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Nevin Manimala Statistics

A Bayesian multivariate spatial point pattern model: application to oral microbiome FISH image data

Biostatistics. 2026 Jan 20;27(1):kxag028. doi: 10.1093/biostatistics/kxag028.

ABSTRACT

Advances in cellular imaging technologies, especially those based on fluorescence in situ hybridization (FISH), now allow detailed visualization of the spatial organization of human or bacterial cells. Quantifying this spatial organization is crucial for understanding the function of multicellular tissues or biofilms, with implications for human health and disease. To address the need for better methods to achieve such quantification, we propose a flexible multivariate point process model that characterizes and estimates complex spatial interactions among multiple cell types. The proposed Bayesian framework is appealing due to its unified estimation process and the ability to directly quantify uncertainty in key estimates of interest, such as those of inter-type correlation and the proportion of variance due to inter-type relationships. To ensure stable and interpretable estimation, we consider shrinkage priors for coefficients associated with latent processes that induce dependencies among point patterns. Model selection and comparison are conducted using a deviance information criterion designed for models with latent variables, providing a practical criterion for balancing model fit and complexity. Furthermore, we use a Bayesian hierarchical pooling model to synthesize image-specific posterior summaries, allowing inference at both the global- (across subjects) and subject-specific levels. An R package, mspatPPM, implements an efficient computational scheme based on Hamiltonian Monte Carlo and adaptive Metropolis-Hastings algorithms. Numerical studies evaluate the practical performance of the proposed framework for model selection and for estimating quantities that characterize the multivariate spatial distribution of cell types. We apply the proposed method to microbial biofilm image data from the human tongue dorsum and find that specific taxon pairs, such as Streptococcus mitis-Streptococcus salivarius and S. mitis-Veillonella, exhibit strong positive spatial correlations, while others, such as Actinomyces-Rothia, show slight negative correlations. For most of the taxa, a substantial portion of spatial variance can be attributed to inter-taxon relationships.

PMID:42613133 | DOI:10.1093/biostatistics/kxag028

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Balancing the rota: registered nurses’ preferences for shift patterns – a discrete choice experiment

BMJ Open. 2026 Aug 18;16(8):e116968. doi: 10.1136/bmjopen-2026-116968.

ABSTRACT

OBJECTIVE: To elicit and quantify registered nurses’ (RNs’) preferences for key shift attributes and to estimate the trade-offs between shift pattern characteristics and pay.

DESIGN: Cross-sectional online discrete choice experiment with d-efficient design; 12 choice tasks per respondent. Preferences were estimated using multinomial logit models with clustered standard errors; willingness to accept (WTA) values were derived as ratios of attribute coefficients to the pay coefficient.

SETTING: United Kingdom.

PARTICIPANTS: 1449 registered nurses (RNs) recruited via the Nursing and Midwifery Council distribution list.

PRIMARY AND SECONDARY OUTCOME MEASURES: Utility coefficients (β) for shift length, schedule predictability, shift request flexibility, weekend working frequency, pay level and night-shift frequency; WTA derived from the pay attribute; subgroup and interaction analyses by age, pay band, current shift status, caring responsibilities, sector and satisfaction.

RESULTS: All six attributes were statistically significant predictors of shift pattern choices. The strongest aversions were to night-only working (β=-1.113) and having no whole weekends off (β=-0.790), which required an estimated 29% additional compensation in the primary model and 21% additional compensation, respectively. Unpredictable rotas (β=-0.220), restricted shift-choice flexibility (β=-0.189 for only swaps) and absence of pay increase (β=-0.525) also reduced utility. Nine-to-ten-hour shifts were preferred over 8-hour shifts (β=0.144), whereas 12.5-hour shifts were disliked (β=-0.179). Subgroup analyses showed significant heterogeneity by age and current shift status, with more limited evidence of pay-band differences. Interaction analyses suggested broadly consistent aversion to night work and weekend loss across the nursing workforce.

