Category: Statistics

Biol Rev Camb Philos Soc. 2026 May 4. doi: 10.1002/brv.70176. Online ahead of print.

ABSTRACT

The impact of plastic pollution on ecosystems and marine fauna is well documented, although research into its effects on waders (also known as shorebirds) remains limited. Given that waders are exposed to coastal marine litter, this exposure could be a significant factor in the decline of their populations. This study aims to assess the global distribution of plastic ingestion in waders and investigate regional differences in their exposure. Our analysis included 30 studies, examining 316 digestive tracts and 1114 faecal samples. Only four studies analysed plastic in wader nests or entanglements. Eastern Asia exhibited the highest prevalence of plastic ingestion in waders, although no significant differences were detected among coastal regions. Descriptive patterns suggest that this trend may be influenced by intensive industrial activity, high population density, and pollution along migratory flyways. Southern Asia had the highest prevalence of plastics in faecal samples. No statistically significant differences were observed across wader families; however, descriptive results indicated elevated ingestion frequencies in Haematopodidae and Scolopacidae, while Recurvirostridae and Haematopodidae tended to show higher plastic prevalence in faecal samples. This study highlights the need for standardised sampling protocols and continued research on the effects of plastic on wader populations, which could contribute to their conservation.

PMID:42077149 | DOI:10.1002/brv.70176

J Biopharm Stat. 2026 May 4:1-22. doi: 10.1080/10543406.2026.2663458. Online ahead of print.

ABSTRACT

Randomized controlled trials with co-primary endpoints refer to trials that are designed to evaluate if the intervention is superior to the control on each endpoint. Data analysis and sample size estimation can be complicated when the endpoints are of different scales. In contrast to trials with multiple primary endpoints, where multiplicity is a concern, multiple co-primary endpoints could cause substantial power/efficiency reduction. We propose a rank-based approach to data analysis and sample size estimation for such studies. For each endpoint, we quantify the treatment effect using the win probability (WinP) that a subject in the treatment group has a better score than (or a win over) a subject in the control group. Inference for the endpoint-specific WinPs is carried out by using multivariate linear mixed models with a unstructured variance-covariance matrix for win fractions, which are derived from (mid)ranks and shown to be asymptotically uncorrelated. We focus on confidence intervals (CIs) for WinPs and testing null hypothesis based on whether all lower limits of the CIs are above 0.50. Sample size formulae are derived with the focus on determining the sample size required to guarantee with a pre-specified assurance probability that the lower limit of CI for each endpoint is above 0.50. Results from a simulation study based on a published trial on ulcerative colitis suggest that our approach performed well in terms of CI coverage and assurance probability. The results also show that baseline adjustments can result in a gain in efficiency, but dichotomizing data can decrease efficiency substantially.

PMID:42077142 | DOI:10.1080/10543406.2026.2663458

Acta Obstet Gynecol Scand. 2026 May 4. doi: 10.1111/aogs.70241. Online ahead of print.

ABSTRACT

INTRODUCTION: Topical vaginal estrogens have been used in the management of postmenopausal vulvovaginal atrophy for some time, locally reintroducing exogenous estrogens to the estrogen-receptive tissues of the female urogenital tract following a decline in systemic levels. The postpartum period is similarly a state of relative estrogen depletion due to the antagonistic effect from raised prolactin levels throughout pregnancy and lactation; this is thought to contribute to post-delivery pelvic floor dysfunction and vaginal atrophy. Given the similar etiology, there may be a role for topical vaginal estrogens in postpartum women.

MATERIAL AND METHODS: A systematic review was performed evaluating the use of topical vaginal estrogens in postpartum women. This was performed as per PRISMA guidelines, with articles screened from online databases from their inception to October 2025.

RESULTS: Three studies were identified that met the inclusion criteria, including a total of 85 women. Two studies focused on the molecular and cellular composition of tissues from postpartum women using topical vaginal estrogens, and one double-blind randomized placebo-controlled trial primarily evaluated postpartum atrophy in the presence and absence of vaginal estrogens. Tissues exposed to estrogen appeared to have increased cellular proliferation, while the Vulval Assessment Score (VuAS), a patient-subjective validated scoring system for vaginal atrophy, was found to be lower in those using vaginal estrogen cream for 12 weeks. No statistically significant difference in bladder, bowel, or sexual function was noted. No serious adverse outcomes were reported, and the use of vaginal estrogens appeared acceptable to women.

