Category: Statistics

Sci Rep. 2026 Apr 11. doi: 10.1038/s41598-026-47567-7. Online ahead of print.

ABSTRACT

Plastic pollution, resulting from the persistence of conventional polymers, remains a critical environmental challenge that necessitates the development of biodegradable alternatives. Polyhydroxyalkanoates (PHAs) represent an attractive solution, being naturally synthesized by microorganisms under nutrient-limited conditions. This study investigates the production of PHAs using lignocellulosic wood waste, specifically sal and teak residues, as an economical carbon source. Fermentable sugars were obtained via dilute sulfuric acid hydrolysis (10% w/v biomass with 4% v/v H₂SO₄), incubated at 120 °C for 1 h, and filtered to yield a hydrolysate containing approximately ~ 36 mg/mL total reducing sugars (DNS assay). The hydrolysate served as the carbon source in bioprocess optimization (optimal carbon concentration: 2.50%, equivalent to 25 g/L). Potential PHA-producing isolates were screened using Nile Blue and Sudan Black staining. The most efficient producer, Klebsiella pneumoniae strain DSM 30,104 (MK2023), confirmed through 16 S rRNA sequencing, demonstrated notable PHA accumulation. Process parameters-including carbon and nitrogen concentrations and Temperature-were optimized through Plackett-Burman Design (PBD) followed by Response Surface Methodology (RSM) using a face-centered central composite design. Optimal production was achieved at 2.50% carbon, 0.105% nitrogen, and 34 °C, yielding 5.7 mg/mL PHA after 72 h with 10% (v/v) inoculum. UV-Vis and FTIR analyses confirmed the polymer’s identity as polyhydroxybutyrate (PHB). The study highlights wood waste as a viable, low-cost substrate for PHA synthesis, promoting sustainable biopolymer production while advancing circular bioeconomy practices.

PMID:41965809 | DOI:10.1038/s41598-026-47567-7

Malar J. 2026 Apr 11. doi: 10.1186/s12936-026-05884-2. Online ahead of print.

ABSTRACT

BACKGROUND: In the Greater Mekong Subregion, militaries constitute a critical but often underserved malaria transmission reservoir, given their high mobility, deployment to endemic areas, and frequent exposure to vectors. In Thailand, the Royal Thai Army (RTA) is a key risk population, yet their malaria practices, perceptions, and the scale and scope of coordination with the Ministry of Public Health (MoPH) are not well understood. A joint military-civilian research team conducted a rapid formative assessment in Sisaket Province, a persistent transmission hotspot, to characterize the unique RTA risk profile and identify opportunities to strengthen RTA-MoPH coordination on malaria elimination efforts.

METHODS: Using a mixed-methods design, the research team conducted a five-year (2016-2020) retrospective analysis of Sisaket’s malaria case and program response data, alongside 16 focus group discussions (FGDs) and 17 key informant interviews (KIIs) with RTA and MoPH respondents across all military ranks and health system levels in the province’s three highest-burden districts (Kantharalak, Khun Han, Phu Sing). Qualitative data were collected between December 2021-January 2022 and thematically analyzed using an inductive content analysis approach. Quantitative data were descriptively analyzed using statistical methods to characterize the RTA malaria risk profile and identify and compare recent trends in program response between military and non-military populations in Sisaket Province.

RESULTS: 432 military malaria cases were reported in Sisaket between 2016 and 2020, accounting for 18% of the province’s total 2425 cases (with the proportion ranging from 14 to 30% annually). All military malaria cases were male, with a median age of 28 years. 96% of military cases were diagnosed and treated at MoPH facilities, with 41% of cases classified as indigenous and 40% as imported from abroad. Qualitative data were collected from a total of 116 respondents (72 RTA, 44 MoPH) through 16 FGDs and 17 KIIs. Malaria prevention and treatment practices and perceptions among soldiers were largely consistent across the three study districts. RTA-MoPH coordination occurred at all levels through both formal and informal channels and was reported to be improving and expanding by some respondents. Though several areas could benefit from increased collaboration: patient follow-up, border control efforts, vector control, and further capacitation of military medics. The RTA and MoPH both expressed strong interest in strengthening military-civilian coordination; though to better enable this, several identified challenges may need to be addressed, including restricted MoPH access to military sites, lack of continuity in relationships due to frequent RTA rotations, communication constraints, and broader differences in military versus civilian operating procedures.

CONCLUSION: Strengthening RTA-MoPH coordination towards successfully interrupting malaria transmission in Thailand may require formalizing and standardizing some joint operating procedures, increasing communication and military-civilian touchpoints, and further capacitating the RTA to carry out malaria prevention, diagnosis and treatment, and patient follow-up activities. For Thailand to achieve its goal of nationwide malaria elimination, it is crucial that the RTA as a high-risk population be fully engaged in the country’s malaria control and response efforts.

