Tag: nevin manimala

Stat Med. 2026 May;45(10-12):e70578. doi: 10.1002/sim.70578.

ABSTRACT

A generalization of the classical concordance correlation coefficient (CCC) is considered under a three-level design where multiple raters rate every subject over time, and each rater is rating every subject multiple times at each measuring time point. The ratings can be discrete or continuous. A methodology is developed for the interval estimation of the CCC based on a suitable linearization of the model along with an adaptation of the fiducial inference approach. The resulting confidence intervals have satisfactory coverage probabilities and shorter expected widths compared to the interval based on Fisher’s Z-transformation, even under moderate sample sizes. Two real applications available in the literature are discussed. The first application is based on a clinical trial to determine if various treatments are more effective than a placebo for treating knee pain associated with osteoarthritis. The CCC was used to assess agreement among the manual measurements of the joint space widths on plain radiographs by two raters, and the computer-generated measurements of digitalized radiographs. The second example is on a corticospinal tractography and the CCC was once again applied in order to evaluate the agreement between a well-trained technologist and a neuroradiologist regarding the measurements of fiber number in both the right and left corticospinal tracts. Other relevant applications of our general approach are highlighted in many areas including artificial intelligence.

PMID:42068150 | DOI:10.1002/sim.70578

Aust J Rural Health. 2026 Jun;34(3):e70202. doi: 10.1111/ajr.70202.

ABSTRACT

INTRODUCTION: Indigenous peoples experience significant health inequities compared to non-Indigenous peoples. The reasons for this are multi-faceted. Access to healthcare for marginalised Indigenous peoples is made more difficult by living rurally; urban counterparts have improved healthcare access and health outcomes.

OBJECTIVE: This review aimed to further understand the healthcare experiences of rural Indigenous peoples residing in New Zealand (Aotearoa), Australia, Canada or the United States of America (USA).

INCLUSION CRITERIA: Participants were required to self-identify as Indigenous consumers of healthcare aged 18 years or older, with personal or family experiences of receiving healthcare. Contextually, rural healthcare service access in any healthcare setting was chosen. The countries chosen for inclusion were New Zealand, Australia, Canada, and the USA. Exclusion criteria included studies with non-Indigenous participants with healthcare experiences that were unable to be isolated and extracted, as well as studies involving both rural and urban healthcare experiences where the urban experiences were unable to be isolated and removed.

METHODS: The electronic databases Scopus (Elsevier), CINAHL Complete (EBSCOhost) and Medline (OVID) were searched. Articles were screened by one author (TC) to identify primary research studies that reported patient lived experiences and included Indigenous participants who live rurally. Searches were completed in June 2024 and limited to full text, English language and date limited to 2004-2024. Articles were then analysed via thematic analysis.

FINDINGS: Seven articles were analysed. The articles were located in Aotearoa, Australia, and Canada. No suitable studies from the USA were identified or included. Five themes were identified as having impacted the healthcare experiences of Indigenous peoples: distance to care; quality of care and racism; support from and impact on, whānau (family); health professional communication and knowledge sharing; and Indigenous solutions and holistic care.

CONCLUSION: Ensuring that patient-centred care also involves wider family members has been shown to be beneficial, as has the engagement of Indigenous health professionals and health workers in providing culturally inclusive healthcare. Health professionals should consider language and communication techniques when engaging with people seeking healthcare and not make assumptions, for example around health knowledge.

PMID:42068139 | DOI:10.1111/ajr.70202

J Sep Sci. 2026 May;49(5):e70429. doi: 10.1002/jssc.70429.

