PLOS ONE Alerts: New Articles

Genomic insights into population structure and adaptive variation of Pimelodus yuma and Pimelodus grosskopfii in the Magdalena-Cauca Basin

2026-06-05T14:00:00Z

by Hayler Edu Ibarra Arcila, Juan Aicardo Segura Caro, Edna Judith Márquez, Jose Gregorio Martinez

The biodiversity of the Magdalena–Cauca Basin, Colombia’s main fluvial system, is under severe threat from anthropogenic activities, imperiling endemic fish species such as Pimelodus yuma and Pimelodus grosskopfii. Using a population genomic approach based on single nucleotide polymorphisms (SNPs), we analyzed 64 individuals of P. grosskopfii and 57 individuals of P. yuma collected across ~1,600 km of the Magdalena–Cauca Basin. We identified two coexisting genetic stocks in both species, maintained by restricted gene flow that is associated with adaptive divergence rather than geographic distribution. Selection pressures, likely linked to the basin’s bimodal hydrological regime, were detected as major drivers of genetic structure. Historical demographic reconstruction analyses indicate that stock 1 in both P. grosskopfii and P. yuma was established in the basin during the Late Miocene–Pliocene (~4.5–5.5 MYA), with P. grosskopfii exhibiting an early expansion followed by long-term stability up to the present, while P. yuma maintained a stable population size until a recent decline. Stock 2 in both species was established during the Early Pleistocene (~1.7–2.5 MYA), followed by expansion and stability in P. grosskopfii, and a stable population size followed by a contraction–recovery–expansion dynamic in P. yuma, suggesting long-term persistence of neutral/adaptive processes shaping these stocks. Each stock should be considered a Management and Adaptive Unit, highlighting the need for targeted conservation actions and broader strategies to ensure their persistence under ongoing environmental and anthropogenic pressures in the Magdalena–Cauca Basin.

Correction: Earliest evidence for invasive mitigation of dental caries by Neanderthals

2026-06-05T14:00:00Z

by Alisa V. Zubova, Lydia V. Zotkina, John W. Olsen, Alexander M. Kulkov, Vyacheslav G. Moiseyev, Anna A. Malyutina, Roman V. Davydov, Sergey V. Markin, Eugene A. Maksimovskiy, Pavel V. Chistyakov, Andrey I. Krivoshapkin, Ksenia A. Kolobova

Clinical characteristics and management strategies in adult foreign-body airway obstruction: A retrospective cohort study

2026-06-05T14:00:00Z

by Hongzhen Yin, Tong Wang, Changshun Zhong, Yingya Cao, Xiaogan Jiang, Qiancheng Xu, Weihua Lu

Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014–30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51–72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.

Why are some children under 24 months still undernourished in urban and peri-urban Vientiane? A mixed-methods study

2026-06-05T14:00:00Z

by Kethmany Ratsavong, Dirk Essink, E. Pamela Wright, Somphou Sayasone, Sengchanh Kounnavong, Jacqueline E. W. Broerse

Child undernutrition remains a significant public health challenge in many low and middle-income countries (LMICs), including Lao PDR, where high levels persist even in urban areas with generally available and accessible food. This study aimed to explore factors underlying the persistently high rates of undernutrition among young children in urban (Saysetha) and peri-urban (Pakgneum) districts of the Vientiane Capital in Lao PDR. A cross-sectional survey employed a sequential explanatory mixed-methods approach, combining a structured questionnaire of 333 mother–child pairs for quantitative analysis with semi-structured interviews of 47 caregivers for qualitative insights. The prevalence of malnutrition among children under 24 months in Vientiane Capital was 27.3% for stunting, 4.2% for wasting, 14.4% for underweight, and 5.11% for overweight. Multiple logistic regression was applied to identify factors associated with malnutrition, while qualitative data were thematically analyzed. The principal findings revealed that, beyond food access, the quality of caregiving and, critically, caregivers’ capacity to translate nutrition knowledge into effective practices distinguished well-nourished from undernourished children. Caregivers of better-nourished children obtained health and nutrition information from diverse sources, whereas those of undernourished children relied mainly on health services. In conclusion, strengthening practical nutrition communication in various methods and channels, such as through videos and demonstrations, and enhancing caregivers’ ability to apply nutritional knowledge, are central to improving child nutritional outcomes in urban and peri-urban settings in Lao PDR.

Numerical and experimental assessment of hydrogen enrichment effects on ci engine characteristics fuelled with dual biodiesel blends: A comprehensive study

2026-06-05T14:00:00Z

by B. Vishnu Vardhana Naidu, B. Musthafa, M. Raja, S. Sivalakshmi, S. A. Srinivasan, B. Saravanan, Yohanis Dabesa Jelila

The growing need for energy around the world is putting pressure on established power sources like fossil fuels, making renewable energy solutions more concern. The high calorific value of hydrogen has made it an attractive technique for increasing combustion rates. To get the best possible results from a dual biodiesel blend of juliflora and kapok, this research seeks to improve the hydrogen enrichment ratio. When compared to diesel, the combined effects of 12H₂ + JK B20 increased BTE by 11.5%, CP by 6.9%, and HRR by 5.9%. The use of H₂ and JK B20 improved combustion, leading to a decrease of 8.5% in BSFC, 10.9% in CO and HC emissions, 11.5% in smoke, and 14.6% in both. The increase in NOx emissions is a result of the trade-off. The RSM results demonstrate that the test blend B20, which included 12% H₂ at 100% load, exhibited an attractiveness index of 0.995. An effective and trustworthy prediction framework for optimizing CI engine properties, the ANN model was fitted using experimental data and validated. Sustainable transportation and environmental protection stand to benefit greatly from the synergistic effects of H₂ enrichment and dual biodiesel.

