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Nevin Manimala Statistics

Bayesian inference for Cox regression models using catalytic prior distributions

Biometrics. 2026 Jan 6;82(1):ujag004. doi: 10.1093/biomtc/ujag004.

ABSTRACT

The Cox proportional hazards model (Cox model) is a popular model for survival data analysis. When the sample size is small relative to the dimension of the model, the standard maximum partial likelihood inference is often problematic. In this work, we propose the Cox catalytic prior distribution for Bayesian inference on Cox models, which extends a general class of prior distributions originally designed to stabilize complex parametric models. The Cox catalytic prior is formulated as a weighted likelihood of the regression coefficients derived from synthetic data and a surrogate baseline hazard constant. This surrogate hazard can be either provided by the user or estimated from the data, and the synthetic data are generated from the predictive distribution of a fitted simpler model. For point estimation, we derive an approximation of the marginal posterior mode, which can be computed conveniently as a regularized log partial likelihood estimator. We prove that our prior distribution is proper and the resulting estimator is consistent under mild conditions. In simulation studies, our proposed method outperforms standard maximum partial likelihood inference and is on par with existing shrinkage methods. We further illustrate the application of our method to a real dataset.

PMID:41631431 | DOI:10.1093/biomtc/ujag004

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Nevin Manimala Statistics

Extended Prone Positioning in ARDS: A Systematic Review and Meta-Analysis

Respir Care. 2026 Feb 3:19433654251405270. doi: 10.1177/19433654251405270. Online ahead of print.

ABSTRACT

BACKGROUND: Prone positioning is a recommended therapy for patients with moderate-to-severe ARDS; however, the optimal duration of this maneuver is still unknown.

METHODS: We performed a systematic review and meta-analysis comparing clinical outcomes of extended (≥24 h) versus traditional prone positioning (16-24 h) of adults with moderate-to-severe ARDS receiving invasive mechanical ventilation.

RESULTS: Ten studies involving 2,412 subjects met the inclusion criteria, including one randomized controlled trial and 9 observational studies, all with COVID-19-related ARDS. Extended prone positioning was associated with reduced mortality compared with the traditional approach (risk ratio [RR]: 0.76, 95% CI 0.66-0.86, I2 = 12.8%). Sensitivity and subgroup analyses confirmed consistency across risk of bias, baseline PaO2/FiO2, and PEEP levels. No differences were found in duration of mechanical ventilation (mean difference [MD]: 2.43 days, 95% CI -1.06 to 5.92, I2 = 70%) or ICU stay (MD: 1.31 days, 95% CI -1.07 to 3.68, I2 = 55%). The extended strategy was associated with a higher incidence of pressure injuries (RR: 1.30, 95% CI 1.02-1.65, I2 = 56%) but no differences in device displacement or hemodynamic instability. Certainty of evidence was rated as low to very low.

CONCLUSIONS: Extended prone positioning was associated with reduced mortality in ARDS but increased risk of pressure injuries, without impact on ventilator duration or ICU stay. While this strategy appears feasible and potentially beneficial, further randomized trials are warranted to confirm its role in routine practice.

TRIAL REGISTRATION: PROSPERO no. CRD42024529311.

PMID:41631378 | DOI:10.1177/19433654251405270

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Nevin Manimala Statistics

Reply to “A critical appraisal of evidence from the VICTOR trial and the VICTOR/VICTORIA pooled analysis: a statistical perspective”

G Ital Cardiol (Rome). 2026 Feb;27(2):154-155. doi: 10.1714/4636.46473.

NO ABSTRACT

PMID:41631336 | DOI:10.1714/4636.46473

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Nevin Manimala Statistics

A critical appraisal of evidence from the VICTOR trial and the VICTOR/VICTORIA pooled analysis: a statistical perspective

G Ital Cardiol (Rome). 2026 Feb;27(2):154. doi: 10.1714/4636.46472.

NO ABSTRACT

PMID:41631335 | DOI:10.1714/4636.46472

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Nevin Manimala Statistics

Risk factors for revictimization during treatment in patients with co-occurring SUD and PTSD

Eur J Psychotraumatol. 2026 Dec;17(1):2617838. doi: 10.1080/20008066.2026.2617838. Epub 2026 Feb 3.