CONCLUSIONS: Nurses strongly prefer rota designs that avoid exclusive night work and protect whole weekends off. Predictability and meaningful scope to request shifts also matter. These preference estimates provide policy-relevant benchmarks for rota design and unsocial-hours compensation.

PMID:42613123 | DOI:10.1136/bmjopen-2026-116968

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Do patients and the public understand and feel engaged and valued after reading outcome set study invitations? A UK qualitative study

BMJ Open. 2026 Aug 18;16(8):e111016. doi: 10.1136/bmjopen-2025-111016.

ABSTRACT

BACKGROUND: The use of core outcome sets (COSs) in health research is widely recommended. COSs are developed with input from key decision makers, patients being a vital group to ensure COS relevance. However, recruitment to COS studies can be challenging.

OBJECTIVES: The study aimed to explore what patients and the public think of COS study invitations, which are usually the first document a patient reads about a COS study.

DESIGN: Qualitative study involving focus groups and interviews. Analysis of transcribed data drew on reflexive thematic analysis.

PARTICIPANTS AND SETTING: Focus groups and interviews were conducted with a diverse range of patients and the public (n=31) from community and patient groups in North West England, exploring their perceptions of a sample of COS study invitations. Participants were eligible if aged over 18 years, they could speak English and had never previously participated in a COS study.

RESULTS: Themes identified included understanding, engagement, safety and accessibility. Participants were concerned about excessive information in the invitations which made them confused. Fear of cybercrime caused numerous concerns and participants were reluctant to click on links or attachments. Trust in the people sending the invitations was key. Participants wanted to see messages that COS studies had a meaningful purpose to feel their contributions were valuable. They were keen to contribute to improving future ‘treatment’ but less motivated to improve ‘research’. Messages that evoked a feeling of connection with others who they could relate to were positively regarded. Participants also highlighted ways that invitations could be made more accessible.

CONCLUSION: COS invitations can present numerous challenges for potential participants, but our study indicates ways that COS developers can address these challenges and make their invitations more appealing to potential participants. As part of the wider Good Research Invitation Study the findings have been used to inform guidance on designing a good COS invitation.

PMID:42613120 | DOI:10.1136/bmjopen-2025-111016

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Nurse-led music-based interventions across clinical care settings: a scoping review protocol

BMJ Open. 2026 Aug 18;16(8):e122147. doi: 10.1136/bmjopen-2026-122147.

ABSTRACT

INTRODUCTION: Music-based interventions are increasingly used as supportive, non-pharmacological approaches in clinical care, yet nursing roles are often described inconsistently and intervention terminology and reporting remain heterogeneous. This scoping review will map the available evidence on music-based interventions with an explicit nursing role, referred to collectively in this review as nurse-led music-based interventions, for patients or care recipients across clinical care settings, with attention to populations, nursing roles, intervention characteristics, reported outcomes and implementation issues.

METHODS AND ANALYSIS: The review will follow Joanna Briggs Institute (JBI) scoping review methodology and will be reported according to Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Preliminary searches of MEDLINE, CINAHL, Embase, Scopus, Web of Science Core Collection, PsycINFO, CNKI, Wanfang Data and VIP Information were conducted on 4 May 2026 solely to validate the database-specific search strategies; the formal search has not commenced. Formal searches of these databases and planned grey literature sources will be conducted from 1 to 7 September 2026, with an update search in February 2027 and completion anticipated in March 2027. Eligible sources will report an explicit and identifiable nursing role in a music-based intervention. Primary roles will be classified using prespecified responsibility-based definitions as nurse-led, nurse-managed, nurse-coordinated, nurse-delivered, nurse-facilitated or multidisciplinary with an explicit nursing role; all reported nursing activities and multidisciplinary involvement will also be retained. Two reviewers will independently undertake each stage of study selection and data charting, with adjudication when consensus cannot be reached. Findings will be presented through descriptive summaries, evidence mapping, tabular displays and narrative synthesis.