CONCLUSIONS: There is a paucity of data currently available regarding the use of topical vaginal estrogens in the post-partum period. Although likely safe for use, further evidence is required to be able to make firm conclusions about their efficacy for postpartum vaginal atrophy, and further high-quality trials are required in the future.

PMID:42077139 | DOI:10.1111/aogs.70241

Health Serv Res. 2026 Jun;61(3):e70123. doi: 10.1111/1475-6773.70123.

ABSTRACT

OBJECTIVE: To evaluate the association between Prescription Drug Monitoring Programs (PDMPs) and postpartum opioid prescribing from 2007 to 2015, prior to the 2016 Centers for Disease Control and Prevention opioid prescribing guidelines, and to assess differences between low- and high-risk populations.

STUDY SETTING AND DESIGN: This cross-sectional study captures delivery episodes across the United States, primarily from commercially insured patients. The exposure was the implementation of PDMPs at the state level from 2007 to 2015, with states classified by whether implementation occurred before or after 2016. We used a difference-in-difference design for analysis. The primary outcome included: (1) morphine milligram equivalents (MME) per day; (2) pills dispensed; (3) average days’ supply, and (4) total number of prescriptions filled during the postpartum period (42 days after delivery).

DATA SOURCES AND ANALYTIC SAMPLE: We analyzed secondary data from IQVIA PharMetrics, an administrative claims database from 2006 to 2015. We identified reproductive-age patients (ages 12-59) with a documented delivery and stratified them into low and high-risk groups by postpartum prescribing and pre-delivery opioid exposure.

PRINCIPAL FINDINGS: Among 361,165 delivery episodes (9.9% cesarean, 90.1% vaginal), PDMP implementation was not associated with changes in postpartum opioid prescribing. In an age-and comorbidity-adjusted analysis by risk groups, PDMP implementation was not associated with statistically significant changes in MME per day per delivery in either low-risk (-0.35; 95% CI, -3.27 to 2.57) or high-risk groups (1.11; 95% CI, -7.46 to 9.68) in the implementation year, and results for pills dispensed, days’ supply, and total prescriptions were similarly null, with confidence intervals spanning zero.

CONCLUSION: State-level PDMP implementation was not associated with changes in postpartum opioid prescribing. These findings suggest PDMPs alone may be insufficient to influence postpartum prescribing, highlighting the need for alternative strategies to optimize pain management and reduce opioid-related risks.

PMID:42077138 | DOI:10.1111/1475-6773.70123

Acta Obstet Gynecol Scand. 2026 May 4. doi: 10.1111/aogs.70238. Online ahead of print.

ABSTRACT

INTRODUCTION: This study aimed to evaluate the role of radiomic analysis applied to ultrasound images in predicting postpartum blood loss at birth in women affected by low-lying placenta or placenta previa.

MATERIAL AND METHODS: In this retrospective, single-center study, we analyzed singleton pregnancies with placenta previa or a low-lying placenta, initially diagnosed at the second-trimester ultrasound examination. Data were collected from ultrasound examinations conducted in the second and third trimesters, along with birth outcomes. Radiomic analysis was conducted on archival ultrasound images to extract quantitative features. Predictive models were constructed utilizing multivariable generalized linear modeling (Gamma regression with a log link), encompassing radiomics-only, clinical/sonographic-only, and an integrated model.

RESULTS: In the final analysis of 107 women, 51 exhibited postpartum blood loss exceeding 500 mL. A prior cesarean delivery was recognized as a notable clinical risk factor. Multiple radiomic features identified in second- and third-trimester ultrasound scans correlated with a heightened risk of significant blood loss during birth. The integrated predictive model exhibited superior accuracy for blood loss exceeding 500 mL, achieving an AUC of 82.32% (95% CI: 74.18%-90.45%). This performance surpassed that of the clinical ultrasound model, which had an AUC of 71.27% (95% CI: 62.27%-80.27%), with a statistically significant difference (p = 0.001). Additionally, it demonstrated a nonsignificant improvement over the radiomics-only model, which recorded an AUC of 77.17% (95% CI: 68.25%-86.09%).

CONCLUSIONS: Radiomic analysis of ultrasound images enhances risk prediction for postpartum major blood loss in pregnancies affected by placenta previa and low-lying placenta. Integrating radiomics with clinical and sonographic data improves predictive accuracy, offering a promising tool for personalized obstetric risk assessment and management.

PMID:42077135 | DOI:10.1111/aogs.70238

Cancer Biother Radiopharm. 2026 May 4:10849785261443946. doi: 10.1177/10849785261443946. Online ahead of print.

