Category: Statistics

JAMA Netw Open. 2026 May 1;9(5):e2610839. doi: 10.1001/jamanetworkopen.2026.10839.

ABSTRACT

IMPORTANCE: Allogeneic hematopoietic cell transplant (HCT) is curative for hematologic cancers, yet access remains inequitable for racially and ethnically underrepresented and socioeconomically disadvantaged populations, making the goal of having a suitable donor for every patient who needs a transplant challenging. The ACCESS trial broadened access by enrolling patients without matched donors, who instead received an HCT from a mismatched unrelated donor.

OBJECTIVE: To compare baseline characteristics of ACCESS trial participants with participants enrolled in a similar clinical trial and a patient-reported outcome (PRO) protocol cohort.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study included adult participants (aged ≥18 years) from 3 cohorts-the ACCESS trial (2021-2024), BMT CTN 1703 trial (2019-2021), and Center for International Blood and Marrow Transplant Research (CIBMTR) PRO Protocol observational study (2020-2025)-who completed a baseline PRO survey. The ACCESS and PRO Protocol cohorts were stratified by conditioning intensity (myeloablative [MAC] vs reduced-intensity and nonmyeloablative [RIC/NMA]); all BMT CTN 1703 participants received RIC/NMA.

EXPOSURE: Hematopoietic cell transplant.

MAIN OUTCOMES AND MEASURES: Racial and ethnic diversity, insurance type, education, and income were compared among cohorts using counts and percentages, and socioeconomic and structural disadvantage were measured using the Social Vulnerability Index and Comprehensive Score for Financial Toxicity-Functional Assessment of Chronic Illness Therapy.

RESULTS: Baseline surveys were completed by 208 participants in the ACCESS trial (median [range] age at transplant, 62.3 [20.4-78.9] years; 108 male [51.9%]), 122 participants in the PRO Protocol study (median [range] age at transplant, 63.9 [21.1-78.0] years; 67 male [54.9%]), and 342 participants in the BMT CTN 1703 trial (median [range] age at transplant, 66.9 [20.7-78.6] years; 218 male [63.7%]). Participants in ACCESS were more racially and ethnically diverse, with 15 (7.2%), 25 (12.1%), 46 (22.2%), 110 (53.1%), and 11 (5.3%) of Asian, Black or African American, Hispanic or Latino, White, and other race and ethnicity, respectively, compared with 4 (3.3%), 2 (1.6%), 8 (6.6%) 104 (85.2%), and 4 (3.3%), respectively, in the PRO Protocol and 10 (3.0%), 0, 16 (4.8%), 302 (91.0%), and 4 (1.2%), respectively, in the BMT CTN 1703 trial. Participants in ACCESS were more likely to have Medicaid (36 [18.1%]) vs PRO Protocol (8 [6.7%]) and BMT CTN 1703 (16 [5.1%]) participants and reported lower education (some college or an associate’s degree: 103 [49.5%] vs 73 [59.8%] in the PRO Protocol; postcollege education: 34 [17.3%] vs 35 [29.2%] in the PRO Protocol) and household income (<$40 000 annually: 25 [24.0%] vs 8 [11.6%] in the PRO Protocol and 7 [38.9%] in the BMT CTN 1703 trial). Median Social Vulnerability Index scores were highest among participants in the ACCESS MAC group (median [range], 0.72 [0.01-0.97] vs 0.61 [0.16-0.78] in the PRO Protocol MAC group), and 16 participants [27.6%] in the ACCESS MAC group reported moderate to severe financial toxicity. The ACCESS participants lived closer to transplant centers, especially in the RIC/NMA group (median [IQR], 28 [14-75] miles vs 47 [16-96] miles for BMT CTN 1703 participants and 49 [21-104] miles for PRO Protocol participants).

CONCLUSIONS AND RELEVANCE: This cross-sectional study of clinical trial participants and a clinical cohort found that the ACCESS trial enrolled a more racially and ethnically diverse and socioeconomically disadvantaged population. Trial designs that broaden eligibility could expand access to HCT, highlighting the need for systemic interventions to ensure equity.