ABSTRACT

A micellar electrokinetic chromatography method was developed for the simultaneous separation of the phosphodiesterase-5 inhibitors sildenafil and tadalafil, two therapeutic agents used in the treatment of erectile dysfunction that are frequently identified as illicit adulterants in dietary supplements marketed for sexual enhancement. Method development was supported by a design of experiments strategy. An initial fractional factorial screening design was used to evaluate the influence of selected experimental parameters on resolution (R_s) and migration time. Pareto analysis of standardized effects indicated that cyclodextrin (CD) concentration, methanol (MeOH) content, and separation voltage significantly affected the separation, whereas pH, sodium dodecyl sulfate (SDS) concentration, and temperature did not show a statistically significant impact within the studied range. Based on the screening results, a Box-Behnken response surface design was employed to optimize the significant factors. Optimized separation conditions consisted of a 50 mM phosphate buffer (pH 2.5) containing 50 mM SDS, 10% MeOH, and 5 mM hydroxypropyl-β-CD, with a separation voltage of -20 kV and a capillary temperature of 20°C. Under these conditions, baseline separation was achieved with a R_s of 4.75 and migration times below 6 min. The method was validated in terms of precision, linearity, accuracy, and robustness, showing satisfactory analytical performance. Application to pharmaceutical formulations and dietary supplement samples confirmed the suitability of the proposed method for routine screening and quality control purposes.

PMID:42068125 | DOI:10.1002/jssc.70429

Cult Health Sex. 2026 May 2:1-14. doi: 10.1080/13691058.2026.2663055. Online ahead of print.

ABSTRACT

This pilot study examined the use of a participatory approach to co-create and prioritise menstrual health actions and interventions with university students in Ecuador. Despite growing recognition of the importance of menstrual health, university students continue to face unmet needs that can affect academic participation and daily life. Between October and November 2023, three in-person workshops engaged a total of 37 students in a structured co-creation process. The first workshop involved collaborative brainstorming, generating 31 proposed actions and interventions organised into four participant-derived categories: resources, support, infrastructure, and education. The second workshop involved thr independent ranking of the actions and interventions using a structured worksheet, with descriptive statistics used to identify a subset of highly prioritised options. The third workshop focused on refining these priorities through guided group discussion. The highest-ranked actions and interventions identified from the participatory process included institutional flexibility for chronic menstrual conditions, education-based initiatives, improved toilet/bathroom access, and student-led support. Rather than providing generalisable evidence of intervention effectiveness or population-level need, this study highlights how participatory, process-oriented methods can help generate a context-specific, student-informed response. Findings highlight the value of participatory approaches in surfacing nuanced, actionable insights in menstrual health research.

PMID:42068113 | DOI:10.1080/13691058.2026.2663055

Allergy. 2026 May 1. doi: 10.1111/all.70372. Online ahead of print.

ABSTRACT

BACKGROUND: To achieve adequate symptom control, patients with allergic rhinitis (AR) often need to increase their medication dose or add other treatments (co-medication). We aimed to perform a systematic review to compare the efficacy and safety of AR medications for increased dose versus co-medication.

METHODS: We searched four bibliographic databases and three trial databases for randomised controlled trials assessing the effect of intranasal and/or oral medications in patients of all ages with seasonal or perennial AR. We performed pairwise meta-analysis based on direct evidence to compare (i) non-standard versus standard treatment doses, and (ii) co-medication strategies versus monotherapy using standard doses. Furthermore, we fitted dose-response network meta-analysis (NMA) to obtain projected estimates for comparisons involving two times the standard dose of AR medications in monotherapy versus co-medication with the standard dose of the same medications. We assessed the certainty of evidence using GRADE for NMA.

RESULTS: We included 262 studies. Co-medication schemes involving oral antihistamines (OAH) + intranasal corticosteroids (INCS) resulted in higher improvements of nasal symptoms and quality of life than doubling the dose of OAH. However, doubling the dose of intranasal medications led to better results than having intranasal medications + OAH. Doubling the dose of INCS was associated with higher efficacy than adding intranasal antihistamines (INAH). No relevant safety differences were found between treatment strategies.

CONCLUSIONS: Results favoured (i) doubling the dose of intranasal medications versus adding OAH, and (ii) adding INCS to OAH over doubling the dose of OAH. This study will inform the ARIA-EAACI 2024-2025 guidelines.