ABSTRACT

BACKGROUND: Esophageal cancer often has a significant locoregional recurrence risk after curative resection. Conventional postoperative radiation is largely based on anatomical imaging, which may not adequately detect microscopic residual disease or biological tumor heterogeneity.

PURPOSE/HYPOTHESIS: The incorporation of radiopharmaceutical-guided molecular imaging enables biologically adaptive dosage adjustment.

POPULATION/SUBJECTS: The study assesses the feasibility and therapeutic efficiency of radionuclide-informed individualized adjuvant radiation planning following esophageal cancer resection.

ASSESSMENT: Positron Emission Tomography (PET)/Computed Tomography (CT) imaging with tumor-specific tracers enabled the identification of biological targets.

STATISTICAL TESTS: Voxel-based dose painting was used, and plans were compared using the conformity index (CI), homogeneity index, V95% coverage, tumor control probability (TCP), and normal tissue complication probability (NTCP). Radiopharmaceutical imaging revealed additional high-risk areas in 34.7% of patients. Personalized planning increased the CI (1.21 to 0.97), V95% (91.2% to 97.8%), and TCP (68.4% to 82.9%). Mean lung and heart doses decreased by 14.3% and 11.7%, respectively, decreasing the predicted NTCP for pneumonitis from 16.5% to 9.2% (p < 0.001).

RESULTS: Radionuclide-guided personalized adjuvant radiation improves biological target coverage, increases TCP, and minimizes normal tissue toxicity, hence confirming its role in precision postoperative management of esophageal cancer.

PMID:42077127 | DOI:10.1177/10849785261443946

Dent Traumatol. 2026 May 4. doi: 10.1111/edt.70077. Online ahead of print.

ABSTRACT

BACKGROUND/AIM: Propolis, known for its potent antioxidant, anti-inflammatory, and antimicrobial effects, when incorporated into a hydrogel, may enhance the preservation of human periodontal ligament cell viability following dental trauma. This study aimed to develop and evaluate a novel propolis-enriched hydrogel as a storage medium for avulsed teeth prior to replantation.

MATERIALS AND METHODS: The hydrogel was prepared by mixing distilled water with a gelling agent and macerating the mixture for 24 h. Subsequently, samples containing 70% ethanol and water were formulated with varying volumes of propolis extract. The physical properties of the hydrogel were then evaluated. Human periodontal ligament fibroblasts were incubated with the test materials for 3 and 6 h, after which cell viability was assessed using the PrestoBlue reagent and compared with pasteurized milk and saline (0.9% NaCl), which served as a negative control. Statistical analysis was performed using one-way ANOVA followed by Fisher’s least significant difference post hoc test.

RESULTS: The findings demonstrated that the incorporation of propolis into the hydrogel formulations enhanced their bioactive properties, particularly increasing phenolic content and antioxidant activity. In terms of human periodontal ligament fibroblast viability, no significant differences were observed among groups after 3 h. However, after 6 h, cell viability in the saline group decreased to 67% of the control, while all other groups maintained approximately 100% viability.

CONCLUSIONS: Propolis hydrogels effectively preserved the viability of human periodontal ligament cells for at least six hours. A comprehensive evaluation of all parameters suggests that the hydrogel formulation containing 6 g of water-based propolis extract provides the most favorable balance between mechanical properties and biocompatibility.

PMID:42077126 | DOI:10.1111/edt.70077

Immunotherapy. 2026 May 4:1-14. doi: 10.1080/1750743X.2026.2668210. Online ahead of print.

ABSTRACT

Relapsed small cell lung cancer (SCLC) is widely considered as a difficult-to-treat disease with an adverse prognosis and scarce therapeutic options, especially in the case of platinum-resistance. Tarlatamab (IMDELLTRA™), a first-in-class, Delta-like ligand-3 (DLL3)-targeted bispecific T-cell engager (BiTE), works by creating a molecular bridge between DLL3 on tumor cells and CD3 on T-cells, leading to T-cell activation and Τ-cell-mediated tumor cell lysis. Tarlatamab demonstrated promising efficacy in early-phase trials at the cost of immune-mediated toxicities like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). CRS and ICANS emerge primarily during the first two cycles of treatment, have low to moderate severity and are generally manageable with general supportive measures and specialized immunosuppressive treatment including corticosteroids and monoclonal antibodies like tocilizumab. Tarlatamab appears to be a promising choice for relapsed SCLC, based on the results of the Phase III DeLLphi-304 trial, which demonstrated a clinically and statistically meaningful improvement in overall survival (OS) with its use compared to approved second-line chemotherapy (ChT) options. Having been recently granted FDA approval for use in patients with SCLC who progressed on or after platinum-based ChT, tarlatamab is currently being evaluated in multiple settings of SCLC, including first-line and maintenance treatment.