PMID:42084866 | DOI:10.1001/jamanetworkopen.2026.10839

Vet Med Sci. 2026 May;12(3):e70981. doi: 10.1002/vms3.70981.

ABSTRACT

Neospora caninum (protozoa: Apicomplexa) is a major cause of economic losses in bovine production systems due to reproductive failure and abortion in cows. Although there is evidence of camelids being exposed to N. caninum, the importance of these animals in the parasite’s life cycle is unclear. Therefore, the present systematic review and meta-analysis was conducted for the first time to assess the seroprevalence of N. caninum in camels to improve understanding of the epidemiology of the disease and identify factors influencing its prevalence. Relevant scientific articles were retrieved from three databases (PubMed, Web of Science and Scopus) and the internet search engine Google Scholar without time limitations up to 1 August, 2025. Meta-analysis was performed using a random-effects model with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q and I²-statistic. Sources of heterogeneity were explored through subgroup and meta-regression analyses. A funnel plot, along with Begg’s and Egger’s tests, was used to detect publication bias. A total of 32 articles, including data on 12,749 camels, published between 1998 and 2025, met the final eligibility criteria. The pooled prevalence of N. caninum in camelids was 10% (95% CI: 7%-12%) with significant heterogeneity (I² = 93.75%, p < 0.0001). The highest seroprevalence was detected in Old World camelids at 14% (95% CI: 10%-19%), indicating greater susceptibility to N. caninum exposure. Higher prevalence rates were observed in Europe (14%, 95% CI: 7%-26%) and Asia (12%, 95% CI: 8%-18%) than in Australia (2%, 95% CI: 0%-8%). No significant differences in N. caninum seroprevalence were found between age groups, genders, host species, or diagnostic methods. The funnel plot and Begg’s and Egger’s tests indicated no substantial publication bias (Egger’s test: p = 0.07). Despite the relatively low seroprevalence of N. caninum in camelids, the present results indicate a wide distribution of this parasite worldwide. Further research is warranted to investigate the role of camels in the life cycle of N. caninum.

PMID:42084849 | DOI:10.1002/vms3.70981

Pharm Dev Technol. 2026 May 5:1-14. doi: 10.1080/10837450.2026.2668485. Online ahead of print.

ABSTRACT

Lornoxicam (LX) is a potent non-steroidal anti-inflammatory drug (NSAID) whose long-term oral administration is limited by gastrointestinal adverse effects. The present study aimed to develop and evaluate LX-loaded proniosomal topical gels as a strategy to enhance dermal permeation and anti-inflammatory efficacy, with direct comparison to a conventional LX gel. LX-loaded proniosomal Gels were formulated by combining lecithin, cholesterol, and a non-ionic surfactant. A conventional gel formulation was also prepared to compare its effectiveness with the proniosomal gel formulation. The vesicle size, Polydispersity index (PDI), zeta potential (ZP), encapsulation efficiency, morphology, in-vitro LX release, ex-vivo, and finally, the anti-inflammatory efficacy of both formulations was thoroughly characterized. For the proniosomal variants, vesicle sizes were recorded at 373 ± 29 nm for Span 60-based proniosomes (NS) and 230 ± 28 nm for Tween 80-based proniosomes (NT), with corresponding PDI values of 0.23 and 0.31 and zeta potentials of -26 mV and -28 mV, respectively. Encapsulation efficiency exceeded 88% across both formulations. Notably, ex vivo evaluations demonstrated markedly improved skin permeation in the proniosomal gels. The Fluxes measured 51. µg/cm²/hr. for NS, 18.7 relative to the standard gel (12.4). These findings were corroborated by anti-inflammatory efficacy studies, which revealed statistically significant improvements with the proniosomal gel (p < 0.05) compared to the standard formulation.

PMID:42084848 | DOI:10.1080/10837450.2026.2668485

Pharmacoeconomics. 2026 May 5. doi: 10.1007/s40273-026-01616-1. Online ahead of print.

