Category: Statistics

Eur Radiol. 2025 Oct 4. doi: 10.1007/s00330-025-12039-5. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the impact of MRI-defined bladder wall invasion from uterine cervical cancer (CC) on disease recurrence and overall survival.

MATERIALS AND METHODS: IRB-approved multicenter retrospective study including women who underwent staging MRI for histologically confirmed CC (Jan 2015-Dec 2020). Image analysis was independently performed by two radiologists. Bladder wall invasion was diagnosed if ≥ 3 of the following criteria were met: loss of the cervix-bladder fat plane, bladder wall thickening, loss of bladder wall T2-hypointensity, and presence of endoluminal tumor growth. MRI findings were compared with endoscopy/cytology. The impact of MRI-defined bladder wall invasion on tumor recurrence and survival was assessed using logistic regression. Survival curves were compared using the log-rank test.

RESULTS: We included 214 women with a median age of 55 (IQR 47-65) years. MRI-defined bladder wall invasion was observed in 21.5% of patients. Cystoscopy revealed bladder mucosal infiltration in 7.0% of patients, all of whom demonstrated MRI-defined bladder wall invasion. No patients without MRI-defined bladder wall invasion showed mucosal infiltration on cystoscopy/cytology. The median follow-up was 32 months: 46.7% of patients had recurrence, and 23.4% had CC-related death. On logistic regression, MRI-defined bladder wall invasion was an independent risk factor for tumor recurrence (OR 2.24, p = 0.047) and mortality (OR 3.55, p = 0.006), whereas cystoscopy-defined bladder mucosa infiltration was not. The log-rank test demonstrated a significant difference in survival between patients with and without MRI-defined bladder wall invasion (χ² = 15.40, p = 0.0001).

CONCLUSIONS: MRI-defined bladder wall invasion represents an independent negative prognostic factor in patients with cervical cancer.

KEY POINTS: Question The prognostic significance of MRI-defined bladder wall invasion in patients with cervical cancer remains unclear with respect to disease recurrence and survival. Findings Bladder wall invasion identified on MRI is an independent predictor of tumor recurrence and tumor-specific mortality, whereas mucosal infiltration detected via cystoscopy is not. Clinical relevance MRI can safely replace cystoscopy in the preoperative staging of patients with uterine cervical cancer. This approach can reduce costs and expedite the staging process.

PMID:41045303 | DOI:10.1007/s00330-025-12039-5

Vet Med Sci. 2025 Nov;11(6):e70622. doi: 10.1002/vms3.70622.

ABSTRACT

BACKGROUND: Cattle have been domesticated by humans for thousands of years for various purposes, including their economic significance. Despite advancements in livestock farming technologies, challenges such as disease outbreaks continue to affect productivity and economic stability.

OBJECTIVES: The aim is to investigate the prevalence and factors associated with various diseases in cattle around the Madhumati River in Gopalganj, Bangladesh. The study also offers insights into the current disease landscape, focusing on animal health status, farmer knowledge and treatment and prevention strategies in Gopalganj.

METHOD: A standardized closed-ended questionnaire was administered using KoboToolBox (2021.2.4) for data collection. Statistical analyses included descriptive statistics, Fisher’s exact test, χ² test, and multivariate logistic regression models with 95% confidence intervals. R (4.4.0) and SPSS (27.0.1) were utilized to explore associations between variables influencing disease prevalence.

RESULT: The findings of the study indicate that Foot and Mouth Disease (17.39%) and Lumpy Skin Disease (13.04%) were the most prevalent diseases. A linear model (95% CI) predicted that poor husbandry practices, lack of knowledge, and inadequate treatment strategies contributed to disease occurrence in different regions of Gobra, Gopalganj.

CONCLUSION: This cross-sectional study investigated the major prevalence rate and causes of diseases in the Gobra region of Gopalganj, identifying FMD and LSD as significant diseases in cattle farming. From the study, we can suggest some strategies to mitigate disease prevalence, including seasonal preventive measures, routine vaccination, deworming protocols, and stringent sanitation practices.