ABSTRACT

Introduction: A host of cross-sectional studies have identified problematic substance use and post-traumatic stress symptoms as risk factors for repeated interpersonal violence (revictimization) in college samples. However, it remains unclear which factors are associated with revictimization for patients who meet diagnostic criteria for both substance use disorder (SUD) and post-traumatic stress disorder (PTSD). The identification of factors associated with revictimization is an important step towards preventing violence against people with psychiatric disorders and can inform treatment.Method: Data were based on the Treatment of PTSD and Addiction (TOPA) study, a randomized controlled trial including N = 209 patients that received inpatient and outpatient treatment for SUD and PTSD. We selected participants who had experienced interpersonal victimization at baseline (N = 203) and assessed revictimization across the 9-month follow-up period. Revictimization included: physical violence, violence with a gun, sexual violence, and ‘other unwanted sexual experience’. The risk factors we investigated were severity of PTSD, severity of alcohol and drug use disorder, interpersonal difficulties, sex, and age. We analysed the data using logistic regression analyses with multiple imputation for missing data.Results: Physical violence was the most common type of revictimization during the study period (26.0%), closely followed by ‘other unwanted sexual experience’ (20.0%). The severity of PTSD and age were univariate predictors for revictimization; however, only age was robustly related to revictimization while accounting for other study variables. We conducted sensitivity analyses with complete cases and observed data.Discussion: Approximately two in five individuals experienced revictimization across the 9-month follow-up period, underscoring it as a clinically relevant issue. Since age emerged as the only risk factor for revictimization in our sample, future research should focus on identifying modifiable factors associated with age, e.g. impulsivity and novelty seeking. These factors may be addressed in interventions aimed at reducing the risk of revictimization.

PMID:41631319 | DOI:10.1080/20008066.2026.2617838

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Nevin Manimala Statistics

Evaluating a Family Medicine Residency Mentorship Program in Riyadh, Saudi Arabia: A Cross-Sectional Survey

Niger J Clin Pract. 2026 Jan 1;29(1):97-104. doi: 10.4103/njcp.njcp_307_25. Epub 2026 Feb 3.

ABSTRACT

BACKGROUND: Mentorship is a key element of postgraduate medical training, offering academic, professional, and psychosocial support that positively influences trainee success and wellbeing. Understanding both mentor and mentee perspectives is crucial to enhancing mentorship programs.

AIM: To evaluate the mentorship experience of mentors and mentees in the Family Medicine Residency Program in Riyadh, Saudi Arabia, and identify strengths and areas for improvement.

METHODS: A cross-sectional descriptive study was conducted from September to December 2023 across Family Medicine Training Centers in Riyadh. We used an online self-administered questionnaire to collect data on demographics, prior mentoring experience, perceived support, mentor qualities, and satisfaction. Data were analyzed using Statistical Package for the Social Sciences (SPSS) v21.0 with descriptive statistics and Chi-square tests to explore associations.

RESULTS: Of 183 participants (84 mentees, 99 mentors), 70.2% of mentees and 65.7% of mentors reported satisfaction with their mentoring experience. Both groups identified clinical rotations, exam preparation, and problem solving as the higher areas of support. Mentees reported lower support in work-life balance (45.2%) and emotional/psychological wellbeing (41.7%). Good communication and trustworthiness were the most valued mentor qualities. Female mentees were significantly more comfortable discussing difficult issues (P = 0.045). While 73.3% of mentors believed their role positively impacted mentees’ development, only 44.4% felt they had sufficient time for mentoring.

CONCLUSION: The program demonstrates strengths in overall satisfaction and academic support but shows gaps in emotional and holistic support. Recommendations include structured mentor training, protected time, gender-sensitive approaches, and regular feedback to enhance program effectiveness.

PMID:41631312 | DOI:10.4103/njcp.njcp_307_25

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Nevin Manimala Statistics

Comparison of Oncologic Outcomes after Mesocolic Resection in Right- and Left-Sided Colon Cancer

Niger J Clin Pract. 2026 Jan 1;29(1):50-56. doi: 10.4103/njcp.njcp_602_25. Epub 2026 Feb 3.

