Nevin Manimala

Health Syst Reform. 2026 Dec 31;12(1):2609358. doi: 10.1080/23288604.2025.2609358. Epub 2026 Jan 27.

ABSTRACT

Previous studies have shown that facility autonomy, especially control over budget allocation, and management practices can have a modest positive effect on health facility performance, but the evidence is limited and often qualitative. Data from the evaluation of the Nigeria States Health Investment Project (NSHIP), a study that examined the effects of direct facility and performance-based financing, offers a novel opportunity to quantitatively examine these relationships in the context of a lower middle-income country. We utilize non-parametric statistics and regression methods to test the hypothesis that autonomy, supervision, and management affected facility performance. Results show that facilities with greater autonomy, more budget control, and better management practices generally outperform their peers on a range of facility readiness and service delivery measures. For example, regressions show that facilities with high autonomy held an additional 2.1 outreach sessions per month and facilities with a business plan offered 1.8 additional outreach services (p < 0.05). Supervision practices, including visit frequency and a quantitative checklist, are associated with 26% higher productivity and up to a 29% increase in equipment availability (p < 0.05). Sensitivity analyses validated that results are robust. We conclude that facility-level autonomy and especially budget control can improve primary healthcare facility readiness and service availability. Further, management practices that are reinforced through supportive supervision and routine monitoring can maximize the benefits that accrue from even small amounts of incremental financing. This shows that these policies and practices can contribute critically to efficiently achieving the goals of universal healthcare policies in the context of limited resources.

PMID:41592278 | DOI:10.1080/23288604.2025.2609358

Am J Audiol. 2026 Jan 27:1-30. doi: 10.1044/2025_AJA-25-00131. Online ahead of print.

ABSTRACT

PURPOSE: Reduced spectral resolution limits speech recognition in cochlear implant (CI) listeners. Although many studies have examined this association, uncertainties remain regarding its strength and contributing methodological and clinical factors. This narrative review synthesizes findings from studies of postlingually deafened adult CI listeners, focusing on psychophysical measures of spectral resolution and their strengths and limitations.

METHOD: We reviewed studies published through January 2025 that examined the relationship between psychophysical measures of spectral resolution and speech perception outcomes in postlingually deafened adult CI listeners. Twenty-four studies met inclusion criteria and tested this association statistically. Where available, the coefficient of determination (R²) and effect size measures were extracted to quantify the strength of this association.

RESULTS: Several studies found a statistically significant association between psychophysical measures of spectral resolution and speech recognition performance. The predictive power of spectral resolution measures for speech perception outcomes varied substantially (R² = .21-.69), depending on the specific measure used and the type of speech material. Spectral ripple discrimination/detection threshold tasks and their modified versions, on average, show higher predictive capacity for investigating this link. These measures are especially predictive when using speech materials such as consonant-nucleus-consonant words and AzBio or Institute of Electrical and Electronics Engineering sentences presented in quiet or multitalker babble at moderate signal-to-noise ratios. In contrast, measures based on forward-masking paradigms and pitch ranking tend to yield weaker or nonsignificant associations.

CONCLUSIONS: The review underscores spectral resolution as a key leverage point in efforts to improve speech recognition outcomes. Variability in observed associations highlights the need for further mechanistic research into the pathways linking spectral resolution to speech recognition outcomes. Future studies are warranted to improve both the predictive accuracy and clinical feasibility of spectral resolution assessment tools.

PMID:41592272 | DOI:10.1044/2025_AJA-25-00131

Commun Dis Intell (2018). 2026 Jan 28;50. doi: 10.33321/cdi.2026.50.004.

ABSTRACT

OBJECTIVE: The primary aim of this paper is to describe the outbreak investigation and public health response to a cluster of mpox cases that occurred in Southeast Queensland; and to investigate transmission dynamics to inform contact management.

BACKGROUND: The transmission of mpox in Australia has continued to circulate among the men who have sex with men community, since the declaration of the global outbreak of clade IIb in 2022. In May 2024, an outbreak investigation was carried out following the admission of an mpox case to a Queensland hospital, which precipitated a response coordinated by two metropolitan public health units (Metro North and Metro South) in Brisbane.

METHODS: A prospective cohort study was conducted to follow up attendees of an intimate group event over a 21-day period. From 21 event attendees, 16 were able to be contacted by public health clinicians, and were included in the cohort. Case histories and their respective contacts were identified and classified as high, medium or low risk. Descriptive statistics were conducted, and relative risk was determined for developing infection after attendance at the group event, when accounting for the level of vaccination against mpox. Whole genome sequencing was performed on collected pathology specimens, and phylogenetic analysis was conducted to support epidemiological investigations.