PMID:41045291 | DOI:10.1002/vms3.70622

Clin Trials. 2025 Oct 4:17407745251378117. doi: 10.1177/17407745251378117. Online ahead of print.

ABSTRACT

BACKGROUND: Cluster randomized controlled trials are increasingly used to evaluate the effectiveness of interventions in clinical and public health research. However, missing data in cluster randomized controlled trials can lead to biased results and reduce statistical power if not handled appropriately. This study aimed to review, describe and summarize how missing primary outcome data are handled in reports of publicly funded cluster randomized controlled trials.

METHODS: This study reviewed the handling of missing data in cluster randomized controlled trials published in the UK National Institute for Health and Care Research Journals Library from 1 January 1997 to 31 December 2024. Data extraction focused on trial design, missing data mechanisms, handling methods in primary analyses and sensitivity analyses.

RESULTS: Among the 110 identified cluster randomized controlled trials, 45% (50/110) did not report or take any action on missing data in either primary analysis or sensitivity analysis. In total, 75% (82/110) of the identified cluster randomized controlled trials did not impute missing values in their primary analysis. Advanced methods like multiple imputation were applied in only 15% (16/110) of primary analyses and 28% (31/110) of sensitivity analyses. On the contrary, the review highlighted that missing data handling methods have evolved over time, with an increasing adoption of multiple imputation since 2017. Overall, the reporting of how missing data is handled in cluster randomized controlled trials has improved in recent years, but there are still a large proportion of cluster randomized controlled trials lack of transparency in reporting missing data, where essential information such as the assumed missing mechanism could not be extracted from the reports.

CONCLUSION: Despite progress in adopting multiple imputation, inconsistent reporting and reliance on simplistic methods (e.g. complete case analysis) undermine cluster randomized controlled trial credibility. Recommendations include stricter adherence to CONSORT guidelines, routine sensitivity analyses for different missing mechanisms and enhanced training in advanced imputation techniques. This review provides updated insights into how missing data are handled in cluster randomized controlled trials and highlight the urgency for methodological transparency to ensure robust evidence generation in clustered trial designs.

PMID:41045255 | DOI:10.1177/17407745251378117

Equine Vet J. 2025 Oct 4. doi: 10.1111/evj.70108. Online ahead of print.

ABSTRACT

BACKGROUND: The healthcare sector contributes significantly to global greenhouse gas (GHG) emissions, with anaesthetic gases being a notable contributor. Implementing sustainable practices in equine anaesthesia, such as low-flow anaesthesia, offers potential benefits.

OBJECTIVES: To audit oxygen and isoflurane usage in five equine hospitals, their associated GHG emissions, and the impact of anaesthesia training on mitigating these emissions.

STUDY DESIGN: Multi-centre clinical audit.

METHODS: This audit covered two periods: study period one (1 June-30 September 2022) and study period two (1 June-30 September 2023). After period one, an anaesthesia training programme introduced low-flow techniques. Data collected retrospectively included patient signalment, anaesthetic protocol, and 5-min recordings of fresh gas flow (FGF) and vapouriser settings. GHG emissions (in carbon dioxide equivalents) and costs (in £) were calculated. Statistical analysis used a linear mixed-effects model with a significance level of p-value <0.05.

RESULTS: A total of 414 general anaesthetics were audited. Between study period one and two, isoflurane and oxygen usage decreased by 9.6% and 17.9%, respectively, resulting in a 9.6% reduction in GHG emissions (from 14.6 to 13.2 tCO₂e). A linear mixed-effects model identified five significant predictors of GHG emissions per case: study period, oxygen usage, anaesthesia duration, average isoflurane vapouriser setting, and the interaction between oxygen usage and study period. Cases in study period two were associated with lower GHG emissions, producing on average 10.4 kgCO₂e less per case (p = 0.01), while each additional litre of oxygen consumed increased emissions by 0.12 kgCO₂e (p < 0.001).

MAIN LIMITATIONS: Missing data from FGF and/or vapouriser settings and the minimal variability between hospitals could be perceived as limitations.

