Nevin Manimala

PLoS One. 2025 May 28;20(5):e0324559. doi: 10.1371/journal.pone.0324559. eCollection 2025.

ABSTRACT

Accurate estimation of the finite population mean is a fundamental challenge in survey sampling, especially when dealing with large or complex populations. Traditional methods like simple random sampling may not always provide reliable or efficient estimates in such cases. Motivated by this, the current study explores complex sampling techniques to improve the precision and accuracy of mean estimators. Specifically, we employ two-stage and three-stage cluster sampling methods to develop unbiased estimators for the finite population mean. Building upon these, the next phase of the study formulates unbiased mean estimators using stratified two- and three-stage cluster sampling. To further enhance the precision of these estimators, a ranked-set sampling strategy is applied to the secondary and tertiary sampling stages. Additionally, unbiased variance estimators corresponding to the proposed mean estimators are derived. Real-world datasets are utilized to demonstrate the application of these complex survey sampling methodologies, with results showing that the mean estimates derived using ranked set sampling are more accurate than those obtained via simple random sampling.

PMID:40435354 | DOI:10.1371/journal.pone.0324559

PLoS One. 2025 May 28;20(5):e0316508. doi: 10.1371/journal.pone.0316508. eCollection 2025.

ABSTRACT

INTRODUCTION: The use of health research evidence is essential for informed decision-making and effective health planning. Despite its importance, there is limited understanding of the determinants for the use of such evidence in planning processes, particularly in lower-middle-income countries (LMICs) like Tanzania. This study aims to investigate the proportion and determinants that affect the use of health research evidence in health planning in Tanzania.

MATERIALS AND METHODS: This quantitative study employed a cross-sectional design. Data on health research evidence and the factors influencing its use were collected using a structured questionnaire from 422 healthcare workers involved in planning within 9 regions of Tanzania from October to December 2023. The association between categorical variables was assessed using a chi-square test, while regression analysis was conducted to identify determinants, both at a 95% confidence level.

RESULTS: The study revealed that 270 (66.2%) of health planning team members strongly agreed that they use health research evidence during planning. Several key determinants were significantly associated with the level of research evidence utilization. These included limited dissemination of research findings (74.5%), inadequate human and non-human resources (70.0%), and insufficient knowledge and training in research (63.7%). A multivariate regression analysis confirmed significant associations between the determinants and the use of research evidence (p<0.05). Descriptive statistics revealed that over 70% of respondents identified the presence of research coordinators, partnerships with universities, availability of research budgets, and internet access as important factors in their research. Inferential analysis indicated that these factors were statistically significantly associated with the use of health research evidence. In addition, more than half of the participants stated motivational factors, such as the presence of continuous quality improvement initiatives, the availability of short- and long-term training programs, on-the-job training opportunities, and incentives like extra duty allowances, as contributors to the enhanced use of research evidence. Bottom of Form.

CONCLUSION: The study found that planning team members used health research evidence in planning, but several determinants, such as lack of dissemination, resource shortages, and inadequate training, persisted. Interventions should focus on improving dissemination, resources, and training. Future research should explore strategies for enhancing these interventions.

PMID:40435352 | DOI:10.1371/journal.pone.0316508

PLoS One. 2025 May 28;20(5):e0323829. doi: 10.1371/journal.pone.0323829. eCollection 2025.

ABSTRACT

BACKGROUND: To explore the safety and effectiveness of partial splenic embolization (PSE) in patients with hypersplenism and hepatocellular carcinoma (HCC) and to compare the efficacy of superselective and non-superselective embolization of splenic artery branches.

PROCEDURE: We retrospectively analyzed 64 patients with HCC who underwent PSE between August 2020 and December 2022. The patients were categorized into two groups based on different treatment plans: Group A (n=33) underwent superselective embolization and Group B (n=31) underwent non-superselective embolization of the splenic artery branches. The safety and effectiveness of the two methods were evaluated along with changes in peripheral blood cells [mainly white blood cells (WBC) and red blood cells (RBC)] and platelet (PLT) counts at different time points after PSE. Postoperative adverse events were also compared between the two groups.

