Nevin Manimala

Palliat Support Care. 2026 Jul 15;24:e196. doi: 10.1017/S1478951526103058.

ABSTRACT

OBJECTIVES: To (1) identify clinical situations that may contribute to the experience of moral distress (MD) among professionals working with motor neuron disease (MND), (2) measure the occurrence and intensity of MD, and (3) explore associations with professional quality of life, turnover intention, and associated risk and/or protective factors.

METHODS: A cross-sectional online survey was distributed to healthcare professionals working in MND services across Europe. Data were analyzed using descriptive and inferential statistics.

RESULTS: In total, 230 responses from professionals across 17 European countries were analyzed from the international survey. And 67% of respondents indicated that MD resonated with their experience of working with MND. Those who considered leaving or changing their position due to the challenges associated with caring for this patient population were also more likely to report resonance with MD (χ² = 7.772, p = 0.020). The intensity of MD was associated with reduced professional quality of life (burnout [β = 0.106, p < 0.05], and secondary traumatic stress [β = 2.881, p < 0.001]). A total of 24 clinical scenarios were identified as potential contributors to experiences of MD in this population. Across all professional groups, service-/organization-level factors were the most common and distressing barriers to providing effective MND care.

SIGNIFICANCE OF RESULTS: This study demonstrates that MD is experienced by healthcare professionals working with MND across Europe. MD was associated with reduced professional quality of life and increased intentions to leave or change positions, underscoring its potential implications for workforce retention and sustainability. The findings show that system/organization, patient/condition and family-level causes are the primary drivers of MD in this population. Future research should focus on evaluating the effectiveness of interventions designed to address these key drivers and mitigate the impact of MD among healthcare professionals working with MND.

PMID:42454435 | DOI:10.1017/S1478951526103058

Biosci Rep. 2026 Jul 15:BSR20260093. doi: 10.1042/BSR20260093. Online ahead of print.

ABSTRACT

Blastocyst culture is an essential part of IVF/ICSI treatments, however, it has been shown to increase the risk of preterm deliveries as well as large for gestational age infants. The effect of the extended culture on offspring phenotype is thought to be mediated by epigenetic mechanisms, since this developmental period coincides with extensive epigenetic remodelling. Here, we compare genome-wide DNA methylation of cord blood and umbilical cord artery samples collected from newborns resulting from cleavage-stage transfer (n = 25), blastocyst-stage transfer (n = 25) and spontaneous conception (n=30). Epigenome-wide association studies, global methylation analyses and epigenetic age comparison did not reveal statistically significant differences between the cleavage-stage and blastocyst-stage groups. However, we identified some loci with a > 10% difference in median methylation level between the groups, which should be studied further with a larger sample size. The genome-wide DNA methylation of spontaneously conceived and cleavage-stage newborns were comparable while in the spontaneous to blastocyst-stage comparison, cg25263722 was differentially methylated (p = 5×10-8) in umbilical cord artery. Our study did not identify major effects of extended culture on DNA methylation, which is reassuring with respect to the future health of newborns conceived via assisted reproductive technologies.

PMID:42454427 | DOI:10.1042/BSR20260093

Br J Math Stat Psychol. 2026 Jul 15. doi: 10.1111/bmsp.70062. Online ahead of print.

ABSTRACT

Standardized mean differences (SMDs) are widely used to quantify treatment effects in cluster-randomized trials. However, covariate adjustment in hierarchical linear models reduces the residual variance components used for standardization, which artificially inflates effect size estimates and undermines comparability across studies. We propose a unified family of estimators that recover the unadjusted variance components by rescaling the covariate-adjusted variance components using pseudo- $R^2$ indices. This rescaling places effect size estimates on a common reference scale, thereby improving comparability across studies and model specifications under standard modeling assumptions. The framework accommodates three covariate adjustment scenarios including level-1, level-2, and simultaneous both-level adjustments. Furthermore, it introduces three estimator types spanning method of moments, maximum likelihood, and a t-statistic reformulation suitable for meta-analysis from published summaries, alongside delta-method variance approximations for each. An empirical example and a simulation study apply the proposed covariate-adjusted SMDs across these scenarios to illustrate their implementation and demonstrate the consequences of omitting the correction.