ABSTRACT

CONTEXT: Colorectal cancer represents the third leading cause of cancer-related mortality worldwide. Emerging evidence suggests distinct biological differences between right-sided colon cancer (RCC) and left-sided colon cancer (LCC), although their prognostic significance remains controversial.

AIMS: To compare clinicopathological features and oncological outcomes between RCC and LCC following mesocolic resection and to identify independent prognostic factors.

SETTING AND DESIGN: A retrospective cohort study was conducted at a tertiary center between January 2010 and December 2020.

METHODS AND MATERIALS: A total of 948 patients with colon adenocarcinoma underwent curative resection and were categorized as RCC (n = 335) or LCC (n = 613), with analysis of demographic, pathological, and survival data focusing on overall survival and disease-free survival endpoints.

STATISTICAL ANALYSIS USED: Continuous variables were compared using t-test or Mann-Whitney U test. Categorical variables were analyzed using Chi-square or Fisher’s exact test. Univariate and multivariate Cox regression was performed to identify prognostic factors.

RESULTS: RCC patients were older (62.6 ± 14.8 vs 59.3 ± 14.4 years, P < 0.001) and more frequently female (48.1% vs 37.0%, P < 0.001). RCC tumors showed more aggressive characteristics: poor differentiation (15.8% vs 7.7%), advanced T-stage (97.6% vs 83.9%), and higher KRAS mutations (53.4% vs 37.4%) (all P < 0.001). At median follow-up of 78.4 months, RCC demonstrated inferior survival with OS 79.1% vs 85.0% (P = 0.031) and DFS 74.0% vs 78.0% (P = 0.042). Multivariate analysis confirmed right-sided location as an independent adverse prognostic factor (Hazard Ratio = 1.45, 95% Confidence Interval: 1.05-2.01, P = 0.024).

CONCLUSIONS: RCC showed more aggressive features and worse survival than LCC, suggesting tumor sidedness as an independent prognostic factor.

PMID:41631306 | DOI:10.4103/njcp.njcp_602_25

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Nevin Manimala Statistics

Relationship of Multidimensional Factors with Digital Addiction among University Students: A Cross-Sectional Study

Niger J Clin Pract. 2026 Jan 1;29(1):43-49. doi: 10.4103/njcp.njcp_275_25. Epub 2026 Feb 3.

ABSTRACT

BACKGROUND: With the rapid spread of technology, excessive and uncontrolled digital device use has become a growing concern, especially among university students. This behavioral pattern, referred to as digital addiction, may negatively affect musculoskeletal health, cognitive function, mental wellbeing, and overall quality of life.

AIM: This study aims to enhance understanding of digital addiction by exploring its prevalence among university students and identifying related factors.

METHODS: A cross-sectional study was conducted among 203 university students to assess their digital addiction using the Digital Addiction Scale (DAS). Other factors were assessed through the Musculoskeletal Health Questionnaire (MSK-HQ), International Physical Activity Questionnaire Short Form, Pittsburgh Sleep Quality Index, Cognitive Failures Questionnaire (CFQ), Depression, Anxiety and Stress Scale-21 (DASS 21), Body Awareness Questionnaire, SF-12, and Jamar hand dynamometer. To identify DAS associated factors, multiple regression analysis was performed using DAS as the dependent variable.

RESULTS: The participants’ mean age was 21.11 ± 1.41 years, with a body mass index of 22.35 ± 3.54 kg/m². About 51.2% of the study participants had high digital addiction. While MSK-HQ (P = 0.001) and SF-12 (Mental Component Score) (P = 0.012) were significantly lower in the high digital addiction group, CFQ (P < 0.001) and DASS 21 (P = 0.037) were found to be higher. Multiple regression analysis showed that DAS was only associated with MSK-HQ (P = 0.013, B = -0.373, 95% CI: -0.66 to -0.08) and CFQ (P = 0.002, B = 0.260, 95% CI: 0.09 to 0.42).

CONCLUSION: The study highlights disparities in musculoskeletal health, cognitive levels, mental health, and quality of life among students based on levels of digital addiction, with higher addiction correlating to poorer musculoskeletal health and increased cognitive errors.