Differential analysis of Short chain fatty acids incubation in autistic organoids based on transcriptome sequencing

2026-06-05T14:00:00Z

by Zaixin Wu, Xinyi Liu, Xiaobo Han, Miao Li

Autism spectrum disorder (ASD) is characterized by difficulty with social communication and restricted, repetitive patterns of behavior, interest, or activities. We hypothesized that a dysregulation in short-chain fatty acid (SCFA) metabolism induces metabolic dysregulation and proinflammatory responses, which collectively contribute to the social behavioral deficits observed in early childhood. Herein, by high-throughput RNA sequencing (RNA-seq) of the whole transcriptome, including GO and KEGG enrichment analyses, we analyzed global gene expression differences in ASD cerebral organoids exposed to different SCFAs. The ASD cerebral organoids were divided into three groups: the ASD group (control), the acetate-treated group (Z group), and the butyrate-treated group (J group), with three biological replicates per group. Organoids were treated with 100 μM sodium acetate or 100 μM sodium butyrate from day 16 to day 23 of cortical differentiation, for a total duration of 7 days. GO functional annotation revealed that acetate treatment primarily altered gene expression related to differential regulation, whereas butyrate exposure activated immune-related processes. KEGG pathway analysis indicated that butyrate treatment was associated with enrichment of the TGF-β immune-related signaling pathway in ASD organoids, whereas acetate treatment primarily affected molecular functions such as transcriptional regulation, catalytic activity, and membrane permeability.

Perspectives on preconception care in Ethiopia: Social, cultural, and structural determinants

2026-06-05T14:00:00Z

by Yared Asmare Aynalem, Pauline Paul, Zohra S. Lassi, Salima Meherali

Background

Although Ethiopia introduced its first national preconception care (PCC) guideline in 2024, PCC remains rarely integrated into routine practice, and existing studies have largely focused on women’s knowledge and behaviors. Little is known about how adults navigate PCC within broader social, cultural, and structural contexts. This study provides an in-depth urban Ethiopian analysis of how adults experience and negotiate PCC within intersecting gender, moral, and institutional systems, offering insights beyond individual-level understanding.

Methods

An interpretive description design guided semi-structured interviews with 18 adults (10 women, 8 men; 19–45 years) recruited through maximum-variation sampling from two public hospitals in Addis Ababa. Interviews were conducted in Amharic, transcribed, translated, and analyzed inductively. Data analysis was guided by ID principles, complemented by thematic analysis techniques informed by grounded theory, including line-by-line coding, constant comparison, and analytic memoing. Field notes captured contextual and relational dynamics.

Results

Seven interrelated themes highlighted complex dynamics in PCC. Knowledge was fragmented and often recognized only after complications, shaped by marital gatekeeping, faith-based beliefs, and exclusion of unmarried women. PCC was valued as protective and morally significant, but stigma, poverty, staff shortages, and inconsistent services constrained practice. Men were largely financial supporters, though many expressed a desire to participate, limited by gender norms and women-centered services. Pharmacies and digital media provide informal but sometimes unsafe guidance. Emotional experiences, fear, guilt, secrecy, and hope were central to PCC engagement. Education, peer influence, schools, and community leaders emerged as catalysts for uptake, yet participants emphasized that sustainable PCC required visible institutional support, reliable services, and government recognition. Strategies to enhance practice included simplifying communication, creating accessible clinic entry points, and mobilizing community networks to normalize pre-pregnancy preparation.

Conclusions

This study reveals PCC in urban Ethiopia as a socially negotiated, morally contested, and structurally uneven practice, far more complex than knowledge deficits imply. These findings offer novel, actionable direction for implementing Ethiopia’s PCC guideline through visible, inclusive, relational, and community-anchored approaches that address the social conditions shaping PCC access.

Explainable IAOA-CNN-CBAM-SVR model for predicting air consumption of auxiliary nozzles with limited sample size

2026-06-05T14:00:00Z

by Min Shen, Yongbo Cao, Xiaoshuang Xiong, Zhen Wang, Lianqing Yu, Xuezheng Yang, Yongfa Lv

Air-jet looms are energy-intensive machines, with auxiliary nozzles accounting for nearly 80% of the total compressed air consumption. However, accurate prediction and visual analysis of nonlinear air consumption remain challenging due to limited training data and the poor interpretability of deep learning models. To address these issues, this study proposes a hybrid CNN-CBAM-SVR model optimized by an Improved Archimedes Optimization Algorithm (IAOA). Comparative experiments show that the IAOA-CNN-CBAM-SVR model achieves the lowest root mean square error (RMSE) of 0.6575, and the highest coefficient of determination (R²) of 0.9941, outperforming SVR, CNN, and CNN-SVR models. Furthermore, the contributions of nozzle structural parameters to air consumption are visually illustrated using the Shapley Additive ExPlanations (SHAP) method. The findings provide a robust and interpretable model for optimizing auxiliary nozzles design and improving energy efficiency in air-jet looms.

Identification of non-cardiomyocytes marker genes in patients with diabetes and cardiomyopathy through single-cell analysis

2026-06-05T14:00:00Z

by Wenze Yu, Hanglie Chen, Lihua Shi, Guofang Gao, Haihua Wang

Background

Diabetic cardiomyopathy (DCM) is a diabetes-related myocardial disorder causing fibrosis, hypertrophy, and progressive diastolic and systolic dysfunction. This study aims to explore how metabolic, inflammatory, and fibrotic mechanisms in non-cardiomyocytes drive DCM to reveal new therapeutic targets.

Methods

Single-cell RNA sequencing (scRNA-seq) was performed to investigate the role of non-cardiomyocytes in DCM, enabling the identification of cell types, gene expression dynamics, and intercellular communication networks in patients with type 2 diabetes. The scRNA-seq data were obtained from the GEO to investigate cell-type-specific contributions and heterogeneity across tissues. Metabolic pathway scores were calculated using scMetabolism. Moreover, cell trajectory analysis and cellular communication studies were performed to examine shared and disease-specific cell populations in diabetes and cardiomyopathy. CCK-8, colony formation, Transwell migration and invasion assays were preformed to explore the function of PTPRC in HUVECs.

Results

Using SingleR annotation, we identified eight distinct cell types, with NK cells and smooth muscle cells representing the shared cell populations across both diseases. Cell trajectory analysis revealed three distinct branches based on gene expression over pseudotime, and the top differentially expressed genes in each cell type clustering into six categories. Metabolic pathway analysis predicted that epithelial cells, macrophages, and neurons as the most metabolically active across multiple pathways, highlighting metabolic heterogeneity among patient samples. Additionally, four key signaling pathways associated with NK cells and smooth muscle cells were predicted to emphasize the divergence in gene expression across cell types. PTPRC is implicated in diabetes and cardiomyopathy and functions as a positive regulator of HUVEC viability, clonogenic growth, migration, and invasion.