PMID:42068093 | DOI:10.1111/all.70372

Int J Urol. 2026 May;33(5):e70483. doi: 10.1111/iju.70483.

ABSTRACT

INTRODUCTION: We assessed the extent of pelvic lymph node dissection (PLND) at partial cystectomy (PC) according to PC eligibility (≤cT2 stage, tumor ≤ 3 cm and segmental resection possible) and tested its effect on cancer-specific mortality (CSM).

METHODS: Within the SEER database (2004-2021), we identified PC patients undergoing PLND and tabulated the number of lymph nodes (LNs) removed according to PC eligibility. Multivariable Cox-regression models tested the effect of PLND extent on CSM after adjusting for age, sex, T stage, N stage, and chemotherapy.

RESULTS: Of 1017 PC patients undergoing PLND, 197 (19.4%) were eligible vs. 820 (80.6%) ineligible according to PC eligibility criteria. Median number of LNs removed at PLND was 6 (IQR: 3-11) in eligible versus 7 (IQR: 3-14) in ineligible patients (p = 0.09). Mean numbers of LNs removed at PLND increased over the study period, from 7 to 16 (p = 0.007) in PC-eligible and from 8 to 13 (p = 0.001) in PC-ineligible patients. In 1017 patients regardless of PC eligibility, 5-year CSM-free survival rate was 65.6%, and PLND extent predicted lower CSM (multivariable hazard ratio [mHR]: 0.99, p = 0.036). In 197 PC-eligible patients, 5-year CSM-free survival rate was 84.2%, and the PLND extent was not associated with CSM (mHR: 0.96, p = 0.2). Conversely, in 820 PC-ineligible patients, 5-year CSM-free survival rate was 61.1%, and PLND extent predicted lower CSM (mHR: 0.99, p = 0.043).

CONCLUSION: In all PC patients regardless of eligibility status, more extensive PLND was associated with improved cancer-specific survival.

PMID:42068079 | DOI:10.1111/iju.70483

Glob Chang Biol. 2026 May;32(5):e70894. doi: 10.1111/gcb.70894.

ABSTRACT

Decades of evidence suggests that the relationship between landscape diversity and ecosystem productivity is positive, nonlinear, and saturating-with remarkable consistency across organisms and conditions. Despite this consensus, evidence of the impact of landscape diversity on agricultural productivity remains mixed. We use mixture modeling to systematically examine consistency in the relationship between landscape diversity and crop yields in the United States across heterogeneous model specifications for different major crops and approaches to operationalizing landscape diversity. While the diversity-productivity relationship varies across crops and landscape diversity metrics, we find a consistent (87%) positive association between landscape diversity and yields. Although not significant at a 95% credibility level, across all conditions examined highly diverse landscapes are associated with yields that are, on average, 2.7% higher than yields in highly simplified landscapes. Moreover, this relationship is not saturating, suggesting that the upper limits of positive landscape diversity effects have not been reached within contemporary U.S. cropping systems.

PMID:42068077 | DOI:10.1111/gcb.70894

FEBS Open Bio. 2026 May 1. doi: 10.1002/2211-5463.70247. Online ahead of print.

