Category: Statistics

Respir Res. 2026 May 1. doi: 10.1186/s12931-026-03693-4. Online ahead of print.

ABSTRACT

BACKGROUND: Numerous in vivo studies have demonstrated beta-2-adrenoceptor (β₂AR) -agonism as permissive in the development of allergic lung inflammation, and have implicated the arrestin-dependent signaling arm of the β₂AR in mediating this effect. However, the specific cell type(s) mediating β₂AR regulation of allergic lung inflammation remain unestablished.

METHODS: To explore the potential contribution of airway epithelia in this phenomenon, we compared the ability of ractopamine (RP), recently identified as a Gs-biased beta-agonist, to that of the unbiased/balanced beta-agonist albuterol (ALB), on IL-13-stimulated mucin and cytokine production in human airway epithelia cultures in air-liquid interface (HAE).

RESULTS: ALB, which activates both the β₂AR-arrestin and -Gs signaling pathways significantly augmented IL-13-induced mucin production in HAE. RP, which preferentially signals via Gs/PKA, did not. Although IL-13 stimulated production of numerous cytokines, including IL-1α, IL-1RA, MDC, TGF-α, and GROα, ALB-mediated augmentation of these cytokines was highly variable and not statistically significant. Similarly, RP did not augment the induction of cytokines stimulated by IL-13. Moreover, in contrast to previous studies that reported a requirement of concomitant β₂AR agonism for IL-13 to stimulate cytokine production, such a requirement was observed only in minority of the (12) cultures examined.

CONCLUSIONS: These data implicate arrestin-dependent β₂AR signaling augmenting airway epithelial mucin production as a contributor to the previously-demonstrated pro-inflammatory effects of β₂AR agonism in vivo. Moreover, they suggest that beta-agonist effects on the cytokine profile in the allergen-inflamed lung may be influenced by specific asthmatic endotypes and involve cooperativity among multiple cell types.

PMID:42067931 | DOI:10.1186/s12931-026-03693-4

BMC Med Educ. 2026 May 2. doi: 10.1186/s12909-026-09332-2. Online ahead of print.

ABSTRACT

BACKGROUND: Strengthening professional identity is crucial to mitigate nursing students’ attrition and ensure a sustainable workforce. While the hidden curriculum and learning engagement are believed to influence this identity, their interrelationships remain unclear.

AIMS: This study aims to explore the relationship between hidden curriculum and professional identity and examine whether learning engagement mediates the relationship between hidden curriculum and professional identity.

METHODS: A cross-sectional study was conducted among 623 undergraduate nursing students from two medical colleges in China. The general information questionnaire, Hidden Curriculum Evaluation Scale in Nursing Education, Utrecht Work Engagement Scale-Student, and Professional Identity Scale for Nursing Students were used for data collection, and IBM SPSS 26.0 and PROCESS macro (Model 4) were used for statistical analysis.

RESULTS: Hidden curriculum, learning engagement, and professional identity were significantly positively correlated. Learning engagement partially mediated the relationship between hidden curriculum and professional identity, accounting for 44.13% of the total effect.

CONCLUSIONS: Nursing educators should proactively develop the hidden curriculum and implement strategies to boost learning engagement, thereby fostering students’ professional identity and reducing future workforce attrition.

PMID:42067930 | DOI:10.1186/s12909-026-09332-2

BMC Oral Health. 2026 May 2. doi: 10.1186/s12903-026-08511-3. Online ahead of print.

ABSTRACT

BACKGROUND: The popularity of white teeth among patients has led to the introduction of various restorative materials with bleach shades. However, color change in these materials remains a drawback to the long-term success of such restorations. The aim of this study was to compare the effects of different light-curing intensities on the color change of three Resin-Based Composite types in two shades after immersion in coffee.

METHODS: In this in vitro study, 120 samples of three types of Resin-Based Composite were prepared, including Vit-l-escence in two shades (PN and OS), Gradia in two shades (A2 and XBW), and Filtek Z350 XT in two shades (A2 and XW). They were polymerized at intensities of 1000 mW/cm² and 1400 mW/cm² using a Valo light-curing device for 20 s. All specimens were incubated in distilled water at 37 °C for 24 h. After measuring the initial color, all specimens were immersed in a coffee solution at 50 °C for 7 days. The final color of the specimens was re-evaluated, and ΔE₀₀ was calculated. Data were analyzed using One and Three-way ANOVA, and Post hoc Tukey HSD test in SPSS 26. P < 0.05 was considered statistically significant.