Conclusion

This study demonstrates significant heterogeneity among non-cardiomyocytes in patients with diabetes and cardiomyopathy, highlighting the need for targeted therapeutic interventions to address these differences.

Mapping the landscape of psychological literature on threat from 1961 to 2023 through structural topic modeling

2026-06-05T14:00:00Z

by Huixiang Ouyang, Ching Wan, Ronald Fischer

The past decades have generated a substantial volume of psychological literature on threat. However, the absence of systematic cross-field synthesis has resulted in limited understanding of major research domains and relationships between different lines of threat research. We analyzed 51,903 psychological publications on threat retrieved from APA PsycInfo, Scopus, and Web of Science Core Collection that were published between 1961 and 2023. We conducted structural topic modeling on publication titles and abstracts to identify key research topics, and network analysis on the resulting topics to map the thematic structure of the literature. 25 topics emerged, organized into four thematic areas through exploratory graph analysis: 1) threat processing mechanisms, 2) health and clinical threats, 3) social psychological threats, and 4) collective threats. Network analysis revealed differential connectivity patterns within and between thematic areas. Areas showed limited connectivity with each other and no area emerged as a central hub, suggesting gaps in cross-domain integration. Topic prevalence trends revealed diversification in research interest over time, together with responsiveness to broader developments within psychology and evolving societal concerns. Notably, mechanism-focused research declined over the past decade while event-driven research on specific threats increased, indicating reactive rather than theory-driven investigation. These findings provide insights into the landscape of psychological literature on threat and reveal critical gaps in current examinations alongside strategic opportunities to advance cross-field integration.

Genetic association and computational analysis of CYP2R1 gene polymorphisms rs2060793 and rs12794714 with vitamin D deficiency and acute myocardial infarction in the Bangladeshi population: A case control study

2026-06-05T14:00:00Z

by Sadia Akter, Md. Nazid Bin Ibrahim, Zimam Mahmud, Sonia Tamanna, Md. Shakhawat Hossain Shawon, Farzana Ansari, Md. Zakir Hossain Howlader

Acute myocardial infarction (AMI) remains a leading cause of cardiovascular morbidity and mortality worldwide. Emerging evidence highlights vitamin D as a critical determinant of cardiovascular health. The CYP2R1 gene encodes the key 25-hydroxylase enzyme responsible for converting vitamin D to its principal circulating metabolite, 25-hydroxyvitamin D. However, the influence of CYP2R1 polymorphisms on AMI susceptibility, particularly within South Asian populations, has not been well characterized. This study investigates the association of two CYP2R1 variants, rs2060793 and rs12794714, with AMI risk and their relationship with serum vitamin D levels in a Bangladeshi cohort. A total of 502 participants comprising 251 AMI patients and 251 age- and sex-matched controls were analyzed. Genomic DNA was extracted and genotyped using PCR-RFLP, while serum 25-hydroxyvitamin D₃ levels were quantified by HPLC. AMI patients exhibited markedly lower vitamin D concentrations (23.92 ± 0.94 ng/mL) than controls (30.3 ± 0.86 ng/mL; p < 0.0001). Genotypic analysis revealed a significant association between rs2060793 and AMI risk: the TC (OR = 2.49, 95% CI: 1.34–4.63) and CC (OR = 2.59, 95% CI: 1.37–4.90) genotypes conferred increased susceptibility compared to the TT genotype (p = 0.0064). The dominant model (TC + CC vs. TT) further confirmed this relationship (OR = 2.53, 95% CI: 1.39–4.61, p = 0.0016). In contrast, rs12794714 showed no significant association with AMI in this population. Stratified analysis indicated that rs2060793 was significantly linked to AMI in males but not females, while both variants were associated with increased risk in individuals aged ≤60 years, but not in those >60 years. Bioinformatic and molecular docking analyses (RegulomeDB, JASPAR, HADDOCK 2.4, DNAproDB) further demonstrated potential regulatory effects of these variants on CYP2R1 function. Collectively, our findings reveal a novel association between CYP2R1 rs2060793 and vitamin D deficiency with AMI risk in the Bangladeshi population, underscoring the interplay of genetic and metabolic determinants in the molecular pathogenesis of AMI.

Longitudinal employment patterns and parental health: A cross-country look

2026-06-05T14:00:00Z

by Wen-Jui Han, Johanna Carrasco Saravia, Matthias Pollmann-Schult, Tinh Doan, Jianghong Li

Study aims

Using a cross-country lens, we investigate the links between longitudinal work trajectories and health among parents with children under age 18.

Background

Employment serves as a valuable resource, affording us a decent standard of living. The rising dominance of digital and technology, together with the service economy since the 1980s, has transformed the utility of employment from a resource to a vulnerability, subjecting more families to uncertain, unstable, and insecure work. Nonstandard work schedules or shiftwork, which often fall outside regular 9-to-5 daytime hours and can be unpredictable, carry potential health consequences.

Methods

Using the longitudinal data from Australia (HILDA), Germany (SOEP), the UK (UKHLS), and the US (NLSY79), we used sequence analysis to first chart parental work schedule patterns between three stages of the life course, 25–34, 35–44, and 45–54, to show the changes and transitions in work patterns. We then conducted multivariate regression analysis to examine how variations in parental work patterns may shape individual health (i.e., physical and mental health) at ages 35/40, 45/50, and 55/60 while controlling for a rich set of sociodemographic characteristics.

Results

Our sequence analyses uncovered roughly 4–6 work patterns during those three periods, revealing the heterogeneities of parental work trajectories that might correspond to childrearing demands and their sociodemographic backgrounds. We also found that mainly not-working pattern or volatile work arrangements (e.g., switching between daytime and non-daytime hours) were associated with significantly poorer physical and mental health; however, the persistence and magnitude of these associations varied by country.

Conclusions

This study advances our understanding of the critical role of employment in our health from a cross-country perspective and bears important implications for the intergenerational transmission of employment and health vulnerabilities.

Seasonal variation in species composition, deltamethrin susceptibility, and kdr mutations in anopheles mosquitoes in Northwest Ethiopia

2026-06-05T14:00:00Z

by Ligabaw Worku, Amha Kebede, Ayalew Jejaw Zeleke, Saron Fekadu, Melat Abdo, Tigist Atele, Netsanet Worku, Mulugeta Aemero

Background

Anopheles mosquitoes are the main vectors of malaria. Effective vector control depends on understanding their species composition, behavior, distribution, and insecticide resistance. This study investigated Anopheles species composition, susceptibility to deltamethrin, and the frequency of knockdown resistance (kdr) mutations in Maksegnit and Gendawuha, Northwest Ethiopia.