PMID:42454368 | DOI:10.1111/bmsp.70062

Adv Med Educ Pract. 2026 Jul 10;17:618836. doi: 10.2147/AMEP.S618836. eCollection 2026.

ABSTRACT

INTRODUCTION: Simulation enables safe, structured practice of laparoscopic skills outside the operating room, yet objective, threshold-referenced performance data from mandatory postgraduate curricula in Central and Eastern Europe remain scarce. We report the educational outcomes of a structured, multi-level virtual-reality (VR) laparoscopy curriculum delivered at a single national simulation center.

METHODS: We conducted a single-center prospective observational study of 29 obstetrics and gynecology residents who completed a four-module laparoscopic course (Basic 1-2, Advanced 1-2) at the Centre for Endoscopy Simulation, Centre of Postgraduate Medical Education (CMKP), Warsaw. Outcomes comprised pre- and post-course single-choice knowledge tests, self-assessed competence, satisfaction, and simulator-based performance evaluated against a priori, criterion-referenced passing thresholds. Technical metrics were simulator-generated (Simbionix LAP Mentor); no human global rating scales were used. Demographic and training-related variables (gender, residency year, training-center referral level, prior endoscopic experience) were analyzed with non-parametric statistics.

RESULTS: Knowledge scores improved from 20.9 (SD = 2.70) to 29.2 (SD = 1.01) (Wilcoxon, p <0.05). Self-assessed competence increased significantly across all domains (p <0.05). Satisfaction was uniformly high (mean 4.7/5, SD = 0.45) but did not correlate with objective performance (all p >0.05). Outcomes did not differ by gender or training-center referral level; residency year was associated with performance only in colpotomy (ρ = -0.37, p =0.047), and prior experience predicted performance mainly in basic camera manipulation (e.g. 30° navigation distance, ρ = -0.50, p =0.005), consistent with a learning-curve effect.

CONCLUSION: A structured, multi-modular VR laparoscopy course significantly improved theoretical knowledge and self-assessed competence among OB-GYN residents. Within this single-center cohort, measured outcomes did not differ by gender or training-center referral level. High satisfaction diverged from objective performance, underscoring the need for balanced, criterion-referenced evaluation. A priori passing thresholds enabled transparent, proficiency-oriented assessment.

PMID:42454356 | PMC:PMC13367472 | DOI:10.2147/AMEP.S618836

Int J Gen Med. 2026 Jul 10;19:620783. doi: 10.2147/IJGM.S620783. eCollection 2026.

ABSTRACT

BACKGROUND: Elevated red cell distribution width (RDW) has been implicated in chronic mountain sickness; however, its relationship with acute mountain sickness (AMS) remains uncertain. We aimed to evaluate the association between elevated RDW and AMS among Chinese young men undergoing high-altitude air ascent.

METHODS: 157 participants (median age, 22 years) were enrolled and passively ascended primarily by air from 500 m to 3,650 m, spending approximately 3.5 hours. Participants were classified as AMS+ and AMS- based on their Lake Louise AMS score (LLS) after 24 hours at 3,650 m. Measurements included heart rate (HR), blood pressure, pulse oximeter saturation (SpO₂), and complete blood count (CBC). Statistical analyses included correlation analysis, logistic regression, and receiver operating characteristic (ROC) curve analysis.

RESULTS: The prevalence of AMS at 3,650 m was 45%. AMS+ participants had higher HR and RDW and lower SpO₂ than AMS- participants. LLS was positively correlated with age, BMI, HR, and RDW, and negatively correlated with SpO₂. Adjusted logistic regression revealed independent risk factors for AMS, including lower SpO₂ (odds ratio [OR] = 0.809, P < 0.01), higher RDW coefficient of variation (RDW-CV) (OR = 2.790, P < 0.01), and a higher neutrophil-to-monocyte ratio (OR = 1.114, P < 0.05). ROC curve analysis demonstrated that elevated RDW-CV is a significant diagnostic indicator for AMS, with an optimal cutoff of 13.7, yielding a sensitivity of 94.37%, specificity of 45.35%, and an area under the curve (AUC) of 0.703.

CONCLUSION: The findings suggest that elevated RDW-CV is linked to an increased risk of AMS among Chinese young men primarily undergoing air ascent to 3,650 m.

