Category: Statistics

JMIR Res Protoc. 2026 Apr 24;15:e87902. doi: 10.2196/87902.

ABSTRACT

BACKGROUND: School health policies and practices are key components of health promotion for children and adolescents and play a central role in shaping healthy school environments, reducing health inequities, and fostering intersectoral collaboration between education and health systems. Despite their relevance, systematic and comparable assessments of how these policies and practices are implemented across different national contexts remain limited, particularly in low- and middle-income countries. Internationally comparable data are essential to identify strengths, gaps, and priorities for investment in school health.

OBJECTIVE: The aim of this study is to describe the protocol of a mixed methods study evaluating and comparing school health policies and practices in Brazil and Portugal.

METHODS: An explanatory sequential mixed methods design (QUAN → qual → [qual] → [qual]) will be adopted. The quantitative phase (phase I) consists of a cross-sectional survey conducted with school administrators using the Global School Health Policies and Practices Survey, which assesses multiple domains of school health policies, coordination, services, and practices. Quantitative findings will inform the subsequent qualitative phases. Phase II involves semistructured interviews with school principals or head teachers to explore institutional decision-making and policy implementation. Phase III includes interviews with school nurses to examine health service organization, intersectoral collaboration, and professional practices. Phase IV comprises participatory research with adolescents using the photovoice technique to capture youths’ perspectives on school health environments and practices. The study will be conducted in elementary and secondary schools and related health services in selected cities in Brazil and Portugal. Data integration will occur sequentially through connected analyses and joint displays, enabling the development of meta-inferences that link quantitative patterns with qualitative explanations.

RESULTS: The study has secured funding from 2 funding agencies, with project activities initiated in 2025. Quantitative data collection and analysis began in October 2025 in the city of Cuiabá, Brazil. The expansion of data collection to additional Brazilian and Portuguese cities is planned for the first half of 2026. The qualitative phases, including interviews and photovoice activities, are scheduled to take place throughout 2026. The final integrated mixed methods analysis and manuscript preparation are planned for 2027, with dissemination of findings through peer-reviewed journals and national and international scientific conferences by the end of the project cycle.

CONCLUSIONS: This study is expected to generate context-sensitive and comparative evidence to support intersectoral actions and inform the development and strengthening of school health promotion policies and practices in different national settings.

PMID:42030489 | DOI:10.2196/87902

J Psychosoc Nurs Ment Health Serv. 2026 Apr 28:1-13. doi: 10.3928/02793695-20260420-02. Online ahead of print.

ABSTRACT

PURPOSE: To examine the effect of metacognitive beliefs and cognitive insight on subjective perception of recovery in individuals with schizophrenia.

METHOD: Participants in the current descriptive cross-sectional and correlational study comprised 133 individuals with schizophrenia being treated in the psychiatry clinic of a training and research hospital in Türkiye. Data were collected using a Personal Information Form, Metacognition Questionnaire-30 (MCQ-30), Beck Cognitive Insight Scale (BCIS), and Subjective Recovery Assessment Scale (SubRAS). Descriptive statistics, bivariate analysis, and hierarchical regression analysis were used to analyze the data.

RESULTS: Participants’ MCQ-30, BCIS, and SubRAS scores were 84.45 (SD = 9.90), -0.15 (SD = 5.12), and 57.78 (SD = 15.26), respectively. Metacognitive beliefs were a predictor of subjective perception of recovery (β = -0.179, p = .034). The meta-cognition score explained 10.1% of the total variance associated with subjective perception of recovery (adjusted R² = 0.101).

CONCLUSION: Results of the current study can guide psychiatric-mental health nurses to develop specific interventions and programs to support subjective recovery in individuals with schizophrenia and improve their mental health outcomes.

PMID:42030479 | DOI:10.3928/02793695-20260420-02

J Psychosoc Nurs Ment Health Serv. 2026 Apr 28:1-13. doi: 10.3928/02793695-20260414-01. Online ahead of print.