ABSTRACT

BACKGROUND: Pulmonary arterial hypertension (PAH) is a rare, progressive condition associated with high per-patient treatment costs and substantial clinical burden. Interpreting cost-effectiveness evidence for rare diseases remains challenging when uniform thresholds are applied across conditions that differ markedly in prevalence and scale of healthcare production.

OBJECTIVE: The aim of this study was to estimate a prevalence-adjusted effective cost-effectiveness threshold for PAH and illustrate how disease prevalence and production scale influence the interpretation of cost-effectiveness evidence under a fixed health care budget.

METHODS: We applied a previously developed prevalence-adjusted cost-effectiveness threshold framework, referred to as a generalized dynamic prevalence (GeDP) approach, to PAH using nationally representative disease prevalence data from the Medical Expenditure Panel Survey. A flexible statistical transformation was used to accommodate the highly right skewed distribution of disease prevalence and to estimate the relationship between prevalence and effective thresholds. The analysis was anchored to an empirically estimated US health opportunity cost benchmark and applied to PAH, with comparisons to selected common and rare diseases. Illustrative scenarios examined how effective thresholds evolve under changes in disease prevalence over time.

RESULTS: Effective cost-effectiveness thresholds increased as disease prevalence declined, reflecting production-side scale effects rather than differences in societal preferences. For PAH (prevalence ≈ 0.013%), the prevalence-adjusted effective threshold was estimated at US$582,270 per QALY (95% CI 581,319-583,163), representing more than a five-fold increase relative to the reference opportunity-cost benchmark of US$104,000 per QALY applied to highly prevalent conditions. Dynamic scenarios showed that effective cost-effectiveness thresholds decline as prevalence changes over time, with larger adjustments observed for initially rare conditions.

CONCLUSION: Applying a uniform cost-effectiveness threshold across diseases implicitly assumes homogeneous production conditions and opportunity costs. Prevalence-adjusted effective thresholds derived under the GeDP framework provide a quantitative, descriptive approach for contextualizing cost-effectiveness evidence for rare diseases such as PAH without redefining societal willingness to pay or prescribing decision rules. This approach can complement existing pharmacoeconomic evaluations by improving transparency around the role of prevalence and scale in shaping opportunity costs.

PMID:42084829 | DOI:10.1007/s40273-026-01616-1

High Blood Press Cardiovasc Prev. 2026 May 5. doi: 10.1007/s40292-026-00803-7. Online ahead of print.

ABSTRACT

INTRODUCTION: The Naples Prognostic Score (NPS) has demonstrated prognostic value in oncology and certain chronic diseases. Its utility in cardio-renal-metabolic multimorbidity (CRMM) remains unexplored.

AIM: This study aims to evaluate the association between NPS and all-cause mortality in individuals with CRMM.

METHODS: We analyzed data from the National Health and Nutrition Examination Survey (1999-2018) comprising 3,602 adults with CRMM. The NPS was derived from serum albumin, total cholesterol (TC), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Weighted Cox proportional hazards models and restricted cubic spline (RCS) analysis were used to evaluate associations between NPS and all-cause mortality.

RESULTS: Over a median follow-up of 79 months, 1,621 (41.4%) deaths occurred. After comprehensive adjustment for potential confounders, each 1-point increase in NPS was associated with a 24.6% higher risk of all-cause mortality (HR 1.246, 95% CI 1.150-1.350, P < 0.0001). The HRs for all-cause mortality was 1.133 (95 % CI: 0.846-1.518, P = 0.401) in the medium NPS group and 1.721 (95 % CI: 1.248-2.375, P = 0.0009) in the high NPS group, as compared with the low NPS group. RCS analysis indicated a nonlinear relationship between NPS and all-cause mortality among participants with CRMM (Pnonlinear=0.014). Weighted quantile sum regression analysis identified NLR as the primary contributor to mortality risk (weight: 0.612 at 2 years, 0.580 at 5 years), followed by TC.

CONCLUSION: This study identified a positive, nonlinear association between NPS and all-cause mortality in CRMM individuals. The NPS integrates inflammatory, metabolic, and nutritional biomarkers into a practical prognostic tool that may enhance risk stratification and guide personalized management in multimorbidity.

