Tag: nevin manimala

Clin Trials. 2026 Mar 3:17407745261421842. doi: 10.1177/17407745261421842. Online ahead of print.

ABSTRACT

BACKGROUND/AIMS: Bayesian designs for clinical trials using assurance to choose the sample size have been proposed in various trial contexts. Assurance allows for the incorporation of uncertainty on both the treatment effect and nuisance parameters into the sample size calculation. In the case of two-arm cluster randomised trials with continuous outcomes, assurance has been proposed with both a frequentist analysis (hybrid designs) and a Bayesian analysis (fully Bayesian designs). A Bayesian analysis in this context ensures a consistent treatment of probability throughout the design and analysis of the trial. In the fully Bayesian design, inference has been achieved via Markov chain Monte Carlo sampling, and since assurance itself is evaluated via simulation, the result is a computationally intensive and often slow-to-run approach. In the case of two-arm cluster randomised trials with binary outcomes, assurance has not yet been explored to specify sample sizes, either in the hybrid or fully Bayesian case.

METHODS: This article considers fully Bayesian designs for two-arm cluster randomised trials with continuous and binary outcomes. For the analysis of the trial, we use a (generalised) linear mixed-effects model. We summarise the inference for the treatment effect based on quantiles of the posterior distribution. We use assurance to choose the sample size. In the continuous case, we investigate Integrated Nested Laplace Approximations for inference to speed up calculation of the assurance and compare Integrated Nested Laplace Approximations in computation time and accuracy to Markov chain Monte Carlo. In the binary case, we develop the first fully Bayesian design for cluster randomised trials and conduct a similar comparison between Integrated Nested Laplace Approximations and Markov chain Monte Carlo. We demonstrate our novel approach using assurance to choose sample sizes for the SPEEDY cluster randomised trial, based on the results of a formal prior elicitation exercise with two clinical experts.

RESULTS: We report comparisons of Integrated Nested Laplace Approximations and Markov chain Monte Carlo for a range of different scenarios for cluster randomised controlled trials (RCTs), to determine when each inference scheme should be used, balancing the computational cost in terms of speed and accuracy. Overall Markov chain Monte Carlo with a very large number of samples produces very accurate inference but does not scale well in terms of computational speed compared to Integrated Nested Laplace Approximations. Based on our simulation study, we recommend that Integrated Nested Laplace Approximations is used for inference in cluster trials with binary outcomes and large (n> 500) cluster trials with continuous outcomes, and that Markov chain Monte Carlo is used in smaller (n≤500) cluster trials with continuous outcomes. Our case study demonstrated how to incorporate the uncertainty of trial clinicians into the sample size calculation to give an overall assessment of the likelihood of success of the trial.

CONCLUSION: A fully Bayesian design can be used for two-arm cluster trials with both continuous and binary outcomes. Integrated Nested Laplace Approximations can allow for more efficient assessment of the assurance for cluster trials with binary outcomes and large cluster trials with continuous outcomes, without loss of accuracy in inference. A fully Bayesian design of a cluster randomised trial provides a coherent design and analysis framework and incorporates uncertainty in model parameters when choosing the sample size.

PMID:41776384 | DOI:10.1177/17407745261421842

Eur J Hum Genet. 2026 Mar 3. doi: 10.1038/s41431-026-02064-3. Online ahead of print.

NO ABSTRACT

PMID:41776349 | DOI:10.1038/s41431-026-02064-3

Sci Rep. 2026 Mar 3. doi: 10.1038/s41598-026-41608-x. Online ahead of print.

ABSTRACT

Ambulatory surgery has become widely used in high-income countries because it is safe, cost-effective, and optimizes hospital resources, yet its development remains limited in many low- and middle-income settings, including Morocco. This study evaluated the feasibility and outcomes of ambulatory digestive surgery in a Moroccan tertiary care hospital and sought to identify factors associated with failure of same-day discharge. Over one year, all adult patients scheduled for elective ambulatory digestive procedures were prospectively included, and their perioperative outcomes were analyzed. Among 595 procedures performed in 2022, 266 were initially planned as ambulatory, but 64 ultimately required unplanned overnight hospitalization, resulting in an effective ambulatory rate of 33.9%. Complication and readmission rates were low, and no 90-day mortality was observed, supporting the overall safety of this approach. However, ambulatory failure was frequently associated with advanced age, comorbidities, prior abdominal surgery, and, importantly, social factors such as illiteracy, lack of caregiver support, and distance from the hospital. These findings indicate that while ambulatory digestive surgery is feasible and safe in this setting, its broader implementation is strongly influenced by non-medical barriers. Strengthening perioperative education, reinforcing family involvement, and adapting organizational infrastructure are essential to expand ambulatory surgery in similar healthcare contexts.