RESULTS: The technical success rate was 100% for both procedures. The PLT and WBC counts of the two groups significantly increased one week after PSE (P<0.05), and there was no statistically significant difference in the RBC count changes. At follow-up (4, 16, and 24 weeks), the PLT and WBC counts remained consistent at levels which were significantly different from those before PSE (P<0.05). However, the RBC counts were not significantly different (P>0.05). An independent sample t-test was used to compare the differences in blood counts between the two groups at the same time point. There were no statistically significant differences in PLT, WBC, and RBC counts between Group A and Group B at any time point after PSE (P>0.05). The incidence of fever and pain in Group B was significantly higher than that in Group A (P<0.05).

CONCLUSION: Partial splenic artery embolization is a safe and effective treatment option for hypersplenism. Both splenic artery branch superselective and non-superselective embolization strategies demonstrated comparable outcomes. However, superselective embolization exhibited a lower incidence of postprocedural complications than non-superselective embolization.

PMID:40435313 | DOI:10.1371/journal.pone.0323829

PLoS One. 2025 May 28;20(5):e0323897. doi: 10.1371/journal.pone.0323897. eCollection 2025.

ABSTRACT

In this article, the effect of the parameters in the properties of a well-known distribution called q-extended extreme value with linear normalization is discussed. Moreover, these parameters are estimated by both maximum likelihood and Bayesian approaches using type-II progressive censoring. The removals of type-II progressive censoring are considered under three well-known random removals (Fixed, discrete uniform, and binomial). Finding effective numerical techniques is a typical challenge for statisticians when estimating MLE parameters for distributions with many parameters. So one of our aims in this article is to show how the metaheuristic optimization like the particle swarm optimization, can handle this problem. Furthermore, the interval estimation for the parameters is calculated using the Fisher information matrix. The Bayesian approach is utilized for both the informative and non-informative under two different loss functions (square error and Linex loss functions) using Lindley’s approximation. Moreover, home price data in California represent a good fit for the q-extended extreme value distribution with linear normalization. By using this fitting some of California’s future home prices are predicted by using the return level function.

PMID:40435305 | DOI:10.1371/journal.pone.0323897

PLoS One. 2025 May 28;20(5):e0320914. doi: 10.1371/journal.pone.0320914. eCollection 2025.

ABSTRACT

BACKGROUND: Frequent ambulance dispatches is a common challenge in developed countries. Several factors have been identified as contributing to increase in dispatches, but no stipulation has explained the particular shift observed in Japan since 1995. This study examined ambulance dispatches in view of changes in a macroeconomic indicator.

METHODS: This longitudinal ecological study covered all annual ambulance dispatch incidents in Japan between 1980 and 2021 (42 years). The regression model comprised the active job openings-to-applicants ratio during deflation, the active job openings-to-applicants ratio during inflation, aging population trend, and mean ambient temperature, with the Japanese total population as an offset variable.

RESULTS: There were a total of 177,042,244 ambulance dispatches during the study period. The active job openings-to-applicants ratio during deflation showed statistical significance in the regression analysis (generalized estimation equations estimate: 0.165, 95% confidence interval: 0.087 to 0.243) whereas the active job openings-to-applicants ratio during inflation did not (0.019, -0.021 to 0.059).

CONCLUSION: The active job openings-to-applicants ratio during deflationary periods was associated with increased ambulance dispatches.

PMID:40435300 | DOI:10.1371/journal.pone.0320914

J Med Econ. 2025 May 28:1-16. doi: 10.1080/13696998.2025.2510814. Online ahead of print.

ABSTRACT

OBJECTIVE: To assess the effects of Liposomal Bupivacaine (LB) and provider LB use rate for 6 months after discharge on service utilization, clinical outcomes, and Medicare expenditures among Fee for Service (FFS) beneficiaries who have undergone hospital outpatient department (HOPD) procedures.