Methods

Anopheles larvae and pupae were collected from breeding sites during the rainy and post-rainy seasons and reared to adults under field insectary conditions following WHO guidelines. In addition, adult mosquitoes were collected from houses near larval habitats. Only field-derived mosquito populations were used in this study. Adult females (3–5 days old) reared from field-collected larvae were tested for susceptibility to 0.05% deltamethrin using WHO bioassays. Based on bioassay outcomes, mosquitoes were classified as phenotypically susceptible (died after exposure) or resistant (survived exposure), while field-collected adults represented an unexposed group. A total of 480 mosquitoes (160 resistant, 160 susceptible, and 160 field-collected unexposed adults) were subjected to genomic DNA extraction. Species identification and detection of knockdown resistance (kdr) mutations (L1014F and L1014S) were performed using PCR.

Results

WHO bioassays conducted on 776 mosquitoes revealed confirmed resistance to deltamethrin, with mortality rates ranging from 48.5% to 72.5% (overall resistance: 37.5%). Resistance intensity exhibited significant variation, peaking after the rainy season and showing a higher prevalence in Maksegnit compared to Gendawuha (p < 0.05). Molecular identification of 480 mosquitoes showed that Anopheles arabiensis was the predominant species (93%, 446/480), followed by An. pharoensis (6%, 29/480) and An. stephensi (1%, z/480), with the latter detected for the first time in Gendawuha. Regarding kdr mutation status, genotypic analysis showed that the L1014F mutation was the predominant allele, particularly among phenotypically resistant mosquitoes (67.8%), while lower frequencies were observed in susceptible (45.8%) and unexposed field-collected groups (61.4%). Conversely, the L1014S mutation was detected at low frequency (≤12.3%) and was restricted exclusively to the Maksegnit population.

Conclusion

Anopheles arabiensis predominated, with confirmed resistance to deltamethrin, particularly in the post-rainy season. The L1014F kdr mutation was prevalent, while L1014S kdr mutation was rare. Detection of Anopheles stephensi highlights emerging risks, underscoring the need for season-specific resistance monitoring and integrated control strategies.

Comprehensive chemical, morphological, thermal, and biological characterization of Agave tequilana extract and chitosan-based dissolving microneedle arrays

2026-06-05T14:00:00Z

by Patricia Quintero-Rincón, Karina Caballero-Gallardo, Oscar Flórez-Acosta

Dissolving microneedles have gained attention as minimally invasive platforms for transdermal research applications. In this study, chitosan‑based dissolving microneedle arrays incorporating a hydroalcoholic extract of Agave tequilana root were formulated and systematically characterized. Chemical profiling by UHPLC-ESI-Orbitrap-MS revealed a diverse phytochemical composition dominated by phenolic acids, particularly rosmarinic acid. Morphological and structural analyses showed that extract incorporation induced concentration‑dependent changes in microneedle geometry: arrays containing 0.25% extract preserved tip sharpness, whereas a 0.50% loading led to surface roughening and partial tip deformation. Thermal analyses demonstrated extract‑dependent modifications in material degradation behavior, consistent with interactions between chitosan and extract constituents. Biological assays confirmed that the agave extract exhibits high antioxidant capacity, moderate tyrosinase inhibition, and inhibitory activity against collagenase and hyaluronidase. Following incorporation into the microneedle arrays, antioxidant activity and inhibitory effects against tyrosinase and hyaluronidase were retained, while collagenase inhibition was reduced, particularly in the 0.25% formulation. In vitro cytotoxicity assays indicated biocompatibility toward HaCaT keratinocytes and concentration-dependent selective cytotoxicity in A375 melanoma cells. Taken together, these findings indicate that extract loading is a critical parameter influencing structural preservation and in vitro bioactivity of chitosan‑based dissolving microneedles. Further studies addressing mechanical performance, insertion behavior, matrix dissolution, and skin permeation are required to evaluate the functional reliability of this system.

Construction of a public health emergency information system framework: A case study of Zhuhai city, China

2026-06-05T14:00:00Z

by Sicheng Huang, Xuebao Zhang, Long Chen, Xihe Ni, Ying Fan, Chaomin Zhao, Junfeng Xiao, Feng Ruan

Background

A public health emergency information system serves as a critical tool for collecting and analyzing data from sudden public health events, thereby providing a scientific basis for governmental decision-making. However, research on the systematic construction of such information system frameworks within China’s public health infrastructure is lacking.

Objective

Taking Zhuhai city as a case study, this study aims to construct a comprehensive public health emergency information system framework applicable to public health departments at the municipal, county, and street/township levels.

Methods

First, through a literature review and expert group discussion, the preliminary framework of system indicators is determined. Second, through two rounds of the Delphi method, 41 experts are invited to qualitatively select the system framework indicators, with the aim of obtaining consensus among experts. Finally, the system is improved through application, feedback, and redesign.

Results

After two rounds of consultation, the final system at the city and county levels consists of 5 first-level indicator modules and 21 second-level indicator modules, whereas the system at the city, county, and street/township levels consists of 4 first-level indicator modules and 17 second-level indicator modules. Most of the indicators in the “emergency preparedness” and “emergency response” modules are considered important and should be retained as they can play a role in collecting and analysing information on infectious disease outbreaks through practical applications.

Conclusion

The public health emergency information system constructed in this study can be applied to public health departments such as disease prevention and control centres. Promotion can improve the efficiency of handling infectious disease outbreaks and provide a scientific basis for decision-making analysis.

Targeted Muscle Reinnervation (TMR) or Regenerative Peripheral Nerve Interface (RPNI) for pain prevention in patients with limb amputation: A protocol for a systematic review and meta-analysis

2026-06-05T14:00:00Z

by Jesús del Moral Preciado, David Gurpegui, Montserrat Royo, Bernardo Hontanilla

Introduction

Regenerative Peripheral Nerve Interface (RPNI) and Targeted Muscle Reinnervation (TMR) have demonstrated superior outcomes compared to classical amputation in prophylactic prevention of pain, primarily by reducing the incidence of symptomatic neuromas, residual limb pain, and phantom limb pain. However, direct comparisons between these two techniques remain limited. Furthermore, their comparative effectiveness across diverse patient demographics (including age, sex, and comorbidities) and surgical variables (amputation level, etiology, and nerve handling) has not been systematically evaluated. Therefore, the objective of this systematic review and meta-analysis is to synthesize the available evidence to determine the comparative safety and efficacy of primary TMR or RPNI.