PMID:41776337 | DOI:10.1038/s41598-026-41608-x

Eur J Surg Oncol. 2026 Feb 27;52(4):111515. doi: 10.1016/j.ejso.2026.111515. Online ahead of print.

ABSTRACT

BACKGROUND: Pelvic exenteration (PE) performed for locally advanced or recurrent pelvic malignancies often required urinary reconstruction but associated with high postoperative morbidity (POM). The influence of urinary diversion type on outcomes remains uncertain.

METHODS: This retrospective cohort study included 90 patients who underwent PE with urinary reconstruction between 2016 and 2023. Urinary diversions were classified as ileal conduit and alternative reconstructions (vesico-urethral anastomosis, Mitrofanoff procedure, ureteral implantation and enterocystoplasty). POM, quality of life (QoL; EQ-5D-5L questionnaire), bowel dysfunction (LARS and Wexner scores), and overall (OS) and disease-free survival (DFS) were analyzed. Statistical analyses compared outcomes between groups.

RESULTS: Sixty-two patients (69%) underwent an ileal conduit and 28 (31%) an alternative urinary reconstruction.The POM rate occurred in 66% of cases, including 34% experiencing major complications with no difference between groups (p = 0.86). Urologic complications were observed in 13% of patients, mainly urinary tract infections (10%); urine leaks (5%) occurred only after ileal conduit. Severe bowel dysfunction (major LARS) affected 30% and significant fecal incontinence (Wexner >10) 35% of patients, with a trend toward worse outcomes in the alternative reconstruction group. QoL was similar across most domains, except for the “usual activities” category, which were more limited after alternative reconstructions(p = 0.046). OS and DFS were comparable while primary cancer had significantly better outcomes than recurrent cancers (p < 0.001).

CONCLUSION: Ileal conduit remains the predominant urinary diversion following PE. Alternative reconstructions do not significantly impact morbidity, survival or QoL, except for a modest limitation in “usual activities”. Shared decision-making is essential given the high morbidity and complex functional sequelae of PE.

PMID:41774974 | DOI:10.1016/j.ejso.2026.111515

J Psychiatr Res. 2026 Feb 12;197:107-117. doi: 10.1016/j.jpsychires.2026.02.025. Online ahead of print.

ABSTRACT

PURPOSE: Increased social demands during adolescence and early adulthood pose specific challenges for individuals with autism spectrum disorder (ASD) without accompanying intellectual impairment. Targeted group-based social competence trainings are effective interventions. This work evaluates the Zurich social competence training (KOMPASS), a manualized program for adolescents and young adults (12-25 years) with ASD.

METHODS: In this quasi-experimental longitudinal study with a naturalistic waiting period and follow-up, we assessed participants of the KOMPASS intervention (N = 108) at our clinic through parent-, teacher- and self-reports along with a computerized task. A subset of participants (N = 65) was additionally assessed during a waiting period prior to intervention, allowing within-subject comparison of change before and during treatment. One-year follow-up data for the KOMPASS intervention group were collected (N = 62). Furthermore, we analyzed pre- and post-data from 35 individuals who completed KOMPASS at external clinics using the KOMPASS- manual without prior introduction to the method. Critically, we used Bayesian statistics to show evidence for stability of effects and comparable outcomes across settings.

RESULTS: Compared to the waitlist period, the KOMPASS training period showed a significant decrease in social and behavioral difficulties associated with ASD and improvements in social competences, which were sustained one year after training. General psychiatric symptoms also improved post-intervention in the KOMPASS training period. Participants from external clinics demonstrated similar significant improvements, affirming the manual’s effectiveness in external settings. No significant gender or age moderation effects were observed for the primary outcomes. Participants and caregivers expressed satisfaction with the training.

CONCLUSION: KOMPASS demonstrates significant effects in improving social functioning and reducing ASD-related difficulties in adolescents and young adults. The study benefits from a large sample, a naturalistic waiting-period comparison, a one-year follow-up, multi-informant assessment, and external validation. Limitations include the quasi-experimental design, the lack of formal fidelity monitoring, and reliance on some older assessment measures.

PMID:41774970 | DOI:10.1016/j.jpsychires.2026.02.025

Waste Manag. 2026 Mar 2;215:115426. doi: 10.1016/j.wasman.2026.115426. Online ahead of print.