PMID:41965802 | DOI:10.1186/s12936-026-05884-2

Trials. 2026 Apr 11. doi: 10.1186/s13063-026-09706-3. Online ahead of print.

ABSTRACT

BACKGROUND: Randomised implementation trials evaluate the effects of implementation strategies on implementation outcomes and may also monitor clinical effectiveness. Routine healthcare data are used in implementation trials for participant identification, intervention delivery, and/or outcome ascertainment. Trial efficiency (scientific, operational, statistical, and economic) is operationalised across trial design, processes, superstructure, infrastructure, and stakeholder engagement (the Trial Efficiency Pentagon). Despite frequent usage, the contribution of routine data to implementation trial efficiency remains underexplored. We aimed to investigate how the use of routine healthcare data affects trial efficiency in two implementation trials.

METHODS: We conducted a qualitative comparative case study of two implementation trials, one UK-based and one US-based. Participants were purposively sampled from trial teams involved in the use and management of routine healthcare data. Data were collected through semi-structured interviews, document analysis, and feedback workshops. Framework analysis guided by the Trial Efficiency Pentagon was used to analyse the data, and data flow diagrams were developed to visualise routine data pathways within each trial.

RESULTS: The two trials (DIGITS and IMP²ART) used routine data to characterise the practice population of eligible patients, support clinical and economic outcome evaluation, facilitate audit and feedback, and assist in intervention delivery. Common facilitators that supported the use of routine data included sufficient IT and hardware capacity, relatively low cost, centralised regulatory approval for multi-site studies, and strong collaboration and partnerships. Common barriers included administrative complexity, redundant bureaucratic processes, and challenges with data sharing requirements. Key differences included the DIGITS trial’s in-house data warehouses within an integrated healthcare system ensured high data quality and enabled preliminary analyses. In contrast, the IMP²ART trial, managing a larger national sample, employed an external research database to integrate data from various EHR systems but faced challenges such as legacy systems, diverse coding practices and site-specific approvals. Data quality can act as either a facilitator or a barrier.

CONCLUSIONS: Routine data has an impact on implementation trial efficiency across trial design, processes, superstructure, infrastructure, and stakeholder engagement. To improve trial efficiency in public healthcare systems, researchers must address technological and regulatory barriers to accessing data. In private healthcare systems, data use and access hinges on investing in robust IT infrastructure and ensuring comprehensive organisational commitment.

TRIAL REGISTRATION: IMP²ART trial registration: ISRCTN15448074; DIGITS trial Clinicaltrials.gov Identifier: NCT05160233.

PMID:41965800 | DOI:10.1186/s13063-026-09706-3

Spinal Cord. 2026 Apr 11. doi: 10.1038/s41393-026-01196-z. Online ahead of print.

ABSTRACT

STUDY DESIGN: Single-center observational study.

OBJECTIVES: To perform the translation, cross-cultural adaptation, and analysis of the measurement properties of the Spanish version of the Spinal Cord Injury Pain Instrument (SCIPI) for the screening of neuropathic pain (NP) in spinal cord injury (SCI).

SETTING: Hospital, Spain.

METHODS: Participants with SCI and pain were included for the pre-final version (n = 10) and the final version (n = 136). Translation and cross-cultural adaptation of the SCIPI were performed by native speakers in both languages. The statistical analysis included internal consistency, validity, test-retest reliability, and diagnostic accuracy.

RESULTS: All the items of the pre-final version of the SCIPI were understood. Moderate test-retest reliability (intraclass correlation coefficient (ICC) = 0.78, 95% confidence interval (CI), 0.69 to 0.84, p < 0.001) and CR coefficient of internal consistency of 0.484 were found. Strong correlations between the SCIPI and the Douleur Neuropathique 4 (DN4) were revealed (rho = 0.619, p < 0.001). The best cutoff value was 2 points, with an outstanding discriminant ability according to the area under the curve (AUC) value (AUC = 0.937) associated with high sensitivity (91.13%) and specificity (91.67%).

CONCLUSIONS: The Spanish version of the SCIPI may be a reliable and valid tool, with an excellent discriminant ability, for the screening of NP in people with SCI.

PMID:41965781 | DOI:10.1038/s41393-026-01196-z

Sci Rep. 2026 Apr 11. doi: 10.1038/s41598-026-44827-4. Online ahead of print.