ABSTRACT

PURPOSE: To compare relational authenticity and empathy among rural and urban psychiatric-mental health nurses and examine their correlation with recovery capital in individuals with substance use disorder (SUD) using Peplau’s Theory of Interpersonal Relations as a conceptual framework.

METHOD: Using a descriptive comparative study design, 278 participants were recruited from rural and urban psychiatric settings. Nurses (n = 152) completed the Kernis-Goldman Authenticity Inventory, Interpersonal Reactivity Index, and Working Alliance Inventory-Short Version. Patients (n = 126) with SUD were evaluated using the Brief Assessment of Recovery Capital.

RESULTS: A statistically significant difference was observed in responses regarding the relational orientation domain of authenticity, as well as the fantasy and empathic concern dimensions of empathy (p = .013, p = .042, and p = .022, respectively). Empathy and therapeutic alliance were identified as significant independent predictors of authenticity among nurses. Higher levels of empathy and authentic engagement were positively associated with increased recovery capital in patients with SUD.

CONCLUSION: Empathetic and authentic nurse-patient relationships, as framed by Peplau’s theory, are critical to supporting recovery in individuals with SUD. Enhancing these relational competencies, especially in under-resourced rural settings, may improve mental health outcomes and reduce disparities in recovery support.

PMID:42030478 | DOI:10.3928/02793695-20260414-01

Vet Med Sci. 2026 May;12(3):e70962. doi: 10.1002/vms3.70962.

ABSTRACT

OBJECTIVE: This study aimed to investigate the potential systemic gastrointestinal (GI) effects of short-term topical administration of ocular steroids and non-steroidal anti-inflammatory drugs (NSAIDs) in rats.

ANIMALS: A total of 56 adult male Wistar rats were assigned to seven treatment groups (n = 8 for each group), receiving topical applications of saline, prednisolone acetate, dexamethasone phosphate, loteprednol etabonate, ketorolac tromethamine, nepafenac or diclofenac sodium for 1 week.

METHODS: GI bleeding was assessed using faecal occult blood tests, gastric and duodenal tissues were analysed histopathologically, and endoscopic evaluations were performed.

RESULTS: Positive faecal occult blood results were observed in the prednisolone acetate group (3/8; 37.5%), dexamethasone phosphate (2/8; 25%), diclofenac sodium (1/8; 12.5%) and loteprednol etabonate (1/8; 12.5%). No positive results were recorded in the ketorolac tromethamine, nepafenac, or saline groups (0%). Differences between groups were not statistically significant (p > 0.05). No significant within-group differences between baseline and post-treatment results were detected (p > 0.05). Endoscopic scores ranged from 0 to 1 across all groups, and histopathology revealed no abnormalities.

CONCLUSIONS AND CLINICAL RELEVANCE: Short-term topical ocular steroid and NSAID treatments were not associated with statistically significant systemic gastrointestinal alterations under the conditions of this study.

PMID:42030432 | DOI:10.1002/vms3.70962

J Chem Theory Comput. 2026 Apr 24. doi: 10.1021/acs.jctc.6c00293. Online ahead of print.