RESULTS: Resin-Based Composite type (P < 0.001), Resin-Based Composite shade (P < 0.001), and light-curing intensity (P < 0.001) had a significant effect on color change. The greatest color change was observed in Vit-l-escence (bleach shade, light-curing intensity of 1000 mW/cm²) and the lowest color change was in Gradia Direct (normal shade, light-curing intensity of 1400 mW/cm²). The higher light-curing intensity (1400 mW/cm²) significantly reduced color change in Gradia for both bleach and normal shades, as well as in Vit-l-escence for both bleach and normal shades.

CONCLUSIONS: Gradia Direct and Vit-l-escence showed less significant color change at a light-curing intensity of 1400 mW/cm² compared to 1000 mW/cm²; however, Filtek Z350 did not exhibit this result. The color change of bleach shade Resin-Based Composites was also greater than that of the normal shades. Thus, light-curing intensity may influence the color stability of Resin-Based Composites, and this effect likely depends on multiple factors, such as Resin-Based Composite shade and type.

PMID:42067920 | DOI:10.1186/s12903-026-08511-3

BMC Oral Health. 2026 May 1. doi: 10.1186/s12903-026-08495-0. Online ahead of print.

ABSTRACT

AIM: The aim of this study is to assess whether coloured resin composites undergo greater colour changes following exposure to a colouring solution after the use of a whitening mouthwash.

MATERIALS AND METHODS: Sixty composite discs (2 × 8 mm) were prepared and divided into three groups (n = 20). Each group was then randomly assigned to one of two different mouthwash groups (n = 10). The samples were then immersed in a coffee solution for 6 days. The samples were immersed in a whitening mouthwash solution for 24 h. The samples were then immersed in the coffee solution again for 6 days. ∆E values were calculated according to the CIEDE2000 color system. For statistical analysis, the Kolmogorov-Smirnov test, one-way ANOVA, and the LSD Post Hoc test were performed. The significance level was taken as P < 0.05.

RESULTS: For both ΔE_{00 (1-0)}, and ΔE_{00 (3-2)}; the highest colour difference values were observed in the OMN group, whilst the lowest values were observed in the EST group (P < 0.001). For ΔE_{00 (2-1)}, the values for the OMN group were found to be significantly higher than those for both the EST and PAL groups (P < 0.001).

CONCLUSION: In this study, which investigated whether coloured composite resins undergo further colour changes following exposure to a whitening mouthwash, varying degrees of colour change were observed in the composite resin samples. Re-exposure of the composite resins, which had changed colour following the use of a whitening mouthwash, to the colouring solution did not result in further colour change.

PMID:42067918 | DOI:10.1186/s12903-026-08495-0

BMC Psychol. 2026 May 1. doi: 10.1186/s40359-026-04611-5. Online ahead of print.

ABSTRACT

BACKGROUND: Adolescence is a critical developmental stage characterized by heightened vulnerability in psychological and behavioral domains. During this period, adverse experiences such as social ostracism, anhedonia, and behavioral problems are more prevalent and can significantly disrupt individual well-being. Interventions that fail to account for adolescents’ developmental characteristics often remain ineffective. This study aims to contribute to the literature by examining the interrelationships among these variables through an integrated and holistic framework.

METHODS: The research employed a correlational survey design and was conducted with high school students. Advanced statistical techniques were used to analyze the data, allowing for a comprehensive exploration of the complex associations among the study variables.

RESULTS: The findings revealed that adolescents’ resilience negatively and indirectly influenced ostracism through anhedonia, and further affected both externalizing and internalizing behaviors indirectly and negatively through anhedonia and ostracism. Conversely, anhedonia was found to have an indirect and positive effect on externalizing and internalizing behaviors via ostracism.

CONCLUSIONS: The study demonstrated that resilience serves as a protective factor, buffering adolescents against adverse emotional and social experiences. However, anhedonic tendencies were shown to weaken social relationships and exacerbate behavioral difficulties. These findings underscore the importance of strengthening protective factors such as psychological resilience in interventions designed for adolescents.

PMID:42067911 | DOI:10.1186/s40359-026-04611-5

BMC Psychol. 2026 May 1. doi: 10.1186/s40359-026-04035-1. Online ahead of print.

ABSTRACT

OBJECTIVE: This study investigates how emotional intelligence mediates the link between future temporal orientation and depressive symptoms in university students and explores whether physical activity moderates this connection.

METHOD: Data were collected from 1,014 undergraduate students (490 males and 524 females) across three universities in Fujian Province, China, between 1 March and 5 July 2024. Participants were selected via random sampling and completed the Future Time Perspective Scale, Emotional Intelligence Scale, Physical Activity Rating Scale, and Epidemiologic Studies Depression Scale. Statistical analyses included Pearson’s correlation, linear regression, and moderated mediation analysis (PROCESS Model 7) using SPSS 22.0.