ABSTRACT

Food waste in schools presents significant environmental, economic, and social challenges. This large-scale study investigates the effectiveness of an awareness-raising campaign aimed at reducing food waste in schools. The intervention included printed materials, campaign videos, and an online food waste tracker to inform students about the consequences of food waste and encourage behaviour change. The study employed a three-phase methodology: initial food waste measurement, an awareness campaign combined with a questionnaire survey, and post-intervention food waste assessment. The survey was conducted across 10 schools, where data were collected on food waste generated from a total of 52,421 prepared lunch menus. Food waste was measured during two separate 10-day survey periods in consecutive years; in the second year, an awareness-raising campaign was implemented in the selected schools. In addition, students’ attitudes towards food waste were assessed through a questionnaire survey, yielding 1,480 responses. Data were analysed using statistical methods (Student’s t-test, Pearson’s correlation). On average, consumers left 103 g of food on their plates from each course, which accounted for 32% of the served meal. Although our hypothesis assumed that the campaign would reduce the amount of waste generated, the results did not support this expectation. The findings indicate that while students recognize the importance of reducing food waste, the campaign did not lead to a measurable reduction. This suggests that simply increasing awareness may not be sufficient to drive behavioural change, highlighting the need for alternative strategies.

PMID:41774966 | DOI:10.1016/j.wasman.2026.115426

Mar Pollut Bull. 2026 Mar 2;227:119456. doi: 10.1016/j.marpolbul.2026.119456. Online ahead of print.

ABSTRACT

Marine debris entanglement is a growing threat to pinnipeds, with acute consequences including injury, restricted movement, and increased energy expenditure now well documented. The use of drones to monitor populations and estimate entanglement prevalence is growing. Drone-borne colour (RGB) cameras enhance detection of conspicuous debris, but thin or transparent materials such as fishing line are often missed. Thermal infrared (TIR) imaging may improve detection by highlighting heat from wounds or disrupted fur caused by entanglement. We assessed the efficacy of drone-borne RGB and TIR imaging for detecting entanglements in Australian fur seals (Arctocephalus pusillus doriferus) at Seal Rocks, south-eastern Australia. Across 54 drone surveys using representative commercial RGB + TIR sensors and concurrent handheld imaging, we captured imagery of entangled and non-entangled individuals. The resultant orthomosaic images and videos were classified by reviewers with relevant experience, and reviewer performance was assessed using generalised linear mixed models to estimate recall and precision. Entanglements were clearly visible in handheld TIR via elevated heat signatures. Similar thermal anomalies were visible in 81% of RGB + TIR drone detections of marine debris entanglements, with 95% reviewer agreement. RGB + TIR videos achieved the highest estimates and most reliable balance of recall and precision, followed closely by RGB alone, though differences were not always statistically significant. Importantly, fishing line was effectively detected in dual RGB + TIR drone imagery. This study presents the first use of drone-borne TIR imaging to detect marine debris entanglements and demonstrates that combining RGB and TIR video maximises detection performance.

PMID:41774946 | DOI:10.1016/j.marpolbul.2026.119456

J Spec Oper Med. 2026 Mar 3:J.Spec.Oper.Med.2026.R9KS-GFTU. doi: 10.55460/J.Spec.Oper.Med.2026.R9KS-GFTU. Online ahead of print.

ABSTRACT

BACKGROUND: Police Tactical Group (PTG) officers, in general, are older than their general duties counterparts. The nature of the occupational role scope demands a high level of fitness; thus, physical assessments are essential. This research investigated the relationship between officer age and completion times for an occupationally relevant physical fitness assessment in specialist police officers.

METHODS: Retrospective data were collected from 34 male PTG officers (age 37.8 [SD 6.5] y); height 181.6 [SD 6.7] cm; body mass 91.5 [SD 10.9] kg) and 18 male PTG candidates (age 32.1 [SD 5.0] y; height 183.7 [SD 5.8] cm; body mass 89.4 [SD 8.7] kg) competing in the RUSH assessment. The RUSH consisted of alternating directional sprints, crawls, 80kg mannequin drags (10-20m), and adopting shooting positions. Operational personal protective equipment (PPE; 22.2 [SD 4.90] kg) was worn.

RESULTS: PTG officers were significantly older (P=.002) and carried significantly lighter PPE loads (P<.001). There were no significant differences in mean RUSH times between PTG officers (105.1 seconds [SD 14.6s]) and candidates (111.7 (SD 9.2) s, P=.056). Correlations and a backward stepwise regression model were consistent in indicating that neither age nor group was a statistically significant predictor of RUSH time. PPE weight was not significantly predictive of RUSH time when entered alone in a regression model.