Methods and design

This review will be conducted following the methodological guidance of the Cochrane Handbook for Systematic Reviews of Interventions. A comprehensive electronic search will be performed in the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Scopus, PubMed, and MedRxiv, without language restrictions. We will include randomized controlled trials, quasi-randomized trials, and observational studies. Study selection and data extraction will be managed using Covidence. Two reviewers will independently screen titles and abstracts, assess full-text eligibility, evaluate risk of bias, and extract data.

Ethics and dissemination

As this systematic review relies on the analysis of secondary data from published studies, ethical approval is not required. Findings will be disseminated through publication in a peer-reviewed journal and presented at relevant conferences.

PROSPERO registration number

CRD42024617299

Changes in tobacco sales before, during, and after the COVID-19 pandemic in Japan: An interrupted time series analysis

2026-06-05T14:00:00Z

by Kanae Kondo, Ichizo Morita, Shigemitsu Sakuma, Isao Ohsawa

Objectives

This study aimed to longitudinally examine nationwide changes in smoking behavior among the Japanese population in response to the COVID-19 pandemic.

Design and setting

A secondary analysis was conducted using cigarette sales data from the Tobacco Institute of Japan, monthly tobacco expenditures from the Family Income and Expenditure Survey conducted by the Ministry of Internal Affairs and Communications, and smoking prevalences from the National Database of Open Data Japan. An interrupted time-series segmented regression model adjusted for seasonality and autocorrelation was used to examine changes in cigarette sales and monthly tobacco expenditures before and after the first declaration of a state of emergency.

Participants

Depending on the data source, data from 2014 to 2022, from 2015 to 2025, or from 2015 to February 2026 were used.

Primary and secondary outcome measures

Changes in level and slope were evaluated before and after the first state of emergency and after COVID-19 was downgraded to a common infectious disease.

Results

Cigarette sales declined at a significantly slower rate after the first state of emergency than before. Price-adjusted monthly tobacco expenditures increased significantly by 132 JPY compared with the previous month, although the expenditure findings were less robust in the quadratic sensitivity analysis. The smoking prevalence among men declined slightly each year, from 34.2% in 2014 to 31.9% in 2022. In contrast, the smoking prevalence among women remained relatively stable, ranging between 9.4% and 9.9%.

Conclusions

Although cigarette sales declined more slowly and household tobacco expenditures increased during the first state of emergency in Japan, smoking prevalences did not change substantially. These findings suggest changes in tobacco purchasing patterns, including stockpiling, and possible changes in smoking intensity among continuing smokers, rather than a meaningful population-level decline in smoking behavior. There was no robust evidence of a clear reversal after May 2023.

Prevalence and determinants of metabolic syndrome among long-shift healthcare professionals in primary hospitals of Central Gondar Zone, Northwest Ethiopia

2026-06-05T14:00:00Z

by Elias Chane, Yilkal Amlaku, Amare Mekuanint, Abebaw Worede, Habtamu Wondifraw Baynes, Getnet Fetene

Background

Metabolic syndrome (MetS) is a group of interrelated metabolic aberrations that significantly elevates the risk of poor cardiovascular outcomes and type 2 diabetes mellitus. Healthcare professionals, particularly those working long shifts, may have elevated risk due to the demanding nature of their work, irregular lifestyles, and associated stress. This study aimed to assess the prevalence and associated factors of MetS among healthcare professionals working long shifts in primary hospitals in the Central Gondar Zone, Northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted among a total of 271 healthcare professionals working in three primary hospitals (from September to December 2023). Study data were collected using structured questionairs, anthropometric measurements, and biochemical assessments. Five mililiters of fasting blood sample was collected from each participant; and serum lipid profile and glucose analyzed on Beckman Coulter DXC 700 AU chemistry analyzer. MetS was defined using the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) criteria. Independent ttest and one-way ANOVA were used for intra and inter group comparison; and Logistic regression model was fitted to identify factors associated with MetS, and adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported to determine the strength of associations.

Results

The prevalence of MetS among healthcare professionals was 11.44% (95% CI 8.14–15.83). Dyslipidemias were observed to be the most common forms of metabolic derangement with 145 (53.51%) of study subjects having at least one lipid profile abnormality; whereas, hyperglycemias was the least common 27 (9.96%) form of metabolic abnormalities. Age ≥ 35 years (AOR = 6.75; 95% CI: 2.34–19.46), a family history of diabetes among first-degree relatives (AOR = 7.78; 95% CI: 2.57–23.53), and short sleep duration (<6 hours per day) (AOR = 7.78; 95% CI: 2.35–25.70) were significant factors associated with MetS (p < 0.05).

Conclusion and recommondation

Metabolic syndrome is prevalent among healthcare professionals particularily those working long shifts; with age, family history of diabetes, and insufficient sleep identified as key risk factors. Hospital administrators and occupational health units should implement routine metabolic screening, optimized shift scheduling, and sleep hygiene support programs specifically for healthcare professionals working prolonged shifts, with particular attention to high-risk staff groups. Further workplace-based research is also needed to evaluate the effectiveness of these targeted interventions.

Cumulative metabolic stress (microfilarial infection + moult) constrains the expression of carotenoid-based honest signals in breeding male village weavers (Ploceus cucullatus) of Amurum Forest Reserve, Nigeria

2026-06-05T14:00:00Z

by Felix A. Andong, Olufemi Olasoji, Abdifatah Ahmed A. Afyare, Ezekiel S. Mayowa, Praise O. Nwanozie, Emmanuel E. Osayi, Ruth A. Agyo, Vincent C. Ejere