RESULTS: (1) Future time perspective significantly and negatively predicted depression (β = -0.32, p < 0.001). (2) Emotional intelligence partially mediated the association between future time perspective and depression (indirect effect = -0.11, SE = 0.02, 95% CI [-0.15, -0.08]). (3) Physical exercise moderated the first-stage path of the mediation model (FTP → EI). Simple slope analyses showed that the FTP-EI association was significant at both low (M – 1 SD) and high (M + 1 SD) levels of physical exercise, but was stronger at high physical exercise (simple slope: β = 0.41, p < 0.01) than at low physical exercise (simple slope: β = 0.25, p < 0.01).

CONCLUSION: Future time perspective influences depression both directly and indirectly through emotional intelligence. Additionally, physical exercise enhances the predictive effect of future time perspective on emotional intelligence, suggesting that active individuals exhibit a stronger link between future-oriented thinking and emotion regulation.

PMID:42067909 | DOI:10.1186/s40359-026-04035-1

Arthritis Res Ther. 2026 May 1;28(1):102. doi: 10.1186/s13075-026-03822-w.

ABSTRACT

Juvenile idiopathic arthritis (JIA) comprises a heterogeneous group of childhood-onset inflammatory arthritides that remain challenging to treat. An expanding range of biologic and targeted synthetic disease-modifying antirheumatic drugs has improved outcomes, yet major unmet needs persist including predicting treatment response and identifying optimal drug sequences. Traditional frequentist randomised controlled trials (RCTs) are often infeasible in JIA because of small sample sizes and ethical concerns about placebo use in children. Modified RCTs – including randomised withdrawal, placebo-phase, and escape designs – have reduced placebo exposure but have inherent limitations. Here we discuss how innovative trial methodologies may enhance our capacity to generate evidence that can improve outcomes for children and young people with JIA. Adaptive designs, Bayesian methods, sequential multiple assignment randomized trials, and two-stage stop-go designs offer greater flexibility within trials, allowing for study protocols to be adapted based on preliminary data. Insights from multiomic analysis of JIA synovial tissue mean that biologically defined endotypes may fundamentally reshape trial stratification and support biomarker-led precision medicine. Master protocols (basket, umbrella and platform trials) provide opportunities to streamline research by combining data into a single trial. The incorporation of external data can increase statistical power and circumvent challenges in recruiting paediatric controls. Integrating these methodological and biological innovations will be critical for delivering targeted, effective, and age-inclusive therapeutic strategies, ultimately improving outcomes for children and young people living with JIA.

PMID:42067908 | DOI:10.1186/s13075-026-03822-w

J Ovarian Res. 2026 May 1. doi: 10.1186/s13048-026-02110-0. Online ahead of print.

ABSTRACT

BACKGROUND: Characterisation of CT detected ovarian masses is challenging with overlapping imaging features, unreliable biomarker or clinical presentation. We proposed a two-staged CT-based radiomics model to identify early-stage ovarian carcinoma (ES-OC) and sub-classify different types of benign ovarian masses (BOM).

METHODS: Patients with histologically confirmed BOM or ES-OC (FIGO I-II) were retrospectively recruited from 5 centres. Radiomics features were derived from CT images using PyRadiomics (v3.0.1), which intrinsically resampled volumes to isotropic 1 mm³ voxels. To reduce feature redundancy, features with high correlation (Spearman’s ρ ≥ 0.85) were excluded. Two-staged feature selection was applied. First, elastic-net regression with repeated 5-fold stratified cross-validation (100 iterations) was performed to identify highly repeatable features, followed by Mann-Whitney U testing for statistical significance. Second, Boruta algorithm with Random Forest (RF) estimator was employed over 500 iterations to robustly select features by comparing their importance to randomized shadow features. Several machine learning (ML) classifiers were evaluated using stratified 10‑fold GridSearch cross-validation with area under the curve (AUC) as tuning metric. The optimal model from each stage with highest cross-validated AUC was then evaluated on the respective test set. The AUC, calibration plot, and decision curve analysis (DCA) were employed to assess the performance and clinical utility of models.

RESULTS: The study enrolled 483 patients with 529 lesions (ES-OC: 192 patients, 192 lesions; BOM: 291 patients, 337 lesions). In the first-stage, logistic regression (LR) algorithm was selected with high sensitivity (0.870), moderate specificity (0.719) and high AUC (0.859) in the test set. In the second-stage, support vector machines (SVM) had high diagnostic accuracy with sensitivity 0.750, specificity 0.839 and AUC 0.918. DCA identified the highest benefit at 0.20 risk threshold probability in determining ES-OC.

CONCLUSION: The two-staged CT-based radiomics model incorporating LR and SVM algorithms had high diagnostic efficiency in characterising ES-OC and BOM, potentially in triaging disease and personalising care.

