Category: Statistics

J Autoimmun. 2026 Apr 12;160:103560. doi: 10.1016/j.jaut.2026.103560. Online ahead of print.

ABSTRACT

PURPOSE: Neuropsychiatric systemic lupus erythematosus (NPSLE) is a serious manifestation of systemic lupus erythematosus (SLE), yet its neuroimaging diagnosis remains challenging. This study aims to explore the value of FW-corrected diffusion model parameters in characterizing white matter microstructural alterations in patients with NPSLE.

MATERIALS AND METHODS: This cross-sectional, case-control study enrolled patients with 33 inflammatory NPSLE patients, 24 ischemic NPSLE patients, and 33 SLE patients without neuropsychiatric manifestations (non-NPSLE) at the time of inclusion between September 2023 and March 2024. All participants underwent diffusion MRI. Tract-based spatial statistics (TBSS) were used to compare white matter differences among groups. Regions showing significant differences were used as regions of interest (ROI) to extract mean FW values. These imaging features were combined with clinical indicators (age, Montreal Cognitive Assessment (MoCA) scores, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) scores) to construct multiple machine learning classification models. Model performance was evaluated using internal and external validation.

RESULTS: TBSS analysis revealed that only the FW parameter showed significant differences between inflammatory NPSLE and non-NPSLE patients, specifically manifested as significantly elevated FW values in the bilateral hippocampal cingulum bundles. In internal validation, Linear Discriminant Analysis (LDA), Adaptive Boosting (AdaBoost), and Logistic Regression (LR) classifiers demonstrated optimal performance (area under the curve (AUC) = 0.910, accuracy 85.0%). In external validation, LDA and LR classifiers achieved the highest AUC value (0.956) and accuracy (92.86%).

CONCLUSION: Elevated FW in the bilateral hippocampal cingulum bundles of inflammatory NPSLE patients likely indicates neuroinflammation. A diagnostic model combining FW parameters from this region with clinical indicators shows strong potential for distinguishing inflammatory from non-inflammatory NPSLE.

PMID:41974094 | DOI:10.1016/j.jaut.2026.103560

J Environ Manage. 2026 Apr 12;405:129654. doi: 10.1016/j.jenvman.2026.129654. Online ahead of print.

ABSTRACT

This study introduces the Ecosystem Carrying Capacity Assessment System (ECCAS), a unified web-based platform that integrates multi-source geospatial data, physical models, and statistical tools within a modular architecture to dynamically assess ecosystem carrying capacity, quantified as water-sustainable gross primary productivity (GPPs). The platform enables scenario-based simulations by coupling future climate projections with adjustable socio-economic parameters and provides interactive visualization to improve accessibility for non-expert users. Applied to China’s Loess Plateau, a water-limited region undergoing large-scale ecological restoration, ECCAS reveals that 24% of vegetated areas historically exceeded sustainable water thresholds, with pronounced overuse in mountainous regions. Future projections indicate consistent increases in GPPs across all scenarios, with the largest growth reaching up to 50% by the 2050s, highlighting both opportunities for carbon sequestration and emerging pressures on water resources. The modular design ensures transferability to other dryland regions, providing a flexible and interactive platform for supporting land and water management under changing environmental conditions.

PMID:41974081 | DOI:10.1016/j.jenvman.2026.129654

Am J Health Promot. 2026 Apr 13:8901171261442056. doi: 10.1177/08901171261442056. Online ahead of print.

ABSTRACT

PurposeTo assess U.S. parents’ perceptions of the healthfulness and safety of non-sugar sweeteners (NSS) and examine their views of NSS front-of-package labels (FOPLs).DesignCross-sectional online survey conducted in August 2024.SettingNational online survey distributed to U.S. parents through a research panel platform.ParticipantsA total of 1047 parents of children aged 2-12 years.MethodsThe questionnaire assessed perceptions of NSS compared with added sugars, confidence in identifying NSS, and evaluations of proposed FOPL formats. Descriptive statistics and were used to summarize all responses. Stratified analyses were conducted by demographic and health characteristics to examine differences in views across five hypothetical NSS FOPL formats.ResultsMost parents viewed NSS as helpful for reducing sugar intake for themselves (82%) and their child (58%), with 52% preferring NSS-containing products over those high in added sugars. While 79.8% and 61.4% considered occasional NSS use safe for adults and children, respectively, only 21.9% viewed daily use as safe for children. Natural NSS were perceived as safer than artificial (60.5% vs 26.6%). Nearly all parents (92.6%) indicated that an NSS FOPL would facilitate product identification, and 76.3% supported mandatory labeling, particularly a yellow triangle stating “Not recommended for children.” The preference for this FOPL was consistent among participants of different demographic and health characteristics.ConclusionParents acknowledged potential benefits of NSS for sugar reduction but expressed caution about children’s intake, showing strong support for mandatory, child-focused FOPL.