CONCLUSIONS: This audit demonstrates that practising low-flow anaesthesia can effectively reduce the environmental impact of inhalant anaesthetic agents during equine anaesthesia. Wider adoption could improve sustainability, although further research and broader professional engagement are needed.

PMID:41045252 | DOI:10.1111/evj.70108

ESC Heart Fail. 2025 Oct 4. doi: 10.1002/ehf2.15417. Online ahead of print.

ABSTRACT

AIMS: Despite the potential of alginate hydrogel intramyocardial injections in the treatment of heart failure (HF), minimally invasive implantation techniques remain scarce. This study evaluated the safety and feasibility of percutaneous transcatheter endocardial alginate hydrogel injection (TEAi), facilitated by novel implants and a dedicated catheter-based device, in patients with HF with reduced ejection fraction (HFrEF).

METHODS AND RESULTS: This first-in-human study enrolled HFrEF patients [New York Heart Association (NYHA) Class III-IV and left ventricular ejection fraction (LVEF) ≤35%]. The primary endpoint was the incidence of procedure- or device-related serious adverse events (SADEs) at 30 days. Secondary endpoints included the device success rate, HF hospitalization at 6 months, and change from baseline to 6 months post-procedure in the following parameters: LVEF as assessed by MRI; NYHA functional class; 6 min walk test distance (6MWT); the quality of life assessed by the Kansas City Cardiomyopathy Heart Failure Questionnaire (KCCQ); and serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) level. Pre- and post-procedural biomechanical analysis was also evaluated. Ten patients successfully underwent TEAi with no SADEs at 30 days. There was one death and two HF hospitalizations at 6 months. At 6 months, LVEF improved from 17.7% ± 3.8% to 24.9% ± 11.2% (P = 0.021), end-systolic volume decreased from 297.5 ± 67.9 mL to 264.8 ± 101.4 mL (P = 0.029), and KCCQ scores increased from 49.7 ± 3.9 to 79.0 ± 8.07 (P = 0.008). No statistically significant changes were observed in end-diastolic volume, NT-proBNP and 6MWT at six months compared with the baseline. Biomechanical analysis revealed a reduction in peak left ventricular end-diastolic wall stress (6.5 ± 1.1 kPa vs. 5.9 ± 1.3 kPa, P = 0.043).

CONCLUSIONS: TEAi is feasible and safe for the treatment of HFrEF, warranting further randomized, efficacy clinical trials.

PMID:41045241 | DOI:10.1002/ehf2.15417

Waste Manag Res. 2025 Oct 4:734242X251374491. doi: 10.1177/0734242X251374491. Online ahead of print.

ABSTRACT

Of the carbon emissions that the National Health Service (NHS) directly produces, waste and water currently make up about 21%, only second to building energy. This study evaluated current knowledge, perception, attitude and behaviour on sustainable healthcare waste management (SHCWM) practices within selected NHS Trusts in Northwest England post-COVID-19 as part of wider research to develop a resilient assessment tool for SHCWM implementation within NHS Trusts in the United Kingdom. The study utilised a questionnaire survey of hospital staff across three NHS Trusts. A total of 58 respondents from clinical and non-clinical roles were analysed. The results showed lack of periodic training, reflected in generally low levels of knowledge on health/environmental risks of healthcare waste management (HCWM), SHCWM practices and legislation on HCWM in the United Kingdom and deficiencies in segregation practice. Statistical tests showed significant differences in attitude among age groups and roles. Those under the age of 35 demonstrated more positive attitude towards SHCWM, whereas clinical support staff demonstrated more positive attitude towards SHCWM compared to doctors and nurses. While the findings demonstrate a lack of periodic training on SHCWM, there appears to be a generally positive perception and attitude towards SHCWM practices. Where SHCWM initiatives are introduced, the findings suggest that staff would be willing to engage and participate. This paper gives those leading sustainability efforts at NHS Trusts a snapshot of current sentiment towards SHCWM and elevates the need to develop minimum mandatory periodic training to improve staff knowledge and practice on SHCWM as part of efforts towards a net zero future.