PMID:42067904 | DOI:10.1186/s13048-026-02110-0

BMC Psychol. 2026 May 1;14(1):643. doi: 10.1186/s40359-026-04627-x.

ABSTRACT

Stigmatizing attitudes toward individuals with mental disorders represent a major barrier to treatment, recovery, and social inclusion. The present research introduces and psychometrically evaluates the German-language Stigma Toward People with Mental Disorders scale (SToP-MD) across three independent studies with distinct samples.In study 1 (N = 266), an initial item pool was developed and refined based on theoretical frameworks and exploratory factor analysis. In study 2 (N = 448), confirmatory factor analysis supported a two-factor structure comprising prejudiced stigmatization (SToP-MD-PS) and assumption of problems (SToP-MD-AP). The model demonstrated adequate fit according to conventional indices (CFI = 0.97, TLI = 0.96, SRMR = 0.07), although robust indices indicated only moderate fit (robust CFI = 0.91, robust RMSEA = 0.13). Internal consistency was good for the PS subscale (ω = 0.83) but limited for the AP subscale (ω = 0.51). In study 3 (N = 266), the scale’s sensitivity to short-term change was examined following exposure to differently framed media content.As hypothesized, the SToP-MD subscales were positively associated with depression stigma (DSS) and social distance (SDI), and negatively correlated with openness and agreeableness (NEO-FFI), supporting convergent validity. Discriminant validity was partially confirmed by low or non-significant correlations with attitudes toward physically disabled individuals (ATDP), suicide-related cognitions (CCSS), and socially desirable responding (BIDR).Across all three studies, the SToP-MD demonstrated preliminary yet consistent evidence of structural and construct validity, as well as change sensitivity. It captures both overt prejudices and implicit burden assumptions, offering a nuanced assessment of public stigma toward mental disorders. The scale can serve as a valuable tool in stigma research, public health monitoring, and evaluation of interventions. Future research should extend validation to more diverse samples and test predictive and longitudinal utility.

PMID:42067898 | DOI:10.1186/s40359-026-04627-x

BMC Musculoskelet Disord. 2026 May 1. doi: 10.1186/s12891-026-09802-0. Online ahead of print.

ABSTRACT

BACKGROUND: Traumeel (Tr14) and diclofenac gels are commonly prescribed topical treatments for Grade I-II acute lateral ankle sprain (LAS). A meta-analysis of two multi-center trials was performed to compare their clinical efficacy and supplement the evidence in support of topical treatments.

METHODS: Data from two Phase III prospective, randomised, double-blind, reference-controlled clinical trials, TAASS (2013) and TRAUMED (2024) were examined. An Individual Patient Data (IPD) meta-analysis was performed on those with an initial pain VAS (Visual Analogue Scale) score ≥ 50 mm, using the statistical analysis plan from the latter to ensure methodological consistency.

RESULTS: A total of 628 patients underwent meta-analysis (mean baseline pain VAS = 72.3, mean age = 32.5). The primary endpoint of the IPD meta-analysis, Area Under the Curve (AUC) of pain VAS scores, indicated beneficial effects of Tr14 gel compared with diclofenac gel, statistically significant on Days 4, 7, and 14 (Day 4 mean difference MD_AUC-META = -6.9 [95%CI -13.7 to -0.1], P_AUC-META = 0.05; Day 7 MD_AUC-META = -26.3 [95%CI -40.4 to -12.2], P_AUC-META = 0.0003; Day 14 MD_AUC-META = -63.6 [95%CI -92.3 to -34.8]), P_AUC-META < 0.0001). A robust Wilcoxon-Mann-Whitney (WMW) analysis revealed percent changes from baseline in pain and function that were significantly superior for Tr14 gel in the pre-planned method of synthesis, compared to diclofenac gel, on all days (all PMETA < 0.05). Finally, translational effect sizes indicated less than “small” superiority on Day 4 (SMD 0.15, OR 0.78, NNT 23), and “small-medium-sized” superiority on Days 7 and 14 (Day 7: SMD 0.31, OR 0.59, NNT 12; Day 14: SMD 0.37, OR 0.53, NNT 10) for pain measured by VAS, as compared to diclofenac gel.

CONCLUSION: The IPD meta-analysis of the TAASS and TRAUMED trials confirms the efficacy of Tr14 gel. In-depth analysis reveals it is a statistically favourable treatment with respect to pain, and function, compared to the gold-standard diclofenac gel. Taking this together, Tr14 gel represents a statistically favourable treatment option for Grade I-II ankle sprain within the context of the analysed endpoints.

PMID:42067889 | DOI:10.1186/s12891-026-09802-0