METHODS: 100% Medicare Research Identifiable Files data from 2019 to 2023 was utilized. Medicare FFS beneficiaries with the top 100 HOPD surgical procedures where LB was utilized were included in the study and divided into two cohorts: received LB (treatment) and did not receive LB (comparison) during the surgical procedure. An Inverse Probability Treatment Weighting Propensity Score model was estimated to balance treatment and control groups. We estimated Emergency Department (ED) admission, Short Term Acute Care Hospitals (STACH) admission, mortality, Opioid Use Disorder (OUD) and Opioid prescription fill events, and spending metrics.

RESULTS: LB use contributed to significant reductions in ED admission (9%; 23.28% vs. 25.69%), STACH admission (8%; 11.61% vs. 12.65%), mortality (39%; 0.67% vs. 1.1%) and opioid prescription fills (6%; 1.8 vs. 1.92) within 180-days post-discharge. Total Medicare expenditures (180-day episode) were $245 lower for the LB user ($9,645 vs. $9,891). For each 10-percentage point increase in provider LB use-rate, the likelihood of ED admission, STACH admission, mortality, and OUD decreased by 0.1, 0.15, 0.01 and 0.02 percentage points, respectively. Total Medicare expenditures (180-day episode) were reduced by $258 for every one percentage point increase in LB use-rate.

CONCLUSION: Use of LB and provider LB use rate are associated with improved patient clinical, service utilization, and expenditure outcomes.

PMID:40434805 | DOI:10.1080/13696998.2025.2510814

JAMA Netw Open. 2025 May 1;8(5):e2510808. doi: 10.1001/jamanetworkopen.2025.10808.

ABSTRACT

IMPORTANCE: Innovative approaches to address interpersonal risk factors for suicide attempts and suicidal ideation may help reduce persistently elevated suicide rates in the US.

OBJECTIVE: To determine whether Peers for Valued Living (PREVAIL), a posthospital peer support intervention, reduces suicide attempts and suicidal ideation among adults psychiatrically hospitalized for suicide risk.

DESIGN, SETTING, AND PARTICIPANTS: This single-masked, randomized clinical trial recruited adult psychiatric inpatients aged 18 years or older from 3 Michigan-based facilities between June 22, 2018, and December 30, 2022. The study compared 3 months of the PREVAIL intervention plus enhanced usual care with enhanced usual care only, with 3 months of postintervention follow-up.

INTERVENTION: One-on-one support from a peer specialist initiated during hospital admission and continued 3 months after discharge.

MAIN OUTCOMES AND MEASURES: Suicide attempts were measured using the Columbia Suicide Severity Rating Scale, and suicidal ideation was measured using the Beck Scale for Suicidal Ideation at 3 and 6 months after randomization.

RESULTS: Of 5310 patients screened, 455 were randomized using a minimization algorithm. A total of 229 participants were randomized to the PREVAIL peer mentorship arm (mean [SD] age, 32.4 [14.0] years, 134 women [58.5%]), and 226 were randomized to the enhanced usual care arm (mean [SD] age, 31.6 [13.5] years; 139 women [61.5%]). In the intention-to-treat sample with nonmissing data, the percentage of participants with any suicide attempt over 6 months (including participants who only completed 3-month follow-up assessments) was 17.2% (28 of 163) for enhanced usual care and 14.9% (24 of 161 with 2 deaths by suicide) for PREVAIL. Mean (SD) suicidal ideation scores were 4.3 (95% CI, 3.2-5.3) for enhanced usual care and 4.9 (95% CI, 3.7-6.1) for PREVAIL at 6 months. There were no statistically significant effects of the intervention for either outcome in the primary analyses. In post hoc analyses, the interaction between study arm and the COVID-19 pandemic was statistically significant. The enhanced usual care arm had a mean (SD) 6-month suicidal ideation score of 3.5 (6.1) before and 6.1 (7.4) after the pandemic vs the PREVAIL arm (mean [SD] scores, 5.0 [7.7] and 4.5 [6.6], respectively). There were 2 study-related adverse events, with 1 resulting in participant withdrawal from the intervention arm.

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, the peer-delivered PREVAIL intervention up to 3 months after discharge did not significantly differ from enhanced usual care in terms of reducing subsequent suicide attempts or suicidal ideation.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03373916.