PMID:41045201 | DOI:10.1177/0734242X251374491

Angew Chem Int Ed Engl. 2025 Oct 4:e202513744. doi: 10.1002/anie.202513744. Online ahead of print.

ABSTRACT

Tailoring supported bimetals to alloyed or phase-separated structures is of vital importance while this process is blocked by the support interferences during universal impregnation processes. Conventional trial-and-error approaches rooted in chemical intuition often lack efficiency and generality. Here, we present a design strategy guided by the statistical sampling of comparative ease of alloy formation through the metadynamics-based gas-solid nanoreactor approach, which enables the rational and systematic development of bimetallic nanocatalysts (NCs). Using metal oxide-supported PdAu coupling with model CO₂ reduction as a proof-of-concept system, the integrated theoretical and experimental results not only validated the reliability of simulation results but also successfully predicted and realized the alloy formation or phase separation of supported PdAu NCs. The generated PdAu alloys over CeO₂ weaken the metallicity of supported Pd species and thus the catalytic hydrogenation property, but increase moderate basicity, contributing to activated CO₂ hydrogenation to CO via a formate intermediate. However, the phase separation of Pd and Au over TiO₂ support promotes formic acid production efficiency attributed to increasing weak basicity to accelerate CO₂ activation during a bicarbonate pathway. These findings highlight statistical sampling as a general broadly applicable framework for the rational design of advanced bimetallic NCs.

PMID:41045186 | DOI:10.1002/anie.202513744

Bioelectromagnetics. 2025 Oct;46(7):e70025. doi: 10.1002/bem.70025.

ABSTRACT

Compliance testing of wireless devices with absorbed power density (APD) limits requires body models that conservatively reproduce the absorption characteristics of human skin. Previous studies indicate that impedance-matching effects are caused by the stratum corneum (SC) layer. The objective of this study is to develop a single macroscopic dielectric model reproducing absorption of electromagnetic fields by the skin up to 110 GHz. The reflection coefficient of the skin of human volunteers was measured at frequencies of 15 to 43 GHz with open waveguide probes, complementing previous data from 45 to 110 GHz. The measurements were made at various regions of the body. The statistical analysis of the results shows that the reflection coefficient in dB follows normal distribution in regions with thin SC, which permits the development of a conservative skin model. In regions with thick SC, for example, the palms, the reflection coefficient is not normally distributed because the thickness of the SC depends on the mechanical stress the hands are exposed to. The measured data allow the derivation of dispersive two-layer models representing absorption and reflection at the skin surface with known uncertainty. The models can be used to conservatively demonstrate compliance with the APD limits of wireless devices in any of the 5G and 6G bands.

PMID:41045064 | DOI:10.1002/bem.70025

J Child Adolesc Psychiatr Nurs. 2025 Nov;38(4):e70038. doi: 10.1111/jcap.70038.

ABSTRACT

BACKGROUND: Family planning significantly reduces maternal mortality and contributes to achieving the Sustainable Development Goals. However, the unmet need for family planning in Ghana is still relatively high. This study assessed the factors influencing the use of family planning in a resource-limited setting.

METHODS: The study used 384 adults (17-56 years) in the Navrongo central sub-municipality, selected using the multi-stage sampling method. Data was cleaned in Microsoft Excel 365 before being transferred to SPSS version 27 and R for analysis. Composite scores were determined and transformed into percentages. The percentage scores of more than 75% were coded as utilisation or good knowledge of modern family planning, depending on the specific section. The Pearson Chi-square test was performed to examine the relationship between the independent variables on overall utilisation and overall knowledge of family planning. Logistic regression and complementary log-log models were used to model the predictors of the utilisation and knowledge of modern family planning. All p-values ≤ 0.05 were deemed statistically significant.