PMID:42454354 | PMC:PMC13367465 | DOI:10.2147/IJGM.S620783

Stat Comput. 2026;36(4):176. doi: 10.1007/s11222-026-10935-4. Epub 2026 Jul 13.

ABSTRACT

State-space models (SSMs) provide a flexible framework for modelling time series data, but their reliance on Gaussian error assumptions makes them highly sensitive to outliers. We propose a robust estimation method, ROAMS, that mitigates the influence of additive outliers by introducing shift parameters at each timepoint in the observation equation of the SSM. These parameters allow the model to attribute non-zero shifts to outliers while leaving clean observations unaffected. ROAMS then enables automatic outlier detection, through the addition of a penalty term on the number of flagged outlying timepoints in the loss function, and simultaneous estimation of model parameters. We apply the method to robustly estimate SSMs on both simulated data and real-world animal location-tracking data, demonstrating its ability to produce more reliable parameter estimates than classical methods and other benchmark methods. In addition to improved robustness, ROAMS offers practical diagnostic tools, including BIC curves for selecting tuning parameters and visualising outlier structure. These features make our approach broadly useful for researchers and practitioners working with contaminated time series data.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11222-026-10935-4.

PMID:42454343 | PMC:PMC13364811 | DOI:10.1007/s11222-026-10935-4

ACS ES T Water. 2026 Jun 10;6(7):4119-4129. doi: 10.1021/acsestwater.5c01051. eCollection 2026 Jul 10.

ABSTRACT

Digital polymerase chain reaction (dPCR) is a powerful technique for quantifying gene targets in environmental samples, with applications ranging from species monitoring to wastewater-based epidemiology. Although accurate statistical models for analyzing dPCR measurements exist, these require exact assay parameters and the number of positive and total PCR partitions. In practice, however, many environmental studies and monitoring programs analyze only concentration estimates, assuming normally or log-normally distributed measurements. Such assumptions ignore key statistical features of PCR assays, including concentration-dependent measurement noise and nondetects, leading to biased environmental estimates. In this work, we present a Bayesian model with a dPCR-specific likelihood that can be fitted directly to reported concentrations, while incorporating uncertainty in assay parameters through interpretable priors. Using real-world case studies of free-eDNA decay in seawater and pathogen transmission from wastewater, we show that our approach yields similar estimates as a fully informed model with partition counts, while avoiding biases from normal or log-normal approximations. This enables accurate inference from dPCR measurements even when partition count data and assay parameters are unavailable. The method is implemented in the R packages “dPCRfit” for regression analyses and “EpiSewer” for wastewater surveillance.

PMID:42454338 | PMC:PMC13366574 | DOI:10.1021/acsestwater.5c01051

Afr J Reprod Health. 2026 Jul 15;(13):(Afr J Reprod Health 2026; 30 [13]:63-73 ). doi: 10.29063/ajrh2026/v30i13.7.

ABSTRACT

This prospective observational study investigated the perioperative dynamics of circulating sialic acid-binding immunoglobulin-like lectin 15 (SIGLEC-15) and soluble programmed death-ligand 1 (sPD-L1) in patients with ovarian cancer undergoing surgery with either total intravenous anesthesia or inhalational anesthesia. Patients were consecutively enrolled, and peripheral blood samples were collected at predefined perioperative time points. Biomarker levels were measured and compared between anesthesia groups, and their associations with immune and inflammatory parameters were analyzed using appropriate statistical methods. Following surgery, levels of SIGLEC-15 and soluble programmed death-ligand 1 increased significantly, peaking at 24 hours and remaining elevated at 72 hours, with more pronounced changes observed in the inhalational anesthesia group. Elevated biomarker levels were associated with greater immune dysregulation, reflected by alterations in natural killer cell proportion, CD4 to CD8 T-cell ratios, and increased levels of interleukin-6 and cortisol. These findings suggest that SIGLEC-15 and soluble programmed death-ligand 1 may serve as blood-based indicators of perioperative immune status. However, their long-term clinical significance requires further investigation. Overall, this study underscores the importance of dynamic monitoring of immune biomarkers during the surgical period to better understand their role in ovarian cancer management.

PMID:42454331 | DOI:10.29063/ajrh2026/v30i13.7

Front Psychiatry. 2026 Jun 30;17:1860027. doi: 10.3389/fpsyt.2026.1860027. eCollection 2026.