FINDINGS: A total of ten cases of mpox were detected, among a cohort of 16 males with differing levels of vaccination. Transmission of mpox occurred exclusively among high-risk contacts; no transmission was observed to medium- or low-risk contacts. Laboratory investigations revealed that all cases were of human MPXV clade IIb. Complete vaccination was a protective factor against development of mpox (relative risk = 0.33; 95% confidence interval: 0.06-1.88), compared with partial or no vaccination, after attendance at the high-risk exposure event. This outbreak resulted in 34 contacts, of which one high-risk contact became a secondary case. Findings from this investigation suggest there is less urgency for follow-up of household contacts and other medium- and low-risk contacts of mpox, compared with high-risk contacts. Fostering a rapport during telephone interviews with cases and contacts was found to be crucial to the overall attainment of accurate case histories, highlighting the need for the development of trust when interacting with members of priority groups. This outbreak investigation describes a comprehensive public health response attributed to the coordination of a range of public health workers in the Southeast Queensland area.

PMID:41592252 | DOI:10.33321/cdi.2026.50.004

Integr Environ Assess Manag. 2026 Jan 27:vjag006. doi: 10.1093/inteam/vjag006. Online ahead of print.

ABSTRACT

The revised 2023 European Food Safety Authority (EFSA) guidance on the risk assessment of plant protection products on bees introduced a major change in the statistical evaluation of higher tier studies, replacing difference testing with the equivalence testing approach. This paper evaluates several statistical models for equivalence testing of colony strength endpoints in honey bee semi-field studies, including a t-test, a two-way ANOVA, and a linear-mixed-effects model incorporating an autoregressive (AR) structure. Using a range of simulated scenarios, model performance was compared to determine suitability and the likely level of replication needed to conclude a low risk of a test substance with a true effect size of <10% reduction in colony strength. The linear mixed-effects model with AR structure and baseline adjustment offered the highest statistical power among the tested approaches. In all simulated scenarios, achieving 80% power to conclude equivalence required substantially more replication than the minimum of three replicates recommended in the EPPO (2010) test guideline. Under the best-case scenario, a minimum of seven replicates was needed when the true effect size was 0, whereas effects close to the equivalence margin (a true 9% reduction) required extremely large sample sizes, up to 612 replicates, to achieve sufficient power. Potential modifications to the study design to reduce replication needs were also explored. Reducing initial inter-colony variability alone did not meaningfully decrease required sample sizes, whereas increasing temporal correlation among repeated observations improved power and lowered replication requirements. Nevertheless, it is questioned whether the large numbers of replicates illustrated here are manageable in a practical study setup. Caution is needed during the implementation of the equivalence approach for regulatory evaluation until applicants and regulatory bodies better understand if such studies can be feasibly designed and conducted to demonstrate acceptable risk against the specific protection goals.

PMID:41592234 | DOI:10.1093/inteam/vjag006

JMIR Form Res. 2026 Jan 27;10:e79606. doi: 10.2196/79606.

ABSTRACT

BACKGROUND: Transgender Latina women in the United States face disproportionate HIV risk due to intersecting social and structural vulnerabilities that limit access to care. While gender-affirming, culturally responsive, and eHealth strategies show promise for improving access, social media-based approaches remain underused despite their potential to reach marginalized groups at scale.

OBJECTIVE: This study aimed to develop and pilot a culturally tailored social media campaign to increase awareness of HIV prevention and care services offered by a community-based organization (CBO) in King County, Washington, for transgender Latina women and to assess the campaign’s feasibility and acceptability.

METHODS: We conducted a community-engaged, mixed methods pilot study using a multiphase design. In phase 1, we conducted cross-sectional, in-depth interviews with transgender Latina women (n=20) recruited by a CBO in King County, Washington. Interviews were analyzed using thematic analysis, guided by the Unified Theory of Behavior, to inform campaign messaging priorities. A subsequent focus group (n=7) then reviewed and refined 6 draft campaign concepts according to the community preferences. In phase 2, the finalized campaign was piloted on Facebook and Instagram. A cross-sectional REDCap (Research Electronic Data Capture; Vanderbilt University) survey was conducted with a subset (n=100) of transgender Latina women exposed to the campaign who voluntarily consented to complete the survey after being directed from the campaign. Survey data were summarized using descriptive statistics to assess campaign reach and feasibility and acceptability outcomes.