ABSTRACT

Glyphosate is the most extensively applied systemic herbicide worldwide, yet its safety remains under scrutiny, with ongoing investigations into potential carcinogenicity. Epidemiological studies associate chronic glyphosate exposure with elevated risks of non-Hodgkin lymphoma and possible endocrine disruption, emphasizing the need for sensitive detection methods. Here, we report a handheld enzymatic biosensor, GlyphoSense Chip, for direct, rapid detection of underivatized glyphosate in drinking water. The device integrates a photodiode-based CMOS chip with an engineered glyphosate N-acetyltransferase and a colorimetric reaction, achieving a sensitivity of 38 µV·mL µg^-1·s^-1 and quantification within one minute. Biosensor response was linear over 0.016-12.5 µg mL^-1 (R² = 0.993) with a detection limit of 0.028 µg mL^-1. Recovery analysis in fortified tap water yielded relative standard errors of 1.2-5.8%, and results were statistically indistinguishable from quantitative mass spectrometry (p > 0.05). This work establishes a robust, field-deployable platform for glyphosate monitoring in water resource safety applications.

PMID:41965777 | DOI:10.1038/s41598-026-44827-4

Australas J Ageing. 2026 Jun;45(2):e70155. doi: 10.1111/ajag.70155.

ABSTRACT

OBJECTIVE: Older adults faced heightened vulnerability during the COVID-19 pandemic, leading to increased mortality. This study investigated the impact of COVID-19 vaccination on COVID-19-related mortality among the main ethnic groups in long-term care during the Delta-Omicron wave in New Zealand.

METHODS: We used national health datasets (interRAI Long Term Care Facility, COVID-19 immunisation, COVID-19 test results, mortality) from August 2021 to August 2022. Multi-state modelling assessed transition hazards from infection to COVID death and other causes of death among Māori, Pacific, Asian and European residents. Transition hazard ratios compared the risk of transitioning from infection to COVID versus non-COVID death.

RESULTS: A total of 34,147 long-term care residents (female: 64.0%, mean age: 84.8 years SD = 8.5) were included. For Māori aged < 85, Asians < 63 and Europeans < 93 who had 3+ doses of vaccine, the risk of COVID death was statistically lower than non-COVID death. Unvaccinated residents showed higher hazards for transitioning to COVID death. For Pacific peoples, transition hazard ratios were not statistically significant, likely due to small sample size. However, successive vaccine doses suggested reduced COVID mortality.

CONCLUSIONS: COVID-19 vaccination reduced the risk of COVID deaths across ethnicities in New Zealand’s long-term care. However, the level of protection offered by the vaccine varied by ethnicity and age.

PMID:41964395 | DOI:10.1111/ajag.70155

J Pain Palliat Care Pharmacother. 2026 Apr 11:1-7. doi: 10.1080/15360288.2026.2655779. Online ahead of print.

ABSTRACT

BACKGROUND: Oral mucositis (OM) pain in patients undergoing cancer treatments remains inadequately managed with conventional treatments. This study aimed to examine pain outcomes associated with methylene blue (MB) mouthwash compared with a standard supportive care mouthrinse in hospitalized patients with OM.

METHODS: In this open label, non-randomized clinical trial, patients selected MB (0.05%) or standard-of-care mixed medication mouthwash. Both groups performed an oral rinse every 8 h for three days. The primary outcome was change in pain numeric rating scores (0-10) from pre-administration to post-administration. Secondary outcomes included changes in daily oral intake volume and opioid use.

RESULTS: Forty-three evaluable patients were included in the analysis. Using a linear mixed model with subject-specific intercepts, both treatment groups demonstrated statistically significant reductions in pain from pre- to post- administration (standard of care: estimate=-0.64, 95% CI [-1.23, -0.05], p = 0.034; MB estimate=-0.87, 95% CI [-1.31, -0.42], p < 0.001). The administration timing-by-treatment interaction effect was not statistically significant, indicating that pain reduction did not differ significantly between groups.

CONCLUSIONS: In this non-randomized study, MB mouthwash was associated with short-term pain reductions in OM-related pain similar to standard-of-care mouthwash. These findings support feasibility and tolerability and underscore the need for larger randomized trials.

PMID:41964386 | DOI:10.1080/15360288.2026.2655779

J Prosthodont. 2026 Apr 11. doi: 10.1111/jopr.70135. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to characterize a mucoadhesive gel containing nystatin (NYS) or chlorhexidine (CHX), complexed or not with β-cyclodextrin (βCD), and evaluate its rheological and mucoadhesive properties, antifungal efficacy, cytocompatibility, and collagen synthesis potential.

MATERIALS AND METHODS: Mucoadhesive formulations were produced using chitosan and hydroxyethylcellulose, incorporating NYS or CHX at 32 mg/g, or complexed with βCD (NYS:βCD, equivalent to 16.1 mg/g of NYS, and CHX:βCD, equivalent to 4.8 mg/g of CHX), and compared to a pure gel (GEL) and a commercially available 2% miconazole gel (DK). The formulations were evaluated for their rheological and mucoadhesive properties; antifungal activity against Candida albicans by halo inhibition, XTT metabolic assay, minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC); cytocompatibility in an organotypic oral mucosa model by LIVE/DEAD and Alamar Blue metabolic assay; and collagen synthesis potential by fluorometric quantification. All microbiological and cytocompatibility tests were performed using mucoadhesive leachates. Statistical analysis was performed (α = 0.05).