PMID:42084825 | DOI:10.1007/s40292-026-00803-7

Indian J Pediatr. 2026 May 5. doi: 10.1007/s12098-026-06162-4. Online ahead of print.

ABSTRACT

OBJECTIVES: To increase the facility-based follow-up rate of high-risk neonates at the first visit and subsequent visits until 24 mo of age.

METHODS: This quality improvement study was conducted in a tertiary neonatal intensive care unit between July 2023 and May 2025. Baseline data were collected, and multiple plan-do-study-act cycles were implemented, including structured pre-discharge counseling, voice call reminders, standard operating procedures, and integration with the District Early Intervention Center. Statistical process control charts were used to monitor the monthly follow-up rates at scheduled visits through 12 mo of age.

RESULTS: A total of 1083 high-risk infants were discharged during the study (mean 46 per mo). Follow-up attendance improved significantly at the first visit (from 38% to 100%), at 1 mo (from 36% to 79%), 4 mo (from 32% to 62%), 8 mo (from 26% to 48%), and 12 mo (from 24% to 45%). The pre-discharge counseling rate increased from 40% to > 85%. Voice calls successfully reached 79% of families, and video consultations enabled the assessment of 30-40% of missed visits. Staff transitions lead to special cause variations, underscoring the need for systematic training.

CONCLUSIONS: Multipronged low-cost interventions can achieve substantial and sustained improvements in the follow-up rate of high-risk infants in a resource-limited public hospital setting.

PMID:42084819 | DOI:10.1007/s12098-026-06162-4

Antonie Van Leeuwenhoek. 2026 May 5;119(6):117. doi: 10.1007/s10482-026-02333-7.

ABSTRACT

BACKGROUND: This study aims to investigate the role of biliary microbiota (defined as the microbial community colonizing the biliary tract, including the gallbladder, intrahepatic and extrahepatic bile ducts) in the pathogenesis of cholelithiasis (CHOL) and cholangiocarcinoma (CCA), with a focus on the associations between microbial communities and these biliary diseases.

METHODS: We conducted a comprehensive bioinformatics analysis using high-throughput sequencing data obtained from the Sequence Read Archive (SRA) database to characterize the composition of microbial communities in patients with CCA and CHOL. We performed operational taxonomic unit (OTU) clustering, statistical analyses and Mendelian randomization (MR) to elucidate the causal relationships between specific bacterial strains and disease outcomes.

RESULTS: Our findings revealed differences in the relative abundance of specific microbial taxa among research groups. The CCA + CHOL group exhibited a significant increase in the abundance of Fusobacteria, particularly Fusobacterium, compared to the Control or CCA group. This suggests a potential pathogenic role for these microorganisms in CHOL formation. Additionally, the CCA group demonstrated a higher diversity index, indicating that increased microbial diversity may contribute to the progression of the disease. MR analysis identified nominally significant statistical associations between specific bacterial strains. However, the presence of pleiotropy in some analyses necessitates caution when interpreting causal relationships.

CONCLUSION: Our study highlights the complex interplay between biliary microbiota and the pathogenesis of CHOL and CCA. Modulating biliary microbiota may represent a promising therapeutic strategy for managing these diseases. Future research should focus on the functional roles of specific taxa in bile metabolism and immune modulation, ultimately improving our understanding of biliary health and disease management.

PMID:42084801 | DOI:10.1007/s10482-026-02333-7

Int J Legal Med. 2026 May 5. doi: 10.1007/s00414-026-03824-y. Online ahead of print.