PMID:41631305 | DOI:10.4103/njcp.njcp_275_25

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Nevin Manimala Statistics

Composite Dietary Antioxidant Index is Inversely Associated with Carotid Intima-Media Thickness in Saudi Patients with Subclinical Atherosclerosis: A Case-Control Study

Niger J Clin Pract. 2026 Jan 1;29(1):9-16. doi: 10.4103/njcp.njcp_404_25. Epub 2026 Feb 3.

ABSTRACT

BACKGROUND: While individual antioxidants have been linked to reduced cardiovascular risk, the association between overall dietary antioxidant intake and subclinical atherosclerosis remains unclear.

AIM: To examine the association between Composite Dietary Antioxidant Index (CDAI) and Carotid Intima-Media Thickness (CIMT) as a marker of subclinical atherosclerosis.

METHODS: A case-control study was conducted among 210 Saudi adults (105 with subclinical atherosclerosis and 105 age- and sex-matched controls) recruited from internal medicine clinics at King Abdulaziz University Hospital. Dietary intake was assessed using a validated food frequency questionnaire. CDAI was calculated from energy-adjusted, standardized intakes of six antioxidants: vitamins A, C, E, manganese, selenium, and zinc. Anthropometric data, blood pressure, lifestyle factors, and medical history were collected via structured interviews and clinical measurements. CIMT was assessed bilaterally using high-resolution B-mode ultrasound. Statistical analyses included group comparisons, correlation tests, and multivariable regression adjusting for potential confounders.

RESULTS: CDAI was inversely associated with CIMT (β = -0.184, P < 0.01) after adjusting for age, sex, BMI, blood pressure, smoking, and physical inactivity. Participants in the highest CDAI quartile had significantly lower mean CIMT than those in the lowest quartile (P < 0.05). Among CDAI components, only vitamin E intake was significantly lower in the subclinical atherosclerosis group (P < 0.05).

CONCLUSION: Higher dietary antioxidant intake, as assessed by CDAI, is associated with reduced CIMT and lower risk of subclinical atherosclerosis. Longitudinal studies are recommended to clarify causality and explore underlying mechanisms.

PMID:41631301 | DOI:10.4103/njcp.njcp_404_25

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Nevin Manimala Statistics

Prevalence of and Factors Associated with Cesarean Delivery in Kigali, Rwanda: A Hospital-Based Cross-Sectional Study

Niger J Clin Pract. 2026 Jan 1;29(1):1-8. doi: 10.4103/njcp.njcp_319_25. Epub 2026 Feb 3.

ABSTRACT

BACKGROUND: Cesarean delivery is rising globally, and Sub-Saharan Africa is no exception.

AIM: This study investigated the prevalence and factors associated with cesarean delivery in Kigali, Rwanda.

METHODS: This hospital-based cross-sectional study was carried out in two hospitals in Kigali, Rwanda. A questionnaire was used to collect sociodemographic and obstetrical data, including mode of delivery. Weight, height, and hemoglobin level were measured using standard procedures. Multivariate binary analysis was performed.

RESULTS: In this study, 445 pregnant women were included. The median (interquartile [IQR]) age and parity were 30.0 (26.0‒35.0) years and 1.0 (0.0‒3.0), respectively. One hundred and eleven (24.9%) women were delivered via cesarean, of whom 66 (59.5%) were delivered via emergency cesarean and the remaining 45 (40.5%) via elective cesarean. In multivariate logistic regression, maternal age (adjusted odds ratio [AOR] = 1.11, 95% confidence interval [CI] 1.05‒1.16), having a husband with educational attainment of secondary or less (AOR = 1.73, 95% 1.08‒2.80), and a history of miscarriage (AOR = 3.77, 95% CI 2.02‒7.03) were significantly associated with cesarean delivery. There was no significant association between cesarean delivery and parity, anemia, or low birth weight.

CONCLUSION: One out of four pregnant women in Kigali was delivered via cesarean regardless of their parity. Age and history of miscarriage can be used as a predictor for cesarean delivery in Rwanda. Additional socio-epidemiological research is recommended to explore the impact of increasing maternal age without an increase in parity and low educational levels among husbands on the mode of delivery in Rwanda.

PMID:41631300 | DOI:10.4103/njcp.njcp_319_25