PMID:40434775 | DOI:10.1001/jamanetworkopen.2025.10808

JAMA Netw Open. 2025 May 1;8(5):e2512299. doi: 10.1001/jamanetworkopen.2025.12299.

ABSTRACT

IMPORTANCE: Referral hospitals in the US are experiencing unprecedented levels of crowding, leading them to increasingly refuse interhospital transfer (IHT) requests. Crowded hospitals are dangerous, but refusing IHTs undermines the role of referral hospitals and may cause harm.

OBJECTIVE: To measure associations of hospital crowding measures (emergency department [ED] boarding and inpatient census) with IHT acceptances overall and for prioritized conditions.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study from January 2019 to May 2023 analyzed data from the only academic and level I trauma center in a highly rural state in the Southwestern US, including transfer center data, ED boarding hours, and inpatient census. All transfer center calls regarding adults (age >18 years) were eligible for the study. Data were analyzed from June to October 2024.

MAIN OUTCOME AND MEASURES: The primary outcome was the proportion of transfer requests accepted on a weekly and monthly basis. Adjusted logistic regression was used to analyze associations of ED boarding time and inpatient census with IHT acceptance, considering prioritized conditions (obstetrics, ST-elevation myocardial infarction [STEMI], stroke, and trauma) and rurality. Transfer data contained IHT request descriptors, including referring facility, date and time of call, decision (accept or decline), diagnosis, and patient demographics. ED boarding was measured daily as a sum of all boarding hours for each ED patient.

RESULTS: The study included 26 020 IHT requests (11 267 women [43.2%]; mean [SD] age, 54.4 [19.6] years), of which 16 062 were accepted (61.7%). There were 22 119 (85.0%) requests from urban and 3901 requests (15.0%) from rural hospitals, with the majority of IHT requests (19 912 requests [76.3%]) seeking transfer from an ED. There was a negative correlation between IHT acceptance and ED boarding (Pearson r, -0.73) and inpatient census (Pearson r, -0.87). At times of worst ED boarding (highest vs lowest quartile), the odds of IHT acceptance were lower (adjusted odds ratio [aOR], 0.71; 95% CI, 0.66-0.78). Of the 3901 rural requests, 2196 (56.3%) were accepted, with lower odds of acceptance for rural vs urban requests (aOR, 0.66; 95% CI, 0.64-0.79). Prioritized diagnoses were more commonly accepted, particularly obstetrics (aOR, 5.28; 95% CI, 4.17-6.70), STEMI (aOR, 3.04; 95% CI, 1.86-4.98), and trauma (aOR, 3.19; 95% CI, 2.86, 3.57).

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of IHT requests, the severity of ED boarding and inpatient census were associated with decreased IHT acceptance, suggesting that overcrowded referral hospitals face tradeoffs as they seek to fulfill seemingly conflicting obligations to safely care for locally hospitalized patients and accept regional patients seeking transfer.

PMID:40434774 | DOI:10.1001/jamanetworkopen.2025.12299

JAMA Netw Open. 2025 May 1;8(5):e2512763. doi: 10.1001/jamanetworkopen.2025.12763.

ABSTRACT

IMPORTANCE: The test-negative design (TND) has been widely used to assess postmarketing COVID-19 vaccine effectiveness but requires further evaluation for this application.

OBJECTIVE: To determine whether the TND reliably evaluates vaccine effectiveness against symptomatic COVID-19 using placebo-controlled vaccine efficacy randomized clinical trials (RCTs).

DESIGN, SETTING, AND PARTICIPANTS: This secondary cross-protocol analysis constructed TND study datasets from study sites in 16 countries across 5 continents using the blinded phase cohorts of 5 harmonized phase 3 COVID-19 Prevention Network RCTs: COVE (Coronavirus Vaccine Efficacy and Safety), AZD1222, ENSEMBLE, PREVENT-19 (Prefusion Protein Subunit Vaccine Efficacy Novavax Trial COVID-19), and VAT00008. Participants included adults who received the intended number of doses, experienced COVID-19-like symptoms, and obtained SARS-CoV-2 testing. Start dates ranged from July 27, 2020, to October 19, 2021; data cutoff dates ranged from March 26, 2021, to March 15, 2022. Statistical analysis was performed from May 11, 2023, to February 25, 2025.