ABSTRACT

The primary question in forensic age assessment is whether an individual has reached a legally defined age threshold. Cervical ring apophysis maturation has been proposed as a potential age indicator; however, it has previously been studied only with ionizing imaging. This study aimed to evaluate cervical ring apophysis maturation using magnetic resonance imaging (MRI) and to determine stage-specific probabilities for legally relevant age thresholds.This retrospective cross-sectional study included 1000 individuals (552 females, 448 males) aged 9.64-26.67 years. Maturation of the ring apophysis at C2-C4 was assessed using a five-stage MRI-adapted system. Sex-specific descriptive statistics were calculated. Age-related stage transitions were modeled using multinomial logistic regression, and conditional probabilities were estimated for the 15-, 16-, 18-, and 21-year thresholds. Observer agreement was assessed using weighted kappa.Maturation progressed sequentially from C2 to C4 in both sexes, with a broad transitional zone between stages 3 and 4. In females, median age at stage 4 ranged from 18.5 to 20.2 years in males, approximately 22 years. However, minimal ages for stage 4 were markedly lower (12.5 years in females, 13.1 years in males), and stage 3 persisted into the third decade. At stage 4, the probability of being ≥ 18 years reached 0.96-0.98 in males but only 0.54-0.61 in females. For the ≥ 21-year threshold, probabilities at stage 4 were approximately 0.65-0.70 in males and 0.34-0.40 in females.Cervical ring apophysis maturation on MRI represents a continuous and overlapping biological process. It should therefore be interpreted as a probabilistic indicator for legal thresholds rather than a definitive test of adulthood.

PMID:42084790 | DOI:10.1007/s00414-026-03824-y

Trop Anim Health Prod. 2026 May 5;58(4):249. doi: 10.1007/s11250-026-05031-8.

ABSTRACT

Mastitis is a major cause of economic losses in the dairy industry. The aim of the present study was to examine the overall prevalence of mastitis in Algeria using a systematic review and meta-analysis. The search strategy was performed for relevant literature published from 2002 to 2023 in English and French language. The databases included were PubMed, ScienceDirect, GoogleScholar, Scopus, Springer, Algerian national database i.e., the Scientific Information Database (pnst.cerist.). A total of 4,698 dairy cows were included in the 20 eligible studies for this meta-analysis. The prevalence of mastitis was estimated at 41% [95% CI 32-49%, PI 10-81%]. Cochran’s Q statistic was 405.5 (df = 19, p < 0.001), with I² = 95% and τ² = 0.0385, indicating substantial heterogeneity. The results indicated that there is high heterogeneity among studies for overall analysis. In conclusion, estimating prevalence of mastitis among cattle in Algeria, through meta-analysis (MAs) can provide adequate measures to control mastitis infection, Moreover, effective early diagnosis and proper medication may help our country to reduce incidence of mastitis and economic losses in dairy industry.

PMID:42084754 | DOI:10.1007/s11250-026-05031-8

Unfallchirurgie (Heidelb). 2026 May 5. doi: 10.1007/s00113-026-01708-9. Online ahead of print.

ABSTRACT

BACKGROUND: Knife stab injuries are rare in Germany but are gaining increasing clinical, societal and political relevance. While nationwide crime statistics document a marked rise in knife attacks, there is currently a lack of robust clinical data on hospitalized cases.

OBJECTIVE: The aim of this study was to present the temporal development of such injuries in Stuttgart over the past 10 years.

METHODS: A retrospective, single-center cohort analysis was conducted of all patients hospitalized with knife stab injuries inflicted by third parties at the Klinikum Stuttgart between 2014 and 2024. Included were externally inflicted injuries occurring in Stuttgart; self-inflicted injuries, accidents without external involvement and cases treated exclusively on an outpatient basis were excluded.

RESULTS: There was a significant increase in hospitalized patients with stab injuries with a peak in 2021. Overall, this corresponds to an increase of approximately 100% over 10 years (10% per year). During the coronavirus disease 2019 (COVID-19) pandemic, around 70% more cases occurred compared to other years. The monthly distribution showed significant peaks in April, August and December. The clustering on Sundays and Mondays indicates an elevated risk during weekend nights. A total of 92% of affected individuals were male, with a mean age of 31.1 years.

CONCLUSION: Hospitalized patients with knife stab injuries in Stuttgart significantly increased between 2014 and 2024, particularly during the COVID-19 years. The majority of the affected individuals were young men. The results confirm the clinical perception of an increasing number of severe knife stab injuries requiring hospital treatment in the Klinikum Stuttgart.

PMID:42084748 | DOI:10.1007/s00113-026-01708-9