RESULTS: Elastic behavior was predominant in the formulations, and greater mucoadhesiveness was observed in the complexed groups (p < 0.05). Limited antifungal activity was found in the GEL and DK groups, while the NYS, NYS:βCD, CHX, and CHX:βCD formulations exhibited significantly superior antifungal efficacy (p < 0.05). While formulations containing CHX significantly reduced cellular metabolic activity, those containing NYS demonstrated better cytocompatibility and increased collagen production.

CONCLUSION: The mucoadhesive gel containing NYS:βCD optimized both antifungal activity without compromising its rheological, mucoadhesive properties, and cytocompatibility at lower therapeutic doses compared to noncomplexed NYS. These findings suggest significant advantages for the treatment of oral candidiasis.

PMID:41964385 | DOI:10.1111/jopr.70135

Clin Psychol Psychother. 2026 Mar-Apr;33(2):e70263. doi: 10.1002/cpp.70263.

ABSTRACT

BACKGROUND: Despite the high prevalence of posttraumatic symptoms in early childhood, there remain significant gaps in clearly defined or widely accepted treatments specifically adapted for young children. This shortcoming highlights the urgent need for developmentally sensitive, evidence-based psychological interventions targeting children who have experienced trauma during early childhood.

OBJECTIVE: This study aimed to develop a Trauma-Focused Interaction module integrated into Parent-Child Interaction Therapy (TFI-PCIT) and to preliminarily evaluate its effectiveness in reducing trauma-related symptoms and behavioural difficulties in traumatized children aged 2-8 years, as well as its impact on parental stress and burnout.

METHOD: A fully integrated mixed-methods randomized controlled design was employed. A total of 19 parent-child dyads were assigned through stratified block randomization to an intervention group (n = 9) or control group (n = 10). The intervention group received the TFI-PCIT module, while the control group received no intervention during the study period. Between-group differences were analysed using linear mixed models, and within-group changes were examined with independent samples t-tests. Postintervention qualitative interviews were conducted to deepen interpretation of outcomes.

RESULTS: Compared to controls, children who received TFI-PCIT demonstrated statistically significant reductions in trauma symptoms and behavioural problems. Parents in the intervention group showed significant decreases in parenting stress and burnout. Qualitative findings reinforced quantitative results, indicating improved emotional regulation and strengthened parent-child interactions.

CONCLUSION: These findings provide preliminary evidence that TFI-PCIT may be a promising, developmentally sensitive intervention for young traumatized children and their caregivers.

PMID:41964379 | DOI:10.1002/cpp.70263

J Cosmet Dermatol. 2026 Apr;25(4):e70749. doi: 10.1111/jocd.70749.

ABSTRACT

BACKGROUND: Photodynamic therapy and cryotherapy are treatment options for actinic keratosis; however, their efficacy and safety remain debated.

AIMS: To perform a high-quality systematic review and meta-analysis exploring the efficacy and safety of photodynamic therapy and cryotherapy in actinic keratosis.

METHODS: A systematic search was performed applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched PubMed, Web of Science, Cochrane, Science Direct, Ovid, EBSCO, Wiley, and Google Scholar for randomized controlled trials.

RESULTS: A total of seven studies with 1233 patients were identified. PDT and cryotherapy showed similar success in clearing lesions (RR, 1.02; 95% CI, 0.92-1.13; p = 0.74). While both treatments performed comparably on the head and face (RR, 1.10; 95% CI, 0.94-1.28; p = 0.24), data from one trial suggested cryotherapy might be more effective for lesions on the arms and legs (RR, 0.88; 95% CI, 0.82-0.94; p < 0.05). However, more research is needed to confirm this finding. Cosmetic outcomes were significantly better for PDT (74.62% vs. 49.11%: RR, 1.52; 95% CI, 1.4-1.65; p < 0.00001) than cryotherapy. Similarly, PDT was superior to cryotherapy in patient satisfaction though the overall difference was not statistically significant (RR, 1.43; 95% CI, 0.91-2.25; p = 0.12). PDT was associated with a significantly higher risk of burning sensations and pain (RR, 1.95; 95% CI, 1.27-3.02; p = 0.002), whereas cryotherapy more frequently led to vesicles and blisters.

CONCLUSION: Lesion clearance may depend on location. It is comparable for head and face lesions, while data from one trial suggests cryotherapy may be better for extremity lesions. PDT is associated with a higher occurrence of pain/burning, while cryotherapy leads to more vesicles/blisters. Future research should focus on standardized protocols, including blinded post-treatment assessments to improve reliability and minimize bias.

PMID:41964358 | DOI:10.1111/jocd.70749