INTERVENTIONS: Participants received vaccines consisting of messenger RNA-1273 (COVE; 2 doses 28 days apart), ChAdOx1 nCoV-19 (AZD1222; 2 doses 28 days apart), Ad26.COV2.S (ENSEMBLE; 1 dose), NVX-CoV2373 (PREVENT-19; 2 doses 21 days apart), CoV2 preS dTM-AS03 (VAT00008; D614) (2 doses 21 days apart), or CoV2 preS dTM-AS03 (D614 plus B.1.351) (VAT00008; 2 doses 21 days apart) or placebo.

MAIN OUTCOMES AND MEASURES: Main outcomes were symptomatic COVID-19 according to each trial’s primary efficacy definition and the Centers for Disease Control and Prevention definition. Vaccine effectiveness was estimated using targeted maximum likelihood estimation under a semiparametric logistic regression model and ordinary logistic regression. Noncase exchangeability, a core TND assumption for unbiased estimation, was also assessed by estimating vaccine efficacy against non-COVID-19 illness.

RESULTS: Among the 12 157 participants included in the analysis, mean (SD) age was 45 (15) years, 6414 were female (53%), 5858 were vaccinated (48%), 2835 experienced primary COVID-19 (23%), and 2992 experienced Centers for Disease Control and Prevention-defined COVID-19 (25%). TND vaccine effectiveness estimates were concordant with RCT vaccine efficacy estimates (concordance correlation coefficient, 0.86 [95% CI, 0.58-0.96] for both outcomes). The semiparametric method had 48% smaller variance estimates than ordinary logistic regression. Noncase exchangeability was generally supported with a median vaccine efficacy against non-COVID-19 illness of 7.7% (IQR, 2.7%-16.8%) across trial cohorts and most 95% CIs including 0.

CONCLUSIONS AND RELEVANCE: In this cross-protocol analysis, the TND provided reliable inferences on COVID-19 vaccine effectiveness in health care-seeking populations for multiple vaccines and symptom definitions when confounding and selection bias were absent. A machine-learning approach for robust confounding control in postmarketing TND studies was also introduced.

PMID:40434773 | DOI:10.1001/jamanetworkopen.2025.12763

Urol Res Pract. 2025 May 21;51(1):38-42. doi: 10.5152/tud.2025.24152.

ABSTRACT

Objective: To evaluate the efficacy of the Quadruple-D scoring system in predicting stone-free rate (SFR) using the newer Generation Piezoelectric lithotripter. Methods: A prospective observational study was conducted from January to December 2023, involving patients who underwent extracorporeal shock wave litho- tripsy (ESWL) for renal stones sized 5-20 mm. Evaluation parameters included stone density, skin-to-stone distance (SSD), stone size (ellipsoid stone volume), and location, with Quadruple-D scores calculated based on predetermined cutoffs. Extracorporeal shock wave lithotripsy sessions utilized the “Piezolith 3000 Plus” lithotripter, and SFR was assessed 4 weeks post-procedure. Statistical analysis included Student’s t-test and receiver operating characteristic curve analysis. Results: Of the 40 eligible patients, 75% achieved stone-free status post-ESWL. Stone density and SSD emerged as leading predictors of SFR, with new cut-off values identi- fied. Comparative analysis demonstrated improved predictive power of the Piezolith Q-D score over the previous Quadruple-D score (AUC: 84% and 80% respectively). Although stone location and size also influenced outcomes, their significance varied in this study. Conclusion: The Piezolith Q-D score system exhibits promise in predicting SFR post- ESWL with piezoelectric lithotripters. External validation and larger-scale studies are warranted to establish the scoring system’s reliability and applicability across diverse populations.

PMID:40434748 | DOI:10.5152/tud.2025.24152