PMID:41974045 | DOI:10.1177/08901171261442056

Hepatol Commun. 2026 Apr 13;10(5):e0932. doi: 10.1097/HC9.0000000000000932. eCollection 2026 May 1.

ABSTRACT

Hepatocellular carcinoma (HCC) remains a major global cause of cancer morbidity and mortality, with marked geographic heterogeneity in incidence and outcomes. The highest age-standardized incidence and mortality rates persist in East Asia and across much of Africa. In contrast, Europe and North America exhibit moderate incidence, while Latin America and Oceania represent intermediate-burden regions with important subregional heterogeneity, with higher mortality concentrated in underserved, rural, Indigenous, and remote populations. Globally, the etiologic landscape of HCC is shifting from predominantly infection-related toward metabolic dysfunction and alcohol-associated liver disease. Rural-urban disparities further exacerbate global HCC burden through gaps in vaccination coverage, antiviral access, diagnostic infrastructure, and specialty care, leading to later-stage presentation and poorer outcomes. In this review, we describe the epidemiological changes in HCC across different areas of the world, focusing on region-specific issues and identifying key aspects of epidemiological transition.

PMID:41974030 | DOI:10.1097/HC9.0000000000000932

Ann Am Thorac Soc. 2026 Jan 30:aaoag006. doi: 10.1093/annalsats/aaoag006. Online ahead of print.

ABSTRACT

RATIONALE: Long-term exposure to air pollution contributes to chronic respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD). While the effect of fine particulate matter (PM2.5) and nitrogen dioxide (NO2) are supported by evidence, the contribution of black carbon (BC), a combustion-related pollutant, remains unclear.

OBJECTIVES: To investigate associations of long-term exposure to BC as well as PM2.5 and NO2 with incidence of adult-onset asthma and COPD in Denmark.

METHODS: We followed 3.2 million Danish residents aged 30 years or older on January 1, 2000 until December 31, 2018, for incidence of asthma and COPD (first hospital contact), and combined incidence [first prescription for obstructive airway disease (OAD) medication]. Annual mean concentrations of air pollutants were estimated using European-wide hybrid land-use regression models. Cox proportional hazard models were used with adjustment of demographic, socioeconomic factors, smoking, and body mass index.

RESULTS: During 50.7, 50.4, and 44.4 million person-years of follow-up, 52,648 participants developed asthma, 146,269 developed COPD, and 393,211 were prescribed OAD medication, respectively. An interquartile range increase of 2.0 and 10.3 µg/m3, and 0.5 × 10-5/m in PM2.5, NO2, and BC, respectively, were associated with higher risks of asthma incidence [hazard ratio: 1.10 (95% confidence interval: 1.08, 1.13); 1.16 (1.13, 1.19); 1.17 (1.14, 1.20)], COPD incidence [1.04 (1.02, 1.05); 1.05 (1.03, 1.07); 1.06 (1.04, 1.08)], and OAD medication [1.02, (1.01, 1.03); 1.05 (1.03, 1.06); 1.03 (1.02, 1.05)]. The observed association with PM2.5 were attenuated or became null after adjusting for NO2 or BC, while those with NO2 or BC remained robust after adjusting for PM2.5.

CONCLUSION: In a large Danish nationwide analysis, air pollution is an important predictor for adult-onset asthma and COPD. Our findings suggest that the relevance of pollutants originating from combustion sources, as reflected by the association with BC and NO2, may contribute importantly to these respiratory outcomes. Targeted actions to reduce combustion-related emissions, including those leading to BC formation, may further help decrease the burden of chronic respiratory diseases.