ETHICS AND DISSEMINATION: Ethical approval is not required because this review will use published and publicly accessible sources. Findings will be disseminated through peer-reviewed publication and conference presentations.

REGISTRATION DETAILS: The protocol was registered on the Open Science Framework on 11 April 2026 (https://osf.io/c6ytn).

PMID:42613119 | DOI:10.1136/bmjopen-2026-122147

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Risk factors for sepsis development in trauma patients admitted to the ICU in Japan: a retrospective cohort study using the Japan trauma data bank

BMJ Open. 2026 Aug 18;16(8):e115951. doi: 10.1136/bmjopen-2025-115951.

ABSTRACT

OBJECTIVES: To clarify the epidemiology and risk factors for sepsis among trauma patients admitted to the intensive care unit (ICU) using the Japan Trauma Data Bank (JTDB).

DESIGN: Retrospective cohort study.

SETTING: Analysis of nationwide JTDB data collected between 2004 and 2019 in Japan.

PARTICIPANTS: A total of 126 433 adult trauma patients with an Abbreviated Injury Scale score ≥3 who survived for at least 72 hours after ICU admission were included.

PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was in-hospital mortality among patients who developed sepsis after trauma. The secondary outcome was identification of risk factors associated with post-traumatic sepsis using multivariable logistic regression analysis.

RESULTS: Sepsis developed in 972 patients (0.77%) and was associated with significantly higher in-hospital mortality compared with patients without sepsis (42.4% vs 4.6%, p<0.001), as well as longer hospital stay (47 vs 20 days, p<0.001). Independent risk factors for sepsis included older age (adjusted OR (aOR) 1.02, 95% CI 1.02 to 1.03), male sex (aOR 1.48, 95% CI 1.27 to 1.73), higher Injury Severity Score (ISS) (aOR 1.58, 95% CI 1.39 to 1.80), blood transfusion within 24 hours of arrival (aOR 2.78, 95% CI 2.36 to 3.26), abdominal or pelvic trauma (aOR 2.28, 95% CI 1.91 to 2.73) and lower extremity trauma (aOR 1.66, 95% CI 1.42 to 1.94). Conversely, head trauma was associated with a lower risk of sepsis (aOR 0.67, 95% CI 0.55 to 0.80). Similar trends were observed in subgroup analyses stratified by ISS.

CONCLUSIONS: Although post-traumatic sepsis was uncommon, it was associated with markedly increased mortality. Older age, male sex, severe injury, early blood transfusion and abdominal/pelvic or lower extremity trauma were identified as major risk factors for sepsis after trauma.

PMID:42613118 | DOI:10.1136/bmjopen-2025-115951

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Prevalence and factors associated with symptoms of common mental disorders, anxiety, depression, burnout, insomnia and stress among primary healthcare workers in Brazil: protocol for a systematic review and prevalence meta-analysis

BMJ Open. 2026 Aug 18;16(8):e118825. doi: 10.1136/bmjopen-2026-118825.

ABSTRACT

INTRODUCTION: The mental health of primary healthcare (PHC) workers is a determinant of service quality and sustainability in the Brazilian Unified Health System (SUS). Brazilian observational studies report symptoms of common mental disorders, anxiety, depression, burnout, insomnia and stress among PHC workers, but the evidence is fragmented across settings, occupational categories, instruments and time periods. This protocol describes a systematic review and prevalence meta-analysis to consolidate prevalence estimates and synthesise associated sociodemographic, occupational and organisational factors among PHC workers in Brazil.