RESULTS: The overall utilisation of modern family planning was not very high (43.2%). Overall, the respondents showed good knowledge (81.3%) of modern family planning. Married young adults (RR = 2.1, 95% CI: 1.39-3.27, p-value = 0.001) were more likely to utilise modern contraceptives. Male young adults are less likely to utilise family planning (RR = 0.21, 95% CI: 0.12-0.34, p < 0.001) than females. Those aged at least 37 years (RR = 1.72, 95% CI: 1.11-2.71, p-value = 0.017) were more likely to have good knowledge of modern family planning than those aged 17 to 26 years. Compared with those with tertiary education, those below SHS (RR = 2.53, 95% CI: 1.54-4.31, p-value < 0.001) and those with SHS education (RR = 1.79, 95% CI: 1.27-2.55, p-value = 0.001) were more likely to have good knowledge of modern family planning. Those with household income between 500 and 1000 (RR = 5.39, 95% CI: 2.18-17.99, p-value = 0.002) and household income more than 1000 cedis (RR = 5.12, 95% CI: 2.04-17.25, p-value = 0.003) were more likely to have good knowledge of family planning than those with household income below 500 cedis per month.

CONCLUSION: This study revealed a high level of knowledge and relatively low utilization of modern family planning. Family planning interventions must incorporate behaviour change theoretical models to translate high knowledge to effective and sustained uptake of family planning among young adults in resource-limited settings.

PMID:41045063 | DOI:10.1111/jcap.70038

J Magn Reson Imaging. 2025 Oct 4. doi: 10.1002/jmri.70130. Online ahead of print.

ABSTRACT

BACKGROUND: The electrocardiogram (ECG) used for gating in cardiac MRI may be compromised by multiple confounders inside the scanner bore.

PURPOSE: To quantify the influence of magnetic field strengths (1.5 T/3 T/7 T), standardized electrode positions, and imaging sequences on ECG signals used for gating.

STUDY TYPE: Prospective.

POPULATION: Sixteen healthy volunteers (eight male; mean age 26.25 ± 7.67 years).

FIELD STRENGTH/SEQUENCE: Balanced steady-state free precession cine (1.5 T/3 T), fast low-angle shot cine (7 T), and 4D flow (1.5 T/3 T/7 T) sequences.

ASSESSMENT: ECG-signals were recorded during breath-hold and non-breath-hold short axis cine (sax-bh and sax-nbh, respectively) and 4D flow scans at 1.5 T/3 T/7 T. All scans were repeated with 4 standardized electrode positionings (pos1-4) at each field strength. Pos1/2 were vendor-recommended positionings for 1.5 T/3 T/7 T scans, respectively, whereas pos3/4 were alternative positionings recommended in previous studies. Similarity between confounded ECG-signals and unconfounded baseline ECG-signals was assessed by QRS-feature correlation. Cine image quality (IQ) was assessed by 3 readers (with 6, 10, and 22 years experience) on a four-point Likert scale.

STATISTICAL TESTS: Linear mixed models with type III tests of fixed effects (overall) and t tests with adjusted degrees of freedom (pairwise subgroup-comparisons) at significance level p < 0.05.

RESULTS: Increasing field strength resulted in significantly decreasing similarity to baseline measurements, with r values (provided with 95% confidence interval) of 1.5 T: 97% (92.6-101.3); 3 T: 91.4% (87.1-95.8); 7 T: 50.4% (46-54.9) and lower IQ: 1.5 T: 2.33 (2.12-2.55); 3 T: 1.96 (1.75-2.17); 7 T: 0.91 (0.7-1.12). Vendor-specified electrode positions pos1: 91.8% (87.2-96.5), pos2: 88.3% (83.7-92.9) showed significantly higher correlation with baseline measurements than alternative positions pos3: 67.5% (62.9-72.1) and pos4: 70.8% (66.2-75.4). The evaluated standardized sequences showed similar amounts of electrocardiogram distortion, with r values of: sax-bh: 77.3% (73-81.7); 4D: 79.3% (75-83.7), p = 0.54; sax-nbh: 82.1% (77.8-86.5), p = 0.31, but the difference between sax-bh and sax-nbh: 4.8% (2.88-6.72) was significant.

DATA CONCLUSION: Increasing field strength leads to significant ECG signal distortions. Vendor-specified positions 1/2 resulted in less distorted ECG signals than alternative positions 3/4 recommended in previous publications.

TECHNICAL EFFICACY: Stage 5.

PMID:41045052 | DOI:10.1002/jmri.70130