PMID:41973987 | DOI:10.1093/annalsats/aaoag006

JCO Oncol Pract. 2026 Apr 13:OP2600018. doi: 10.1200/OP-26-00018. Online ahead of print.

ABSTRACT

PURPOSE: Phase II trials are intended to identify promising treatment paradigms for definitive phase III testing, but how effectively they serve this role in radiation oncology is unknown. We evaluated whether phase II cooperative group studies of radiation therapy function as effective gateways to phase III testing and identified factors associated with downstream progression.

METHODS: Using ClinicalTrials.gov, we identified completed phase II radiation therapy trials conducted through the National Clinical Trials Network cooperative groups. We assessed whether trials met their prespecified primary end point and whether successful trials progressed to phase III evaluation. Logistic regression evaluated associations between trial characteristics and phase III transition. Decision concordance between phase II outcomes and subsequent development decisions was examined.

RESULTS: Among 92 completed phase II trials (2003-2019), 54% met their primary end point, yet only 17% progressed to phase III testing. Among trials that met their end point, fewer than one third advanced, with 71% representing discordant successes (positive phase II trial without phase III progression). Toxicity-based end points most frequently met phase II criteria (67%) but were least likely to translate to phase III (8% of successful trials). Larger enrollment number (odds ratio [OR], 1.68 per 50 patients [95% CI, 1.21 to 2.31]) and longer duration (OR, 1.20 per year [95% CI, 1.00 to 1.44]) were associated with phase III transition. Trials that advanced to phase III were not completed more rapidly (median duration 132 v 108 months).

CONCLUSION: Most phase II radiation oncology trials that meet prespecified end points do not progress to definitive phase III testing. This phenomenon appears driven less by statistical futility than by structural and decisional barriers. Greater prespecification of advancement intent and selection of decision-relevant end points may improve the efficiency and impact of radiotherapy cooperative group trials.

PMID:41973969 | DOI:10.1200/OP-26-00018

Clin Neuropharmacol. 2026 Apr 1. doi: 10.1097/WNF.0000000000000683. Online ahead of print.

ABSTRACT

OBJECTIVES: Borderline personality disorder (BPD) is often comorbid with major depressive disorder (MDD), and there has been a suggestion in the literature that this comorbidity may interfere with MDD treatment response. Our objective was to conduct a pilot study of psilocybin in adults with BPD and MDD.

METHODS: Adults aged 18 to 65 years with a DSM-5 diagnosis of MDD and BPD were enrolled in an open-label pilot study of a single dose of psilocybin. Assessments were conducted 1 week before dosing (baseline), on the dosing day (visit 2), and at 1, 2, and 4 weeks postdosing. The co-primary outcome measures were changes in depressive and BPD symptoms from baseline to study endpoint, and we used a paired-samples t test to examine changes in symptoms.

RESULTS: Nine participants (4 males; mean age=31.3 y) with MDD and BPD were enrolled. MDD symptoms significantly changed from baseline to visit 5: baseline (M=28.56, SD=4.53) and final visit (M=17.22, SD=10.39); t(8)=-4.217, P=0.003; Cohen d=1.41. BPD scores did not significantly change from baseline to study endpoint.

CONCLUSIONS: This small open-label study resulted in statistically significant improvement in MDD symptoms but not for BPD symptoms. These findings, which await larger clinical trials, suggest that BPD does not appear to interfere with response to depressive symptoms.

PMID:41973961 | DOI:10.1097/WNF.0000000000000683

JMIR AI. 2026 Apr 13;5:e81028. doi: 10.2196/81028.

ABSTRACT

BACKGROUND: Oropharyngeal dysphagia (OD) commonly occurs in patients with COVID-19 disease, posing diagnostic challenges due to isolation protocols.

OBJECTIVE: This study aimed at evaluating Artificial Intelligence Massive Screening for Oropharyngeal Dysphagia (AIMS-OD), a machine learning software for real-time OD screening, comparing OD prevalence and clinical outcomes using OD ICD-10 (International Statistical Classification of Diseases, Tenth Revision) R13 codes (R13-OD) and high-risk AIMS-OD (H-AIMS-OD) scores (>0.5), in hospital and primary care patients with COVID-19 disease. It explored clinical characteristics, OD risk factors, and clinical outcomes.