METHODS AND ANALYSIS: We will conduct a systematic review and prevalence meta-analysis in accordance with Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and report the completed review following PRISMA 2020. We searched MEDLINE (via PubMed), Embase, PsycINFO, CINAHL and BVS/LILACS from inception to 16 September 2025, complemented by grey literature searches (Google Scholar and CAPES Theses and Dissertations) and reference-list screening. Eligible studies will be quantitative observational studies conducted in Brazil with workers linked to PHC within the SUS, including health professionals and other occupational groups (eg, community health workers and administrative/operational staff). Studies must report prevalence based on validated instruments for use in Brazilian populations and an explicit case definition/cut-off for common mental disorders, anxiety symptoms, depression, burnout, insomnia and stress. Two independent reviewers will screen records and full texts in Rayyan; disagreements will be resolved by consensus or a third reviewer. Risk of bias will be assessed using the Joanna Briggs Institute checklist for prevalence studies. We will pool prevalence estimates by outcome using random-effects models (primary approach: binomial models), quantify heterogeneity (I², τ², Q) and estimate prediction intervals. Prespecified subgroup/sensitivity analyses will explore geographic region, occupational category, instrument/cut-off, sampling approach, risk of bias and data collection period, classified as prepandemic, pandemic/postpandemic or mixed. Associated factors will be synthesised as a structured narrative by domain; meta-analysis of associations will be considered only when exposure definitions and effect measures are sufficiently comparable.

ETHICS AND DISSEMINATION: Ethics approval is not required because this study uses secondary data from published reports. For queries related to research integrity, please contact the Research Ethics Committee of the Federal University of Espírito Santo ([email protected]). Findings will be disseminated through publication in a peer-reviewed journal and presentations at scientific meetings.

PMID:42613114 | DOI:10.1136/bmjopen-2026-118825

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Access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings in Africa: a systematic review

BMJ Open. 2026 Aug 18;16(8):e105911. doi: 10.1136/bmjopen-2025-105911.

ABSTRACT

OBJECTIVES: To assess access, barriers and health outcomes of abortion and postabortion care in humanitarian and fragile settings across Africa.

DESIGN: Systematic review following Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines.

DATA SOURCE: Scopus, PubMed, Epistemonikos, along with websites like Google and Google Scholar were searched through 15 February 2025.

ELIGIBILITY CRITERIA: Studies conducted in African humanitarian settings that focus on abortion, postabortion care and abortion-related complications were included, regardless of study design or language.

DATA EXTRACTION AND SYNTHESIS: Before commencing actual data extraction, a prior data extraction template was developed by reviewers through using a sample of two included articles. The thematic content analysis was conducted using MAXQDA software, guided by the socioecological model.

RESULTS: Humanitarian conditions increased unintended pregnancies and demand for abortion services while health system disruptions limited access to safe care. Women were frequently resorting to unsafe abortion methods using traditional substances, detergents or harmful objects because of legal restrictions, stigma and limited access to family planning. Delays in abortion care are often driven by distance, cost, lack of confidentiality and fear of legal consequences. Cultural influences and cost concerns also led women to delay seeking healthcare, resulting in complications. Common challenges across many humanitarian settings included limited access to family planning, inadequate health system infrastructure and shortages of trained healthcare providers. Barriers are operated across individual, community, health system and policy levels, reinforcing inequities in access and outcomes.

CONCLUSIONS: In African humanitarian settings, barriers to safe abortion and postabortion care are amplified in humanitarian settings through interconnected social, structural and policy factors including legal ambiguity. Implementing comprehensive strategies such as empowering women, engaging communities, reforming policies and strengthening health systems can help improve access, safety and maternal health outcomes in humanitarian settings, thereby reducing unsafe abortions and enhancing postabortion care.

TRIAL REGISTRATION NUMBER: CRD420251026961.

PMID:42613113 | DOI:10.1136/bmjopen-2025-105911

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Effectiveness of an artificial intelligence-based self-management intervention to support sick-listed individuals with musculoskeletal disorders in Norway: rationale and protocol for the SmaRTWork randomised controlled trial

BMJ Open. 2026 Aug 18;16(8):e122680. doi: 10.1136/bmjopen-2026-122680.