In wild birds, the breeding season involves a convergence of metabolically demanding life-history stages, including reproduction, moult, and immune defense. We investigated the relationships between microfilarial infection, moult, redox homeostasis, and plumage quality in breeding male village weavers (Ploceus cucullatus) at the Amurum Forest Reserve, Nigeria. We compared four groups (n = 148 total) sampled within 3 mins post-capture: infected-moulting (IM), infected-non-moulting (IN), non-infected-moulting (NM), and non-infected-non-moulting (NN). Physiological condition was assessed using the erythrocyte glutathione ratio (GSH:GSSG) and circulating glucose, while plumage reflectance traits were integrated into a composite quality axis (PC1). Microfilarial infections were present in 52.0% (n = 77) of individuals; mean parasite intensities were 6.13 ± 0.35 mf/µL (IN) and 6.45 ± 0.41 mf/µL (IM). Physiological indices varied strongly across groups. The GSH:GSSG ratio was reduced in infected birds, indicating altered redox balance (rs = −0.65). Circulating glucose was highest in the infected non-moulting group (IN) but substantially reduced in the infected moulting group (IM). Across physiological and ornamental traits, individuals experiencing both infection and moult (IM group) exhibited the strongest reductions relative to all other groups. However, this pattern reflects a statistically supported Infection × Moult interaction, rather than an untested synergistic or non-linear effect, as evidenced by significant IN vs. IM contrasts in glucose (Table 3; z = 33.43, P < 0.0001, d = 6.10) and plumage quality. This interaction was associated with reduced plumage hue and lower integrated signal quality. Our results suggest that microfilarial infection and moult impose overlapping physiological demands that constrain metabolic regulation and the expression of carotenoid-based ornaments. Intracellular redox balance emerges as a potential mechanistic link between physiological state and ornamental expression, supporting the hypothesis that village weaver plumage reflects variation in sustained physiological condition under natural ecological stress.

Urban compactness and Land Use Efficiency in Indochina Capitals: A multi-method spatial assessment (2017–2024)

2026-06-05T14:00:00Z

by Tran Tuan Nguyen

This study assesses land use efficiency (LUE) and urban spatial structure in three Indochina capitals, Hanoi, Vientiane, and Phnom Penh, during the period 2017–2024. By integrating the SDG 11.3.1 indicators with spatial agglomeration analysis (global Moran’s I) and urban form measurement (Polsby-Popper index), the study provides a multidimensional assessment of urban expansion patterns. The results indicate that land expansion outpaces population growth in all three cities (LUE > 1). Phnom Penh exhibited the highest LUE value (5.03), strong spatial agglomeration, and the most compact urban form. Hanoi recorded the lowest LUE (2.47), characterized by moderate compactness and weak spatial autocorrelation. In contrast, Vientiane displayed fragmented and largely random urban expansion, accompanied by a declining compactness index and no statistically significant agglomeration. These contrasting patterns reflect distinct urban development trajectories shaped by differences in planning regimes, land management practices, and investment orientations. The findings highlight the urgent need for spatially controlled and compact urban development strategies in rapidly growing cities, while also acknowledging data limitations. The proposed analytical framework is transferable and can be applied to other developing cities worldwide.

Identifying key factors in building fires: A novel approach fusing K-shell entropy gravity

2026-06-05T14:00:00Z

by Yongping Yu, Ning Wang, Shibo Cui, Enhui Zhao

Building fire key factors are the fundamental control variables that govern both the initiation of fires and dynamics of propagation. The accurate identification of key factors in building fires is crucial for enhancing the effectiveness of fire prevention strategies. To improve the accuracy of key factor identification in building fires, a novel K-shell Entropy Gravity (KEG) algorithm that integrates multiple topological metrics is proposed in this study. First, a complex network is constructed to characterize the relationships among accident factors, where nodes represent influencing factors and edges denote their co-occurrence in fire incidents. Subsequently, considering the positional importance and core connectivity of nodes, the information influence and irreplaceability of nodes, as well as the collaborative coupling and nonlinear characteristic among multiple indicators, a composite attribute integrating K-shell value, information entropy difference, and total shortest path length is developed to quantify node importance, thereby capturing both the local coreness and the global influence of nodes within the network. Then, these metrics are incorporated into an established gravity-based model to comprehensively assess the influential scope of each node, and the results are employed to identify the key factors. Finally, the proposed method is compared with baseline methods based on the Susceptible–Infected–Recovered (SIR) model and network robustness evaluation using the California Building Fire Dataset (2012–2024). In addition, a sensitivity analysis is performed to investigate how the removal of key factors affects accident propagation. To further verify the robustness of this method, fire data from Alaska are applied for comparison, and an ablation experiment is designed. The results indicate that the KEG algorithm achieves superior accuracy in identifying critical factors and offers a reliable analytical tool for developing targeted fire prevention and mitigation strategies.

Clinical performance of the BioFire Blood Culture Identification 2 panel for microorganism species identification and resistance gene detection in blood culture-positive specimens

2026-06-05T14:00:00Z

by Haruki Naruse, Noriyuki Watanabe, Sachie Koyama, Sachi Tanaka, Yoshitada Taji, Yasuhiro Ebihara

Introduction

Bloodstream infections are life-threatening, and the rapid identification of pathogens and resistance genes is essential for the administration of appropriate antimicrobial agents. The BioFire Blood Culture Identification 2 (BCID2) panel on the FilmArray multi-parameter genetic analyzer is a fully automated PCR test that rapidly identifies species and resistance genes. Here, we compared the performance of the Filmarray BCID2 panel (BCID2 method) with the conventional method.

Methods

Among the blood culture-positive specimens submitted between January 2023 and November 2024, this study analyzed 201 specimens that contained the target microorganisms of the BCID2 panel. In our laboratory, after subculturing the culture medium obtained from a positive blood-culture bottle, we perform species identification using mass spectrometry and drug susceptibility testing (the conventional method). We compared the results of the BCID2 method with those of the conventional method.

Results

Concordance between the BCID2 and conventional methods was found in 152 of the 161 monomicrobial specimens (94.4%) and in 31 of the 40 polymicrobial specimens (77.5%). The 18 specimens that were discordant were mostly matched at the genus level, but the BCID2 method also detected other microorganisms that were not identified by the conventional method. Resistance genes were identified in 57 of the 61 matched specimens (93.4%).

Conclusion

The BCID2 method exhibits excellent identification results and resistance gene detection rates, suggesting that it is a reliable and rapid diagnostic test system for bloodstream infections.

The application of large language models in bariatric surgery: A scoping review

2026-06-05T14:00:00Z

by Ningjing Guo, Xuyan Li, Xiaoxue Li, Congmin Kang, Xiaoyan Gong, Xinyu Ji, Jie Zheng

Background

Exploratory applications of large language models within the specialized field of metabolic and bariatric surgery have begun to emerge. Nevertheless, existing research remains fragmented, lacking comprehensive integration.