CONCLUSION: Age was not a significant predictor of RUSH times; as such, the RUSH can be used for initial candidates and for older qualified personnel. Ongoing physical strength and conditioning practices undertaken by PTG officers may mitigate age-related fitness loss.

PMID:41774931 | DOI:10.55460/J.Spec.Oper.Med.2026.R9KS-GFTU

JMIR Hum Factors. 2026 Mar 3;13:e75263. doi: 10.2196/75263.

ABSTRACT

BACKGROUND: The rising number of refugees and migrants has created growing mental health needs that health care systems struggle to address. Providing assessment and treatment for mental health problems in a digital format could help increase access to care and facilitate the provision of adapted interventions. Psychologists are key stakeholders in the delivery and influence of clinical services within routine care settings, but there are limited data on their perspectives regarding the use of digital solutions to assess and treat common mental health problems in refugees and migrants.

OBJECTIVE: This study aimed to examine psychologists’ usage, knowledge, and attitudes toward digital mental health solutions for assessing and treating common mental health problems in refugees and migrants within the Swedish health care system.

METHODS: A cross-sectional online survey was conducted among psychologists in Sweden between December 2023 and February 2024. Responses included Likert-scale items and categorical variables, which were analyzed using descriptive statistics, independent samples t tests, and Fisher exact test to explore differences between subgroups.

RESULTS: A total of 81 psychologists responded to the survey. Among them, 58 (72%) were women, and nearly half (40/81, 49%) worked in a public health care region. Respondents showed the highest acceptance for guided internet-based cognitive behavioral therapy (ICBT), blended treatment, and videoconferencing therapy. Only 20% (16/81) reported using digital solutions for refugees or migrants with mental health problems. Most respondents had low or very low knowledge of digital assessment and screening (61/81, 75%) and digital treatment (58/81, 72%) for these groups. Those using digital formats for refugees and migrants, or working in a setting that did so, had significantly higher ratings on all 5 knowledge items compared to those that did not (P<.001 to P=.01). Respondents emphasized the importance of digital solutions being provided in refugees’ and migrants’ native languages (70/81, 86%) and being culturally adapted (56/81, 69%). Those using digital formats for refugees and migrants considered cultural adaptation less necessary (P=.05). The preferred implementation approach was through specialized or decentralized units in primary care (66/81, 81%).

CONCLUSIONS: While psychologists recognize the potential of digital mental health solutions, significant barriers remain, including limited knowledge and experience with using digital formats for refugees and migrants. Psychologists prefer digital solutions in the native language of refugees and migrants that are implemented at the primary care level. The need for cultural adaptation should be further explored. Addressing psychologists’ preferences could facilitate the future integration and implementation of digital formats for refugees and migrants in routine care settings.

PMID:41774913 | DOI:10.2196/75263

Ecol Evol Physiol. 2026 Jan-Feb;99(1):33-42. doi: 10.1086/739792. Epub 2026 Jan 20.

ABSTRACT

AbstractFitness of interspecific hybrids can be higher or lower than that of their parental genotypes, with major ramifications for evolution and conservation. A recent study found that hybrid tiger salamanders had higher metabolic rates than their parental forms. Specifically, the ratio of resting metabolic rate to water loss, which was used as a measure of performance, was greater in hybrids. Recent genetic research showed that over half of the experimental subjects in that study were genetically pure California tiger salamanders (Ambystoma californiense) misclassified as hybrids. We reanalyzed the data using the corrected identification of hybrids and parentals. As expected, updating the classification revealed even stronger evidence for differences between hybrids and parentals. Hybrids had higher resting metabolic rates and greater water loss than parentals. The ratio of resting metabolic rate to water loss was also higher in hybrids. However, we suggest that this ratio might not be a positive measure of salamander performance. Higher metabolic rate means higher energy expenditure, and higher water loss suggests increased risk of desiccation. Both are major challenges for terrestrial amphibians, especially salamanders, which are hypothesized to be low-energy, low-water-loss specialists. Under this hypothesis, the ratio of energy expenditure to water loss is a ratio of two costs rather than a ratio of benefit to cost. While our analyses corroborate and strengthen the previous statistical results, we suggest that high resting metabolic rate is better interpreted as hybrid dysfunction, not vigor. Both hypotheses are speculative, and specific research on the fitness effects of these physiological differences is needed to resolve this important ecological question.

PMID:41774889 | DOI:10.1086/739792