ABSTRACT

INTRODUCTION: Long-term sickness absence represents a major public health challenge with far-reaching consequences for both individuals and society. Musculoskeletal disorders (MSDs) are among the leading causes of sickness absence. Although mobile apps show promise for supporting self-management of MSDs, high-quality evidence remains limited, and outcomes related to work participation are rarely examined. This trial aims to evaluate whether an individually tailored, app-based self-management intervention (SmaRTWork), provided in addition to usual care, improves return-to-work compared with usual care alone among individuals on sick leave due to MSDs.

METHODS AND ANALYSIS: We will conduct a randomised controlled trial with two parallel arms: 1) SmaRTWork in addition to usual care and 2) usual care alone. Individuals 20-59 years old who have been sick-listed for <12 weeks due to back, neck or widespread pain will be recruited through clinicians in primary health care. Eligible participants are randomised 1:1 to one of the two arms. We aim to include 298 participants, 149 in each arm. The primary outcome is time to sustainable return-to-work, defined as one consecutive month without receiving medical benefits, assessed over a 12-month period using registry data. Secondary outcomes include health-related measures assessed at baseline, 3, 6 and 12 months. The trial will also incorporate qualitative studies, a process evaluation and a health economic evaluation.

ETHICS AND DISSEMINATION: The trial is approved by the Committees for Clinical Trials of Pharmaceuticals and Medical Devices (Ref. 563919). Results will be published in peer-reviewed journals and presented at national and international conferences.

TRIAL REGISTRATION: NCT07034040.

PMID:42613108 | DOI:10.1136/bmjopen-2026-122680

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Evaluating Telemedical Supervision for Critical Anesthesia Scenarios: Randomized Controlled Simulation Study

JMIR Med Inform. 2026 Aug 18;14:e88056. doi: 10.2196/88056.

ABSTRACT

BACKGROUND: Telemedicine may improve access to specialized care, but its use for supervision during critical anesthesia situations remains underexplored. A standardized tele-supervision (TSV) solution for operating rooms (ORs) is lacking.

OBJECTIVE: This study aimed to evaluate a novel telemedical supervision system for critical anesthetic scenarios in a simulated OR environment and compare it to traditional on-site supervision. Specifically, adherence to standard operating procedures (SOPs), the number and modality of senior physician contacts, workload, and user perceptions were assessed.

METHODS: In this randomized controlled simulation study, 16 anesthesiology residents in their first 2 years of training at the Uniklinik Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen (Germany) were randomized using block randomization into 2 groups. The intervention group received remote support exclusively via a TSV system, while the control group used a conventional phone with on-site support. The telemedical system comprised an anesthesia workstation that integrated data from the patient monitor, anesthesia device, and syringe pumps using the Institute of Electrical and Electronics Engineers (IEEE) 11073 Service-Oriented Device Connectivity (SDC) standard and a mobile supervision workstation that enabled the senior physician to monitor multiple ORs and communicate via text, audio, and video. The simulated scenario involved a male patient aged 51 years undergoing an appendectomy who developed an anaphylactic reaction 3 minutes after receiving cefuroxime. Primary outcomes focused on the completion rate of necessary SOP measures. Secondary outcomes included workload, measured using the NASA Task Load Index (NASA-TLX), and participants’ postscenario questionnaire responses. Statistical comparisons were performed using a Welch t test.

RESULTS: All participants in both groups contacted the senior physician at least once. The control group had a mean of 6.44 (SD 4.80) SOP measures supported by the senior physician, whereas the intervention group had a mean of 5.00 (SD 3.06). The mean SOP completion rate was 92.5% (SD 0.04%) in the control group and 91.6% (SD 0.05%) in the intervention group, with no significant difference (t11.94=0.439; P=.67). NASA-TLX scores revealed that compared to the control group, there was lower mental demand in the TSV group but higher temporal demand. Subjective evaluations indicated mixed preferences regarding on-site support; however, most participants acknowledged the TSV system as a viable alternative when on-site support was not feasible.