RESULTS: In-depth interview participants were a mean age of 37.6 (SD 9.5) years and reported an average of 10.2 (SD 10.8) years residing in the United States (n=20). Interviews revealed four key themes: (1) importance of HIV prevention and awareness, (2) accessibility of HIV services, (3) provision of culturally tailored care, and (4) need for confidentiality. Among survey respondents (mean age of 29.7, SD 5.2 years), 97% (97/100; 95% CI 91.5%-99.0%) had ever tested for HIV and 44% (44/100; 95% CI 34.3%-53.7%) reported testing within the past 6 months. A total of 3 respondents were living with HIV, all on antiretroviral therapy. Nearly all (91/100, 91%; 95% CI 84.3%-95.2%) reported campaign-motivated action, including HIV testing or seeking information or services.

CONCLUSIONS: Findings demonstrate the feasibility and acceptability of a culturally tailored campaign, cocreated with community members, to promote HIV prevention and care among transgender Latina women. By integrating participatory methods with digital outreach, this study contributes an innovative model that centers community voices in campaign design while leveraging widely used platforms. The study has implications for providing CBOs with scalable, low-cost strategies to expand culturally responsive HIV services, reduce stigma, and motivate health-seeking behaviors in populations often overlooked by mainstream public health messaging. This work underscores how codesigned social media campaigns can complement traditional outreach and inform future HIV prevention strategies for underserved populations.

PMID:41592163 | DOI:10.2196/79606

PLoS Comput Biol. 2026 Jan 27;22(1):e1013908. doi: 10.1371/journal.pcbi.1013908. Online ahead of print.

ABSTRACT

Polymerase Chain Reaction (PCR) is a critical step in amplicon-based microbial community profiling, allowing the selective amplification of marker genes such as 16S rRNA from environmental or host-associated samples. Despite its widespread use, PCR is known to introduce amplification bias, where some DNA sequences are preferentially amplified over others due to factors such as primer-template mismatches, sequence GC content, and secondary structures. Although these biases are known to affect transcript abundance, their implications for ecological metrics remain poorly understood. In this study, we conduct a comprehensive evaluation of how PCR-bias influences both within-samples (α-diversity) and between-sample (β-diversity) analyses. We show that perturbation-invariant diversity measures remain unaffected by PCR bias, but widely used metrics such as Shannon diversity and Weighted-Unifrac are sensitive. To address this, we provide theoretical and empirical insight into how PCR-induced bias varies across ecological analyses and community structures, and we offer practical guidance on when bias-correction methods should be applied. Our findings highlight the importance of selecting appropriate diversity metrics for PCR-based microbial ecology workflows and offer guidance for improving the reliability of diversity analyses.

PMID:41592132 | DOI:10.1371/journal.pcbi.1013908

PLoS One. 2026 Jan 27;21(1):e0341187. doi: 10.1371/journal.pone.0341187. eCollection 2026.

ABSTRACT

Hospital readmissions prolong patient suffering and increase healthcare expenditures. Unplanned readmission rates, such as those reported by the Center for Medicare & Medicaid Services (CMS), distinguish between planned and unplanned readmissions. However, within unplanned readmissions, there is no distinction between those that are preventable versus unpreventable by the hospitals. Alternative approaches attempting to identify potentially preventable readmissions directly from coded medical data have been explored but have shown low sensitivity. Consequently, identifying preventable readmissions remains a time-consuming task for hospital quality managers seeking to allocate improvement resources effectively. To address this challenge, we aimed to develop and evaluate a probabilistic approach to improve the identification of preventable readmissions among unplanned readmissions. Using a retrospective record review of 600 single inpatient stays from a tertiary referral hospital group in Switzerland, we investigated the hypothesis that readmitted patients with a low expected probability for readmission (based on a logistic regression model using patient characteristics) would retrospectively show higher odds of having experienced a potentially or most likely preventable readmission (as assessed by the reviewers). The results confirmed our hypothesis: patients in the third with the lowest expected probability of readmission (compared with those in the highest third) had 6.6 and 8.7 times higher odds, respectively, of having experienced a potentially or most likely preventable readmission. Among preventable readmissions, the leading causes of readmission were surgical complications, medication-related reasons, nonsurgical complications, and premature discharge. Our proposed probabilistic approach can be used by hospital quality managers to focus case finding efforts on unexpectedly readmitted patients and aid effective resource allocation for improvement initiatives.

PMID:41592101 | DOI:10.1371/journal.pone.0341187

PLoS One. 2026 Jan 27;21(1):e0341870. doi: 10.1371/journal.pone.0341870. eCollection 2026.