ABSTRACT

FcγRI is a high-affinity receptor for IgG, associated with autoimmune disease pathology and determines clinical responses to antibody-based immunotherapies. FcγRI has a complex evolutionary history that is not fully understood, and to address this we explored signatures of positive selection in the receptor’s functional gene, FCGR1A, using codon-based selection tests on aligned 1-1 orthologous sequences from placental mammals (n = 32). Signatures of positive selection have occurred at several locations within the gene, with two sites (H¹⁴⁸ (M2a ω 0.997 & M8 ω = 0.993)) and (W¹⁴⁹ (M2a ω = 0.999 & M8 ω = 1.000)) exhibiting highest posterior probabilities, suggesting strong evidence of positive selection; these positions are known to form one of the FcγRI-IgG binding interfaces. We employed ancestral reconstruction to statistically infer prior codon sequences at these sites and identified ancestral H¹⁴⁸P and W¹⁴⁹R codons at different nodes in the phylogeny. Employing molecular dynamics simulations, we determined how evolutionary changes at these sites may have influenced the binding of FcγRI-IgG of modern-day Homo sapiens. Measuring RMSD, free energy, radius of gyration, hydrogen bond formation, and analyzing free energy landscapes, we demonstrate that structural instability between mutant structures vs the WT counterpart; however, overall binding potential increases at position 148, yet decreases at 149 in potential. H¹⁴⁸P protonation at physiological pH remains similar, yet during acidotic calculations, protonation is likely reduced, with predicted reduction in affinity for IgG. While ancestral W¹⁴⁹R substitutions demonstrate an implication for electron conjugation. Examining key sites at this binding FcγRI-IgG interface, our data demonstrate that these two codons have evolved in humans to be relatively insensitive to shifts in pH promoting a more stable interaction with the Fc portion of IgG during diseases that promote acidosis.

PMID:42068062 | DOI:10.1002/2211-5463.70247

Scand J Pain. 2026 May 1;26(1). doi: 10.1515/sjpain-2026-0004. eCollection 2026 Jan 1.

ABSTRACT

OBJECTIVES: To investigate if sociodemographic factors are associated with selection to an interdisciplinary pain rehabilitation program (IPRP) in Swedish tertiary care, in an intersectional perspective.

METHODS: This study involved 39,346 patients referred to tertiary care, who were registered in the Swedish Quality Registry for Pain Rehabilitation during 2009-2016. Self-reported sociodemographic data, and data related to pain and its consequences, were registered prior to IPRP (at baseline). Self-reported data on pain and its consequences were also registered directly after the IPRP and at a 12 months’ follow-up. Patients not selected for IPRP reported only baseline data. The statistical analyses used logistic regressions including interaction terms, and the results were analyzed in an intersectional framework to emphasize unequal health care.

RESULTS: Sex, age, education, and region of birth were found to influence the likelihood of being selected to IPRP. Non-Nordic-born patients with elementary education had the lowest proportion of selection to IPRP, with a similar proportion for men and women. Other subgroups showed a smaller difference between Nordic and non-Nordic countries in the proportion selected to IPRP. For several groups, longer education had a positive impact on the proportion of selection. Selection increased with age to a peak in middle age and then decreased. Unexpectedly, the youngest patients were less likely than middle-aged patients to be selected.

CONCLUSIONS: In Swedish tertiary care, sex, age, education, and region of birth influence selection to IPRP as combinations but not necessarily as single factors. More knowledge is needed to ensure equal, knowledge-based rehabilitation for patients with chronic pain. The regional ethics review board in Uppsala (IRB/REC 2018/036) and the Swedish ethical review authority (IRB/REC 2020-00828) issued ethical approvals.

PMID:42068060 | DOI:10.1515/sjpain-2026-0004

Ecol Lett. 2026 May;29(5):e70393. doi: 10.1111/ele.70393.

ABSTRACT

Understanding how plants influence each other’s spatial distribution is pivotal not only for interpreting current communities, but also for anticipating their responses to global changes. The combination of high-resolution, multi-scale sampling and novel statistical frameworks now enables us to identify species aggregations and segregations within their local co-occurrences. By applying this approach to approximately 800 plant species and their communities across the French Alps, we discovered that local species associations are dependent on soil acidity and nitrogen rather than climate. By building a regional network from these associations, we identified a centralised core comprising a few dominant, stress-tolerant graminoids and shrubs with high leaf dry matter content and no unique functional roles. Our findings demonstrate that plant community assembly is less dependent on random co-occurrence and more dependent on segregation around a few dominant, stress-tolerant species, with soil conditions modulating the outcome of local associations.

PMID:42068051 | DOI:10.1111/ele.70393