CONCLUSIONS: This study demonstrated no statistically significant differences between the groups, indicating similar performance with high adherence to SOPs and comparable clinical decision-making in a simulated high-stakes environment. Despite increased temporal workload, user feedback was positive, underscoring the system’s potential to address staffing shortages and resource limitations. Further research in real clinical settings is needed to optimize usability and validate these findings.

PMID:42612211 | DOI:10.2196/88056

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Digital Physical Exercise Interventions for Cognitive Functions in Older Adults: Systematic Review and Bayesian Network Meta-Analysis of Randomized Controlled Trials

J Med Internet Res. 2026 Aug 18;28:e92764. doi: 10.2196/92764.

ABSTRACT

BACKGROUND: Cognitive decline in older adults imposes a major global burden, with physical inactivity a leading modifiable risk factor for dementia. Digital physical exercise interventions offer scalable alternatives to traditional programs, but comparative effectiveness across cognitive domains remains unclear.

OBJECTIVE: The aim of the study is to compare and rank 4 digital physical exercise interventions-immersive virtual reality exercise (IVR_E), nonimmersive exergame (NI_ExG), remote exercise (RE), and virtual reality exercise combined with cognitive training (VR_EC)-against routine intervention (RI) or nonintervention (NI) on global cognition, executive function, and memory function in older adults aged ≥60 years.

METHODS: Eligible studies were English-language randomized controlled trials evaluating digital physical exercise on any untrained cognitive outcome in older adults. In total, 6 databases (PubMed, Embase, Web of Science, CENTRAL, PsycINFO, and CINAHL) and 2 trial registries were searched from January 2010 to April 2026; reference lists were screened. Screening, data extraction, and risk-of-bias assessment were conducted independently in duplicate using the Cochrane tool. Bayesian network meta-analyses were performed in R, reporting standardized mean differences (SMDs) with 95% CIs and prediction intervals (PIs); surface under the cumulative ranking curve (SUCRA) ranked interventions, and CINeMA (Confidence in Network Meta-Analysis) assessed certainty of evidence, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses).

RESULTS: In total, 51 randomized controlled trials (3673 participants) were included. NI_ExG significantly outperformed both NI (SMD 0.51, 95% CI 0.26-0.78; PI -0.03 to 1.07) and RI (SMD 0.32, 95% CI 0.12-0.53; PI -0.20 to 0.86) for global cognition (30 studies); IVR_E also outperformed NI (SMD 0.74, 95% CI 0.11-1.36; PI -0.04 to 1.53) and ranked highest by SUCRA. For executive function (33 studies), only NI_ExG versus NI was significant (SMD 0.39, 95% CI 0.04-0.76; PI -0.48 to 1.29). For memory function (20 studies), RE was significantly superior to both NI (SMD 1.30, 95% CI 0.15-2.44; PI -0.05 to 2.70) and RI (SMD 1.22, 95% CI 0.15-2.28; PI 0.07-2.56), with its PI also excluding the null; VR_EC was significantly inferior to RE (SMD -1.54, 95% CI -2.89 to -0.24; PI -3.09 to -0.07). Cumulative training ≥1000 minutes was associated with more stable memory benefit. Certainty was very low for most comparisons, downgraded for unclear allocation concealment, heterogeneity, and suspected reporting bias in executive function.

CONCLUSIONS: This Bayesian network meta-analysis compares 4 digital physical exercise categories against active and passive controls across 3 cognitive domains. Comparative effectiveness was domain-specific: NI_ExG most consistently benefited global cognition and executive function; RE produced the only statistically robust memory improvement; and IVR_E achieved the highest rankings but requires confirmatory trials. The scalability of RE and NI_ExG makes them practical for older adults in rural and resource-limited settings, providing an evidence base to inform clinical guidelines and digital health investment.

PMID:42612199 | DOI:10.2196/92764