ABSTRACT

INTRODUCTION: Maternal and child undernutrition remains a major public health challenge globally, with the highest burdens observed in low- and middle-income countries. Coexisting maternal and child undernutrition has serious implications for survival, growth, and quality of life.Maternal and child undernutrition is a complex, multifactorial issue influenced by a web of interconnected determinants including health, socio-economic status, education and environmental conditions.

OBJECTIVES: To examine the spatial distribution and multilevel determinants of coexisting maternal and child undernutrition in Ethiopia using EDHS data from 2000-2016.

METHODS: We analyzed a weighted sample of 33,445 participants from four consecutive EDHS surveys. Spatial autocorrelation, hotspot, and interpolation analyses were conducted using ArcMap 10.8. Multilevel logistic regression was performed in Stata 17. Cluster variability was assessed using ICC, MOR, and PCV. Variables with p < 0.05 were considered statistically significant.

RESULT: A total of 33,445 weighted sample was used for this study. The prevalence of coexisting maternal and child undernutrition was 22.87% (95% CI: 22.42, 23.32). Spatial analysis result showed that hot spot areas were concentrated in the northern regions especially Tigray, Amhara, and parts of Benishangul-Gumuz. Multilevel logistics regression analysis result revealed that maternal primary education (AOR = 0.88; 95% CI: 0.78, 0.98), secondary/higher education (AOR = 0.38; 95% CI: 0.29, 0.49), medium household wealth (AOR = 0.85; 95% CI: 0.75, 0.97), high household wealth (AOR = 0.78; 95% CI: 0.69, 0.89), child age 12-23 months (AOR = 2.77; 95% CI: 2.44, 3.16), ANC use (AOR = 0.83; 95% CI: 0.75, 0.92), improved toilet (AOR = 0.83; 95% CI: 0.71, 0.98) and regions.

CONCLUSION AND RECOMMENDATIONS: Coexisting maternal and child undernutrition shows marked geographic clustering in northern Ethiopia. Strengthening maternal education, improving household economic conditions, enhancing ANC use, and expanding sanitation services particularly in high-risk regions are essential to reduce the burden.

PMID:41592092 | DOI:10.1371/journal.pone.0341870

JCI Insight. 2026 Jan 27:e197261. doi: 10.1172/jci.insight.197261. Online ahead of print.

ABSTRACT

The survival of patients with acute myelogenous leukemia (AML) carrying mutations in TP53 is dismal. We report the results of a detailed characterization of responses to treatment ex vivo with the MDM2 inhibitor MI219, a p53 protein stabilizer, in AML blasts from 165 patients focusing analyses on TP53 wildtype (WT) patients. In total 33% of AML were absolute resistant to MDM2 inhibitor induced apoptosis, of which 45% carried TP53 mutation and 55% were TP53 WT. We conducted array-based expression profiling of ten resistant and ten sensitive AML cases with WT TP53 status, respectively, at baseline and after 2h and 6h of MDM2 inhibitor treatment. While sensitive cases showed the induction of classical TP53 response genes, this was absent or attenuated in resistant cases. In addition, the sensitive and resistant AML samples at baseline profoundly differed in the expression of inflammation-related and mitochondrial genes. No TP53 mutated AML patient survived. The 4-year survival of AML with defective MDM2 inhibitor induced TP53-mediated apoptosis despite WT TP53 was dismal at 19% when NPM1 was co-mutated and 6% when NPM1 was WT. In summary, we identified prevalent multi-causal defects in TP53-mediated apoptosis in AML resulting in extremely poor patient survival.

PMID:41592087 | DOI:10.1172/jci.insight.197261

Cereb Cortex. 2026 Jan 6;36(1):bhaf346. doi: 10.1093/cercor/bhaf346.

ABSTRACT

Frontal midline theta oscillations are key neural markers for learning, set-shifting, and adaptive behavior, signaling cognitive control and the reorganization of neural representations. The present study explored how these oscillations mediate the extraction and updating of statistical regularities. We delivered 6-Hz in-phase or sham transcranial alternating current stimulation, synchronizing frontal midline theta during an eye-tracking probabilistic sequence learning task designed to test cognitive flexibility and assess changes in pre-stimulus gaze direction. A novel probabilistic sequence with a partially overlapping structure was introduced that allowed us to distinguish between the retention of old sequences and the acquisition of new ones. Following comparable statistical learning in both groups during the stimulation session, our results showed that frontal midline theta synchronization enhances the adaptation of predictive processes shown by the reduction of erroneous anticipations of previously learned regularities and more flexible anticipation of novel regularities. These results suggest a role of frontal midline theta in the flexible rewiring of the mental representations of prior probabilistic structures and in making predictions more accurate.

PMID:41592083 | DOI:10.1093/cercor/bhaf346