METHODS: This retrospective, observational study analyzed patients with SARS-CoV-2 aged 18 years and older in Catalonia from January 1 to August 31, 2020, including hospital and primary care data on clinical information, International Classification of Diseases, Tenth Revision (ICD-10) codes, hospital stay, discharge destination, and mortality. AIMS-OD assessed OD risk, stratifying patients by age (aged 18-69 years and 70 years and older).

RESULTS: Among 257,541 patients with COVID-19 disease, 59.3% (152,721/257,541) were aged 18-69 years and 40.7% (104,820/257,541) were aged 70 years and older. Hospital and primary care R13-OD prevalence was 3.5% and 4.3%, respectively; AIMS-OD showed 34.8% and 15.4%, with True prevalence at 16.7% and 7.4%. Patients aged 70 years and older had worse clinical outcomes and worse prognosis. Patients in R13-OD experienced significantly worse clinical outcomes than patients with H-AIMS-OD, who in turn fared worse than those with no R13-OD and with low AIMS-OD risk. Risk factors for patients with COVID-19 R13-OD included age, neuroleptic use, stroke, dementia, and delirium.

CONCLUSIONS: AIMS-OD screening revealed high prevalence and significant underdiagnosis in patients with COVID-19 disease across settings. Early detection and risk stratification using AIMS-OD could improve clinical decision-making, diagnosis, and management, particularly in older patients with comorbidities.

PMID:41973941 | DOI:10.2196/81028

JMIR Cancer. 2026 Apr 13;12:e87591. doi: 10.2196/87591.

ABSTRACT

BACKGROUND: There is a growing interest in characterizing the relationship between long-term physical activity (PA) habits and cancer-related outcomes such as treatment-related toxicities, recurrence, and complications. Wearable devices can provide critical information to achieve this goal; however, inferences are significantly influenced by device wear adherence.

OBJECTIVE: This study aimed to assess the feasibility of using wearable devices to monitor short- and long-term PA in adolescent and young adult (AYA) patients with sarcoma during and after chemotherapy in a free-living environment and evaluate the ability to accurately capture changes in PA over 3 years.

METHODS: A total of 63 AYA patients with sarcoma were provided with a Fitbit Charge 3 to track daily steps, sedentary time, and heart rate for up to 3 years.

RESULTS: On average, during the first 30 days of follow-up, 57.1% (36/63) of patients wore their device at least 10 hours per day, and only 23.8% (15/63) of patients wore their devices thereafter. Patients spent a mean of 80% (SD 11%) of their day in a sedentary state. Despite low adherence, daily step count trends increased over time.

CONCLUSIONS: This study highlights the adherence challenges met with longitudinal PA monitoring in AYA patients with sarcoma. Wearer discomfort, lost devices, and lack of data uploading compliance contributed to data missingness and attrition. Caution is warranted when relying on wearable activity trackers to inform program decisions, accurately assess PA outcomes, and monitor program adherence longitudinally without consideration of wearer bias. Alternative methods that would be more broadly accepted by AYA patients for effective long-term monitoring should be considered.

PMID:41973938 | DOI:10.2196/87591

Proc Natl Acad Sci U S A. 2026 Apr 21;123(16):e2536005123. doi: 10.1073/pnas.2536005123. Epub 2026 Apr 13.

ABSTRACT

We investigate associations between community water fluoridation (CWF), adolescent IQ, and cognition across the life course using representative data from the US state of Wisconsin. Exposure is inferred from historical records on community water fluoridation; adolescent IQ is ascertained from state testing records; and cognition in later life is assessed as part of the Wisconsin Longitudinal Study [P. Herd et al., Int. J. Epidemiol. 43, 34-41 (2014).]. In contrast to studies cited in recent decisions to end CWF in Utah, Florida, and elsewhere, we find no evidence that CWF is negatively associated with adolescent IQ or adult cognitive functioning.

PMID:41973917 | DOI:10.1073/pnas.2536005123