ABSTRACT

BACKGROUND: Mental illness stigma undermines help-seeking, treatment engagement, and social inclusion globally. Although the Gulf Cooperation Council (GCC) region has undergone rapid social and health-system modernization, few studies have simultaneously assessed public knowledge, attitudes, and intended behaviour toward people with mental illness using validated instruments.

OBJECTIVE: To examine mental-health knowledge, public stigma, and social acceptance among adults in GCC countries using the Mental Health Knowledge Schedule (MAKS), the Reported and Intended Behaviour Scale (RIBS), and the 40-item Community Attitudes toward the Mentally Ill (CAMI) scale.

METHODS: An Arabic-language online survey was completed by 1, 557 adults (84.1% female; mean age = 26.2 years, SD = 10.6; 80.5% from Kuwait). Descriptive statistics, bivariate analyses, and simultaneous-entry multiple linear regression were conducted. Internal consistency was evaluated using Cronbach’s α and McDonald’s ω, supplemented by item-total correlations and confirmatory factor analysis (CFA) of the CAMI.

RESULTS: Participants reported moderate mental-health knowledge (MAKS M = 41.6, SD = 5.9), moderately positive attitudes (CAMI M = 135.2, SD = 16.2), and moderate behavioural willingness (RIBS M = 13.1, SD = 3.2). Knowledge and attitudes were moderately correlated (r = .341, p <.001), but the association between attitudes and intended behaviour was weaker (r = .209, p <.001). In regression, social restrictiveness was the strongest predictor of behavioural engagement (β = .374, p <.001), followed by male sex (β = .098) and MAKS total (β = -.103). A confirmatory factor analysis indicated poor fit of the original four-factor CAMI structure (CFI = .673, RMSEA = .141), supporting cautious subscale-level interpretation. A supplementary regression using the more reliable CAMI total score confirmed the primary pattern. Sensitivity analyses following removal of implausible age entries and restricting to Kuwait-only participants produced substantively identical findings.

CONCLUSION: These findings, drawn from a predominantly Kuwaiti, female, and university-educated convenience sample, indicate that respondents endorsed sympathetic and recovery-oriented principles yet showed substantial hesitation regarding close social contact. The disconnect between attitudes and behavioural willingness highlights the need for culturally grounded, contact-based anti-stigma interventions that target social distance specifically, while requiring replication in more representative GCC populations.

PMID:42454325 | PMC:PMC13364959 | DOI:10.3389/fpsyt.2026.1860027

Front Public Health. 2026 Jun 30;14:1752192. doi: 10.3389/fpubh.2026.1752192. eCollection 2026.

ABSTRACT

OBJECTIVES: Amid China’s population structure adjustment, shortage of high-quality, accessible childcare services for 0-3 years old constrains fertility willingness and family well being. Existing studies lack targeted analysis on demand structure and influencing mechanisms in urban areas. Therefore, this study investigated the characteristics of childcare service demand and key socioeconomic determinants among Ningbo’s childbearing population. These results provide empirical support for optimizing regional childcare policies.

METHODS: A self-designed questionnaire was administered online in Ningbo, China from July to September, 2024. Information on personal and family characteristics, as well as demand for childcare services, was obtained. Descriptive statistics and multiple linear regression were used to analyze the determinants of childcare services.

RESULTS: Of the 320 questionnaires distributed, 300 had valid responses (response rate of 93.8%). The seven dimensions of childcare service demand were ranked from highest to lowest: convenient conditions (9.39 ± 4.39 points), early education (8.86 ± 4.60), environmental facilities (8.60 ± 4.67), teaching staff quality (8.57 ± 4.23), childcare center management (8.40 ± 4.64), home-care interaction (7.73 ± 3.72), and childcare services (5.73 ± 3.04 points). Analysis revealed three variables in the regression model: parents’ age, occupation, and educational background (p < 0.001).

CONCLUSION: Demand for childcare services was influenced by multiple factors. Innovating cooperation models that optimize policy support and strengthen new supportive measures can help provide convenient childcare services. Furthermore, enhancing government-industry supervision and positive community publicity, improving early education policies, and developing service models can increase the demand and level of childcare services in China.

PMID:42454319 | PMC:PMC13365250 | DOI:10.3389/fpubh.2026.1752192