Objective

To conduct a scoping review of studies on the application of large language models in the field of metabolic and bariatric surgery, aiming to provide a reference for clinical practice and future research.

Methods

This scoping review adhered to the Joanna Briggs Institute methodological framework and followed the preferred reporting items for systematic reviews and meta-Analyses extension for scoping reviews (PRISMA-ScR) guidelines.PubMed, Web of Science, The Cochrane Library, Embase, CINAHL, CNKI, Wanfang, and VIP databases were searched for relevant studies, with the search timeframe from database inception to November 2025. The included literature was summarized and analyzed.

Results

A total of 21 English-language studies were included. LLMs were primarily applied in scenarios such as patient education and information consultation, clinical decision support, and professional knowledge assessment. While LLMs performed well in information-provision tasks, they showed low consistency with expert opinions in complex clinical tasks such as individualized surgical recommendations. Performance varied across different models, with GPT-4 generally demonstrating superior performance, and domain-specific models showing professional potential. Current research still faces challenges regarding information accuracy, readability, and clinical applicability.

Conclusion

Large language models hold auxiliary potential in the field of metabolic and bariatric surgery, particularly for knowledge dissemination and patient education. However, their reliability in complex clinical decision-making remains limited. Future efforts should focus on conducting high-quality studies, advancing model specialization and standardized evaluation, and exploring safe and effective human-AI collaboration models.

Comparative impact of insect growth regulators on mortality and development of Amrasca biguttula (Hemiptera: Cicadellidae)

2026-06-05T14:00:00Z

by Sabrine Attia, Shimat V. Joseph

The two-spot cotton leafhopper, Amrasca biguttula (Ishida) (Hemiptera: Cicadellidae), recently detected in the United States, represents an emerging threat to cotton, vegetable, and ornamental crops. Insect growth regulators (IGRs) are considered reduced-risk insecticides. Despite their availability to growers and effectiveness on several piercing and sucking insects, the lethal effects of IGRs on the development of A. biguttula remain poorly understood. Thus, the objective of this study was to determine the effects of common IGRs on various stages of A. biguttula. We evaluated four IGRs: pyriproxyfen, novaluron, azadirachtin, and buprofezin applied at field-recommended rates, alone or combined with nonionic and organosilicone adjuvants, on survival, molting disruption (exuviae production), and longevity of early (1^st-2^nd), intermediate (3^rd-4^th), and late (5^th) nymphal instars, as well as adults using leaf dip and adaxial leaf smear bioassays. All IGRs induced significant, stage-dependent lethal effects. Mortality of 1^st–2^nd instars reached over 90% with buprofezin and novaluron, and molting inhibition reached up to 55%, indicating strong effects of the tested insecticides. The chitin biosynthesis inhibitors buprofezin and novaluron caused rapid mortality, strong molting inhibition, and reduced longevity, particularly in early and intermediate instars. Pyriproxyfen and azadirachtin elicited weaker, delayed responses, with limited effects on late instars and adults. Although adding adjuvants slightly enhanced efficacy, their overall impact was marginal. These findings demonstrate that IGRs can profoundly disrupt A. biguttula population development through interference with insect growth and metamorphosis, supporting their use as selective and sustainable tools in integrated pest management programs targeting this invasive leafhopper.

Navigating the digital era: The impact of digitalization and work-life harmony on well-being among solo self-employed individuals

2026-06-05T14:00:00Z

by Hyeon Jo, Hyunchul Ahn

In an era where technological advancements and work-life integration significantly shape the professional landscape, understanding their impact on individual job satisfaction and well-being is crucial, particularly for self-employed business owners. This study explores the effects of digitalization, autonomy, work-life balance, work engagement, and burnout on the job satisfaction and well-being of the self-employed. Using Partial Least Squares Structural Equation Modeling (PLS-SEM) on a sample of 12,703 respondents from the Sixth Korean Working Conditions Survey (2020), this research offers comprehensive insights into the unique challenges faced by this demographic. The findings indicate that digitalization and automation significantly increase technology anxiety. In contrast, leadership autonomy and responsibility enhance job satisfaction but adversely impact well-being. Work-life interference negatively affects job satisfaction and well-being but positively correlates with burnout. Conversely, life-work interference positively influences job satisfaction but negatively impacts work engagement. Both work engagement and job satisfaction positively affect well-being, while burnout shows a negative relationship. Notably, work-life time balance positively influences job satisfaction and well-being, and overtime work has a surprisingly positive effect on these aspects. This research contributes to existing literature by underscoring the distinct experiences of the self-employed in the digital age, laying a groundwork for future research.

Single-cell profiling of kinase substrate phosphorylation by single-molecule imaging

2026-06-05T14:00:00Z

by Takuya Hidaka, Ryotaro Motoya, Gao Jintian, Sooyeon Kim, Yuichi Taniguchi

Protein phosphorylation regulates diverse cellular processes, yet its analysis at the single-cell level remains challenging due to the low abundance of phosphoproteins. Here, we present a highly sensitive system for profiling phosphorylation of kinase substrates in individual cells. The method integrates fluorescence labeling of single-cell proteomes, immunoprecipitation using antibodies recognizing phosphorylation within specific amino acid motifs, miniaturized SDS-PAGE, and single-molecule detection using a custom-built light-sheet fluorescence microscope. We applied this approach to analyze substrates of casein kinase 2 (CK2) in HeLa cells treated with the phosphatase inhibitor calyculin A. Bulk and pseudo-single-cell analyses confirmed treatment-induced accumulation of phosphorylated CK2 substrates and demonstrated quantitative performance over biologically relevant input ranges. Importantly, true single-cell measurements revealed heterogeneous phosphorylation patterns across molecular weight regions, highlighting cell-to-cell variability in CK2 signaling that is obscured in bulk analyses. This platform enables profiling of the phosphorylation states of a wide range of kinase substrates in individual cells and provides a foundation for dissecting heterogeneous signaling dynamics.