PMID:42077112 | DOI:10.1080/1750743X.2026.2668210

Arch Ital Urol Androl. 2026 May 4:14920. doi: 10.4081/aiua.2026.14920. Online ahead of print.

ABSTRACT

BACKGROUND: The Acute Cystitis Symptom Score (ACSS) is an internationally validated patient-reported outcome (PRO) tool for diagnosing and monitoring acute uncomplicated cystitis (AC) in women, available in several language versions. The current study reports the linguistic and clinical validation of the Kazakh version of the ACSS.

METHODS: Linguistic validation followed internationally accepted guidelines for the cultural adaptation of PRO instruments. The current validation study included 100 Kazakhspeaking women. All respondents participated in cognitive debriefing to ensure clarity and comprehensibility of the translated PRO. Participants completed diagnostic Part A of the Kazakh version of the ACSS at initial admission and follow- up Part B at each follow-up visit. Descriptive statistics were used to summarise demographic characteristics. The comparative analysis included parametric and nonparametric tests where appropriate. Reliability of the Kazakh version of the ACSS was measured using Cronbach’s alpha and splithalf reliability. Diagnostic performance was assessed by sensitivity and specificity. Statistical significance was set at p = 0.05.

RESULTS: Sixty-seven women with AC (mean age 39.24 ± 13.66 years) and 33 without evidence of urinary tract pathology (mean age 44.94 ± 17.99 years) were included in the Patient and Control groups, respectively. No significant demographic differences were observed between groups. Median scores in the “Typical” domain were significantly higher in Patients than in Controls (5.00 vs 0.00). Internal consistency was high for the “Typical” (Cronbach’s α = 0.86) and “QoL” (α = 0.91) domains. Split-half reliability analysis showed a correlation coefficient of 0.65, a Spearman-Brown coefficient of 0.79, and a Guttman split-half coefficient of 0.77. The sensitivity and specificity of the Kazakh version of the ACSS, using the predefined cut-off value of 6 based on the “Typical” domain summary score, were 0.85 and 0.90, respectively.

CONCLUSIONS: The Kazakh version of the ACSS demonstrates good reliability and strong discriminative ability, supporting its use in the clinical assessment of AC in Kazakh-speaking women.

PMID:42077093 | DOI:10.4081/aiua.2026.14920

Br J Psychiatry. 2026 May 4:1-9. doi: 10.1192/bjp.2026.10652. Online ahead of print.

ABSTRACT

BACKGROUND: Attention-deficit hyperactivity disorder (ADHD) is increasingly recognised as a social identity as well as a medical diagnosis. Social identity theory suggests that group identification can benefit self-esteem, well-being and mental health, but little is known about ADHD social identification or preferred terminology in English.

AIMS: We aimed to measure ADHD social identification and preferred terminology in a sample of adults with ADHD in the UK and to understand whether ADHD social identification is related to improved self-esteem, well-being and mental health.

METHOD: Three hundred and nineteen adults with ADHD in the UK participated. They were aged between 18 and 73 years and 59% were female. Participants completed self-report measures of ADHD social identification, self-esteem, well-being, anxiety, depression, terminology preferences, medication use and sources of learning about ADHD. Descriptive statistics were used to identify the percentage of participants who preferred ADHD-first versus person-first terminology. Pre-registered serial mediation models tested hypothesised pathways from ADHD identification to mental health via self-esteem and well-being. Further analyses examined associations between terminology preferences, medication use and sources of learning about ADHD.

RESULTS: ADHD identification was not significantly correlated with self-esteem, anxiety or depression. Most participants (77%) preferred person-first terminology (‘person with ADHD’). Higher ADHD identification was associated with identity-first language preference and medication use. Social media was the only source of learning about ADHD related to higher ADHD identification. In mediation models, ADHD identification was not associated with self-esteem or well-being; however, a subcomponent of ADHD social identification – satisfaction – was indirectly related to better mental health via self-esteem and well-being.

CONCLUSIONS: These cross-sectional findings indicated that ADHD identification did not show the hypothesised protective associations with mental health. Preferences for person-first terminology suggest ADHD is not always central to identity. Longitudinal and qualitative studies are needed to clarify causal relationships and clinical implications.

PMID:42077043 | DOI:10.1192/bjp.2026.10652