ABSTRACT

Nuclear quantum effects (e.g., zero-point motion and tunneling) can control hydrogen transfer and diffusion, but fully quantum dynamics is rarely feasible for realistic systems. Ring-polymer molecular dynamics (RPMD) samples quantum statistics with a classical ring polymer, yet ab initio RPMD is costly because electronic-structure energies and forces are required for every bead at every time step. Here, we introduce a Feynman path tube-guided surrogate RPMD framework that propagates all beads on an on-the-fly surrogate ring-polymer Hamiltonian with an uncertainty estimate: ab initio data are acquired only when the uncertainty exceeds a threshold and are shared across beads and trajectories. Combined with well-tempered metadynamics, the method targets quantum free-energy surfaces and activation barriers. On gas-phase OH + H₂O and CH₄ + Cl benchmarks with full-dimensional reference potentials, surrogate ab initio RPMD reproduces brute-force RPMD profiles within 0.1-0.2 kcal/mol, preserves the symmetry of the OH + H₂O identity exchange, and resolves subkcal barriers. We then compute ab initio RPMD free-energy surfaces for proton transfer on TiO₂(011), H migration on graphene, and H₂ dissociative chemisorption on Cu(111), including a two-dimensional surface and minimum free-energy path on the metal. Across all five systems, the number of ab initio calls grows sublinearly with bead number, delivering speedups of 10³-10⁵ ring-polymer bead-steps per QM evaluation and reducing the expensive force workload by three to more than 4 orders of magnitude. Tube-aware surrogate sharing therefore makes quantum-statistical free-energy sampling with ab initio RPMD practical for both molecular and interfacial reactions.

PMID:42030428 | DOI:10.1021/acs.jctc.6c00293

PLoS Med. 2026 Apr 24;23(4):e1005081. doi: 10.1371/journal.pmed.1005081. Online ahead of print.

ABSTRACT

Why obesity increases cancer risk has long remained a biological mystery. Rapid advances in statistical and analytical methods are now opening the door to mechanistic discoveries that may finally help resolve this question.

PMID:42030412 | DOI:10.1371/journal.pmed.1005081

PLoS One. 2026 Apr 24;21(4):e0345413. doi: 10.1371/journal.pone.0345413. eCollection 2026.

ABSTRACT

Engaging the private sector in contraceptive method supply is critical for creating equitable, sustainable, and accessible healthcare systems. To achieve this, it is essential to understand where women obtain their modern contraceptives. While national-level estimates provide valuable insights into overall trends in contraceptive supply, they often obscure variation within and across subnational regions. Addressing localised needs has become increasingly important as countries adopt decentralised models for family planning services. Decentralization has also underscored the need for reliable subnational estimates of key family planning indicators. The absence of regularly collected subnational data has hindered effective monitoring and decision-making. To bridge this gap, we propose a novel approach that leverages latent attributes in Demographic and Health Survey (DHS) data to produce Bayesian probabilistic projections of contraceptive method supply shares (the proportions of modern contraceptive methods supplied by public and private sectors) with limited data. Our modelling framework is built on Bayesian hierarchical models. Using penalized splines to track public and private supply shares over time, we leverage the spatial nature of the data and incorporate a correlation structure between recent supply share observations at national and subnational levels. This framework contributes to the domain of subnational estimation of proportions in data-sparse settings, outperforming comparable and previous approaches. As decentralization continues to reshape family planning services, producing reliable subnational estimates of key indicators is increasingly vital for researchers and policymakers.

PMID:42030401 | DOI:10.1371/journal.pone.0345413

PLoS One. 2026 Apr 24;21(4):e0347849. doi: 10.1371/journal.pone.0347849. eCollection 2026.

ABSTRACT

BACKGROUND: Transcutaneous auricular vagus nerve stimulation (taVNS) is a non-invasive neuromodulation technique that activates vagal afferents projecting to prefrontal-limbic circuits implicated in attention, memory, and emotion regulation. Preliminary studies suggest that taVNS may enhance cognitive performance; however, the evidence remains fragmented across domains and populations.

OBJECTIVES: This systematic review and meta-analysis aim to (1) quantify the overall effects of taVNS on cognitive functions, (2) examine its efficacy across clinical and non-clinical populations, and (3) identify moderators influencing variability in outcomes, including stimulation parameters, participant characteristics, and study design features.