Focusing on legal cases: Automatic classification of legal documents with sentence embeddings and deep learning models

2026-06-05T14:00:00Z

by Fawaz Khaled Alarfaj

The justice system is indispensable to any society as it enforces the rule of law, safeguards fundamental rights, and ensures the equitable resolution of disputes through structured legal frameworks. Artificial Intelligence (AI) has significantly advanced the legal and justice system by automating time-intensive tasks such as document review and contract analysis, thereby enhancing efficiency and reducing human error. Additionally, AI-powered predictive analytics and decision support systems have improved access to justice by providing data-driven insights, enabling faster case resolution, and ensuring more consistent application of the law. Legal document classification using AI techniques is imperative as it enables efficient organization, retrieval, and analysis of vast volumes of legal texts, enhancing accuracy, reducing manual effort, and facilitating faster decision-making in legal processes. In this research study, the main aim is to classify legal text documents using Machine Learning (ML) and state-of-the-art Deep Learning (DL) algorithms. Using a real-world dataset that consists of thousands of legal documents having complex language related to legal cases poses a challenging natural language understanding task by applying various textual features, deep features, and advanced sentence embeddings. The results reveal that the ensemble learning model of Extremely Randomized Trees shows better results with 89% accuracy, as it aggregates the results of multiple decorrelated decision trees to enhance predictive accuracy and control over-fitting. However, the best results of 96% are achieved with sentence embeddings. Sentence embeddings with Long Short-Term Memory (LSTM) networks are highly effective in Natural Language Processing (NLP) due to their ability to capture complex semantic and syntactic information within text.

RNA metagenomic profiling of mosquito viromes associated with Vector-Borne diseases in Quebec, Canada

2026-06-05T14:00:00Z

by Ines Levade, Benjamin Delisle, Éric Fournier, Christian Therrien

Mosquitoes harbor diverse viral communities, including both medically important arboviruses and insect-specific viruses, yet the viromes of mosquito populations in northern temperate regions remains poorly characterized. In this study, we used metagenomic sequencing to analyse pools of archived mosquito samples from Québec, Canada representing multiple species previously identified as arbovirus carriers. Our analyses identified 60 viral species, including three arboviruses, several insect-specific viruses, and multiple dual-host non-pathogenic viruses, revealing the rich viral diversity present in these mosquito populations. Phylogenetic analysis of complete viral genomes demonstrated genetic relationships with viruses reported from diverse geographic regions. We describe, a newly proposed bipartite Culex tombus-like virus and report the complete resolution of thirty-five viral genomic sequences. These results highlight the utility of metagenomic approaches for comprehensive characterization of the mosquito virome and underscore their potential to enhance surveillance of emerging arboviruses, including West Nile virus, in Québec and similar northern ecosystems.

J-shaped relationship between stress hyperglycemia ratio and delirium risk in critically ill patients: A population-based study

2026-06-05T14:00:00Z

by Yingyang Li, Mengyuan Qiao, Hui Yang, Lu Chen, Haiyan Wang

Background

The incidence of delirium in critically ill patients is strongly correlated with poor prognosis. The stress hyperglycemic ratio has emerged as a novel marker for assessing the response to acute hyperglycemia. Glycemic fluctuations during periods of stress play a crucial role in precipitating or directly causing delirium. However, the association between SHR and delirium in hospitalized ICU patients remains uncertain.

Objective

This study aimed to investigate the potential relationship between SHR and delirium in ICU patie nts and to examine possible subgroup differences in this association.

Methods

A total of 2,093 Intensive care unit (ICU) patients were included in this retrospective cohort study. The relationship between SHR and delirium was explored using multifactorial logistic regression, subgroup analyses, smoothed curve fitting, and threshold effect analysis models.

Results

Among the 2,093 participants, 59.05% were male and 40.95% were female, with a mean age of 64.19 ± 16.31 years. We identified a non-linear positive correlation between SHR and delirium, with an inflection point at 0.68, and the odds ratio (95% CI) after the inflection point was 1.88 (1.35, 2.62), P < 0.001. This interaction was statistically significant concerning the APACHE II scores and C-reactive protein levels at admission.

Conclusion

We found a nonlinear positive association between SHR and delirium. Our study highlights that managing SHR levels in critically ill patients may help to prevent or mitigate the development of delirium, emphasizing the potential value of SHR as an early intervention and precision treatment for delirium.

Topological data analysis for predicting disease outbreaks in humanitarian settings: A machine learning approach

2026-06-05T14:00:00Z

by Job Agba Opue, Uchechukwu Emena Okorie, Victor Ede Itita

Background

Humanitarian settings are highly vulnerable to infectious disease outbreaks because displacement, crowding, disruption of health services, insecurity, and inadequate water and sanitation often interact in ways that are difficult to capture with conventional prediction models. There is a need for forecasting approaches that can integrate heterogeneous data sources and better represent complex system structure.

Methods

We developed and evaluated a machine-learning framework incorporating topological data analysis to predict cholera and measles surge events (binary indicators per LGA-week) across 97 Local Government Areas in Nigeria between 2018 and 2023. These 97 LGAs represent a selected high-burden subset (12.5%) of Nigeria’s 774 LGAs with sufficient surveillance data. Weekly district-level predictors included climate, conflict, displacement, health-system, and socioeconomic variables. Persistent homology was used to derive topological summaries from multivariate risk profiles, and these were combined with selected raw predictors in gradient-boosting models. Outcomes were defined using surveillance-based outbreak thresholds with a 4-week prediction horizon. Model performance was assessed using temporally ordered hold-out validation, with evaluation of discrimination, calibration, and incremental value over baseline models.

Results

The topological models achieved ROC-AUC of 0.78 (95% CI: 0.74–0.82) for cholera and 0.81 (95% CI: 0.77–0.85) for measles, representing modest improvements of 0.08–0.12 over models using only conventional predictors. At the optimal decision threshold determined using Youden’s index on validation data, sensitivity was 0.72 (range across folds: 0.68–0.76) and specificity was 0.82 (range: 0.79–0.85) for cholera, with false alert rates varying from 2.8–3.6 per LGA per year across temporal folds. Topological features contributed 35% of predictive importance. Calibration slopes were 0.94 (cholera) and 0.97 (measles).

Conclusions

Topological feature representations provide a modest but meaningful complementary approach for outbreak prediction in complex humanitarian environments. Their value appears to lie in summarizing higher-order structure across multiple interacting risk domains, rather than replacing established epidemiologic indicators. However, routine deployment requires prospective validation and context-specific threshold tuning. Further external validation, operational threshold analysis, and prospective testing are needed before routine deployment in public-health early warning systems.