwent thyroid surgery for differentiated TC. Methods: The analysis combines bivariate exploration of associations between variables with univariate and multivariate analyses stratified by histological subtype. We examined pathological characteristics (tumor location, nodal metastases, distant metastases, margin involvement, lymphovascular invasion, vascular invasion, and perineural invasion), clinical characteristics (clinical stage), biochemical markers (thyroglobulin, anti-thyroglobulin antibodies, and thyroid-stimulating hormone), and demographic variables (sex assigned at birth and age). In addition, exploratory multivariable models were used to investigate factors associated with lymph node metastasis and margin involvement in papillary microcarcinoma, the diffuse sclerosing variant, and the classical variant of papillary thyroid carcinoma. Results: Notably, moderate to high effect size correlations highlight the interdependence of invasive histopathological features in thyroid cancer and their collective link to adverse surgical outcomes and prognosis. Conclusions: This study provides an analysis of associations between the variables and subtype-specific descriptive estimates, serving as a foundation for future work in tailoring personalized medicine. Full article

Background and Objectives: Many patients present with urgent endodontic conditions characterized by pain and swelling, requiring prompt intervention. Failure to return for definitive root canal treatment (RCT) after urgent care can compromise tooth prognosis. This study examined the frequency and diagnostic patterns of urgent endodontic visits at a university dental college and evaluated predictors of follow-up after urgent treatment, considering demographic, anatomical, and clinical factors. Materials and Methods: A retrospective cohort analysis of 1619 patient records (August 2023–May 2025) was conducted. Data on urgency type, pulpal/periapical diagnosis, tooth characteristics, urgent treatment modality, and follow-up attendance were collected. Descriptive statistics and chi-square tests were used to assess bivariate associations. Multivariable logistic regression was performed to evaluate factors associated with completing follow-up after urgent care. Results: Approximately 50.2% of visits involved urgent endodontic care, most commonly symptomatic irreversible pulpitis (SIP) with symptomatic apical periodontitis (SAP), particularly in posterior teeth. Pulpectomy was the most frequently provided urgent treatment. Overall, 72.8% of urgent-care patients returned for completion of RCT (overall OR = 2.67). While urgency incidence and follow-up rates did not differ by gender, arch, or region, gender-stratified comparisons within urgent cases showed significant differences by arch and region. In multivariate analysis, mandibular teeth demonstrated higher odds of follow-up than maxillary teeth, whereas gender and region showed no association. Patients diagnosed with asymptomatic irreversible pulpitis (AIP)/SAP had lower odds of returning, and those treated with canal debridement with occlusal reduction (CD/OD) were also less likely to complete treatment. No other diagnostic or treatment categories showed significant associations. Conclusions: In this university-based cohort, urgent endodontic visits were common and primarily involved SIP/SAP. While the overall follow-up rate was high, certain diagnostic and treatment scenarios, specifically AIP/SAP and CD/OD, were associated with a reduced likelihood of returning for completion of RCT. Given the study’s limitations, these findings should be interpreted with caution. Full article

Background: Deep convolutional neural networks (DCNNs) are increasingly used in computer-aided dental diagnostics. However, the relative diagnostic performance of commonly applied architectures, particularly Faster R-CNN and Mask R-CNN, has not been systematically synthesized across imaging modalities. This systematic review and meta-analysis compared the diagnostic accuracy of Faster R-CNN and Mask R-CNN for dental caries detection using radiographic and photographic images. Methods: PubMed (MEDLINE), EMBASE, Web of Science, and Scopus were systematically searched for studies published up to 15 June 2025. Studies applying Faster R-CNN and/or Mask R-CNN to dental caries detection were included. Binary diagnostic data were extracted, and pooled sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) were estimated using a bivariate random-effects model. Study quality was assessed with QUADAS-AI, and radiomics-based radiographic studies were additionally evaluated using the Radiomics Quality Score (RQS). The protocol was registered in PROSPERO (CRD420251074443). Results: Seventeen studies met the inclusion criteria. Across all imaging modalities, Mask R-CNN showed significantly higher pooled sensitivity (85.6% vs. 71.7%, p = 0.0244), specificity (94.2% vs. 81.4%, p = 0.00089), and AUC (0.95 vs. 0.84, p = 0.0053) than Faster R-CNN. In radiographic images, Mask R-CNN consistently outperformed Faster R-CNN in sensitivity (86.3% vs. 67.2%, p = 0.0497), specificity (96.5% vs. 85.0%, p = 0.00105), and AUC (0.97 vs. 0.86, p = 0.0067). In photographic images, Mask R-CNN achieved a higher AUC (0.91 vs. 0.83, p = 0.048), whereas differences in pooled sensitivity (83.5% vs. 77.3%, p = 0.435) and specificity (86.0% vs. 75.1%, p = 0.156) were not statistically significant. Conclusions: Faster R-CNN and Mask R-CNN both show potential for dental caries detection, but current evidence is limited by substantial heterogeneity, predominantly retrospective designs, and variability in imaging and labeling. Across the included studies, Mask R-CNN showed higher pooled performance estimates than Faster R-CNN, with the clearest differences in radiographic applications; however, this comparison is indirect and should be considered suggestive rather than definitive given study-level heterogeneity and uncertainty in the reference standard in a sizable proportion of studies. Prospective, multi-center studies with standardized imaging protocols, rigorous annotation, and independent external validation are required to support reliable clinical implementation. Full article

Objectives: Cardiovascular diseases (CVD) remain a leading cause of premature mortality globally, despite the proven efficacy of physical activity in reducing risks. This research aims to identify risk characteristics and characterise pathologies related to the onset of CVD in relation to physical activity levels. The study tests the hypothesis that adequate physical activity is associated with CVD-related events, while sedentary behaviour is a factor related to increased risk factors. Methods: A cross-sectional, observational, descriptive, and analytical study was conducted with 116 participants of both sexes (aged 16 to 77 years) in El Espinal, Tolima. Clinical, anthropometric, and biochemical assessments were performed, including blood pressure, Body Mass Index (BMI), visceral fat, and lipid profiles. Physical activity was self-reported and categorised as weekly, monthly, and occasional exercise. Descriptive and bivariate statistical analyses were performed. Quantitative variables were expressed as means and standard deviations. Qualitative variables were presented as absolute frequencies. Statistical interaction graphs were used to analyse the effects of age and exercise frequency on pulse pressure. Results: Weekly exercise was identified as a key modulator of hemodynamic stability; while BMI and visceral fat increased with age, pulse pressure remained stable (44.17–46.55 mmHg). In contrast, occasional exercise was linked to high cardiovascular vulnerability, with pulse pressure spiking to a critical 75.00 mmHg in elderly participants (77 years) and BMI reaching obesity levels (38.15 kg/m²). Monthly exercise showed high variability and progressive lipid profile deterioration, with total cholesterol reaching 282.00 mg/dL in late maturity. Conclusions: Regular weekly physical activity acts as a physiological buffer that dissociates chronological ageing from vascular damage. While weekly exercise maintains optimal hemodynamic and metabolic ranges, occasional or inconsistent activity fails to prevent critical increases in pulse pressure and arterial stiffness during senescence. These findings underscore the necessity of regular, rather than sporadic, exercise as a vital “medicine” for maintaining arterial integrity across the lifespan. Full article