METHODS: Following PRISMA-P guidelines, this protocol will be prospectively registered with PROSPERO. Six databases (PubMed, EMBASE, PsycINFO, Web of Science, CENTRAL, and Scopus) and major trial registries will be systematically searched. Eligible studies include randomised controlled trials assessing validated cognitive outcomes following taVNS compared with sham or active controls. Effect sizes will be calculated as Hedges’ g and pooled using random-effects models. Heterogeneity will be evaluated with I² and τ statistics; moderator and meta-regression analyses will explore dose-response and population effects. Risk of bias will be assessed with RoB 2 for randomised trials and ROBINS-I for non-randomised studies, and the certainty of evidence will be rated using GRADE separately by study design.

EXPECTED RESULTS AND CONCLUSIONS: This review will provide the first quantitative meta-analytic synthesis of taVNS-induced cognitive modulation across executive, attentional, affective, and learning domains in both clinical and healthy populations, complementing recent narrative syntheses by offering pooled effect size estimates, formal heterogeneity assessment, and a GRADE-rated evidence hierarchy. By delineating domain-specific efficacy and optimal stimulation parameters, the findings aim to inform future clinical applications and the development of standardized neuromodulation protocols.

PMID:42030358 | DOI:10.1371/journal.pone.0347849

J Clin Pharmacol. 2026 Apr;66(4):e70192. doi: 10.1002/jcph.70192.

ABSTRACT

Labetalol is widely prescribed as a first-line antihypertensive in pregnancy; however, rare but potentially severe idiosyncratic hepatotoxicity has been reported, with a disproportionately strong reporting signal for liver injury relative to other β-blockers. In this report, a fatal case is described in which mild initial symptoms rapidly progressed to fulminant hepatocellular injury and acute liver failure within days, underscoring the importance of early recognition of drug-induced liver injury and prompt discontinuation of labetalol. A PRISMA-guided systematic review of MEDLINE, Embase, CINAHL, Cochrane Library, PubMed, and Google Scholar (from inception to December 2025) identified 27 published case reports. Patients were predominantly female (≈80%), and one-third were pregnant or postpartum. Latency ranged from 7 to 365 days (median ≈60 days). The injury phenotype was consistently hepatocellular, often with autoimmune-like serologic or histologic features. Outcomes included full recovery in most (≈75%), but also liver transplantation and death. In the FDA Adverse Event Reporting System (2020Q1-2025Q1), labetalol showed strong disproportionality signals for DILI (PRR 22.7, 95% CI 15.6-33.1; ROR 23.7, 95% CI 16.0-35.1; IC025 2.5) and autoimmune hepatitis (PRR 59.8, 95% CI 34.1-104.8; ROR 60.9, 95% CI 34.4-108.1; IC025 2.8), which persisted when restricted to other β-blockers as comparators. Signals for acute hepatic failure and hyperbilirubinemia were elevated but less statistically robust. The available evidence is consistent with a clinically meaningful and biologically plausible association between labetalol and idiosyncratic hepatotoxicity, supporting heightened clinical awareness and further mechanistic and population-based study.

PMID:42030085 | DOI:10.1002/jcph.70192

Chaos. 2026 Apr 1;36(4):043133. doi: 10.1063/5.0324747.

ABSTRACT

The renewal process is a key statistical model for describing a wide range of stochastic systems in physics. This work investigates the behavior of the probability distribution of the number of renewals in renewal processes at the short time limit, with a focus on cases where the number of renewals is large. We find that the specific details of the sojourn time distribution ϕ(τ) in this limit can significantly modify the behavior in the large-number-of-renewals regime. We explore both ordinary and equilibrium renewal processes, deriving results for various forms of ϕ(τ). Using saddle-point approximations, we analyze cases where ϕ(τ) follows a power-series expansion, includes a cutoff, or exhibits non-analytic behavior near τ=0. Additionally, we show how the short-time properties of ϕ(τ) shape the decay of the number of renewals in equilibrium compared to ordinary renewal processes. The probability of the number of renewals plays a crucial role in determining rare event behaviors, such as Laplace tails. The results obtained here are expected to help advance the development of a theoretical framework for rare events in transport processes in complex systems.

PMID:42030067 | DOI:10.1063/5.0324747