PLOS https://journals.plos.org/plosone/ customercare@plos.org https://journals.plos.org/plosone/feed/atom All PLOS articles are Open Access. https://journals.plos.org/plosone/resource/img/favicon.ico https://journals.plos.org/plosone/resource/img/favicon.ico 2026-10-19T19:26:19Z The PLOS One Editors 10.1371/journal.pone.0360868 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0360865 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0360864 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0360779 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by The PLOS One Editors </p> Simote T. Foliaki Brent Race Katie Williams Chase Baune Bradley R. Groveman Cathryn L. Haigh 10.1371/journal.pone.0360777 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by Simote T. Foliaki, Brent Race, Katie Williams, Chase Baune, Bradley R. Groveman, Cathryn L. Haigh</p> The PLOS One Editors 10.1371/journal.pone.0360775 2026-10-19T14:00:00Z 2026-10-19T14:00:00Z <p>by The PLOS One Editors </p> Likai Wu Chee-Onn Chow Wei Ru Wong Joon Huang Chuah Jeevan Kanesan Meina Zhang 10.1371/journal.pone.0361099 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Likai Wu, Chee-Onn Chow, Wei Ru Wong, Joon Huang Chuah, Jeevan Kanesan, Meina Zhang</p> Joint failures can disrupt gait coordination, velocity tracking, and body stability in quadruped robots by reducing the available control authority. This study investigates faults in which joints remain locked at fixed angles and presents Adjudicate Reconfiguration and Evolving Regularization Meta Reinforcement Learning (ARER-MetaRL). The framework combines task inference from context, modular routing tailored to each task through an Adjudicate Reconfiguration (AR) network, and Evolving Gradient Regularization (ER) to support rapid adaptation. Tasks differ in the identities and locking angles of the faulty joints, the number of simultaneous faults, the commanded motion direction, and the terrain. Experiments in NVIDIA Isaac Sim cover all 12 actuated joints, with 0–3 stuck joints during meta-training and severity tests involving up to 6 simultaneously stuck joints. ARER-MetaRL achieves higher Mean Episode Linear Velocity Tracking Reward (MELV) and Mean Episode Roll–Pitch Tracking Reward (MERP) than single-task reinforcement learning, ablated variants, and the evaluated learning and adaptation baselines. Cumulative rewards further demonstrate the benefit of combining the proposed components. In the study of fault severity, ARER-MetaRL achieves MELV/MERP values of 0.86/0.84 with one stuck joint and 0.55/0.54 with six stuck joints, compared with 0.21/0.18 and 0.05/0.03, respectively, for the single-task baseline. These results show improved adaptation across different configurations of locked joints and terrain conditions. Hafez Mohammad Nazmul Ahsan Shaheera Rahman Labida Islam Monjur Rahman Farhana Zaman Rowshan Ara Hossain Mohammed Omar Khayum Saidur Rahman Mashreky 10.1371/journal.pone.0361054 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Hafez Mohammad Nazmul Ahsan, Shaheera Rahman, Labida Islam, Monjur Rahman, Farhana Zaman, Rowshan Ara, Hossain Mohammed Omar Khayum, Saidur Rahman Mashreky</p> Sven-Erik Bursell Stephanie J. Fonda Kaitlynn Borik Jeff Stainback Dara Shahon 10.1371/journal.pone.0361052 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Sven-Erik Bursell, Stephanie J. Fonda, Kaitlynn Borik, Jeff Stainback, Dara Shahon</p> Diabetic retinopathy (DR) regression is not regularly reported; yet understanding of its prevalence in early-stage DR may impact strategies for eye care management. This study’s primary aim was to examine DR regression in patients initially diagnosed with very mild or mild nonproliferative DR (NPDR). A secondary aim was to assess the association between retinopathy regression and diabetes therapy, diabetes duration, and Hemoglobin A1c (HbA1c). This was a retrospective, longitudinal cohort study using medical record data from the United States’s Indian Health Service’s teleophthalmology program for DR evaluation. Baseline exams occurred in 2015–2017 and follow-up (FU) exams occurred within 3 years of baseline. There were 2,348 patients included in this cohort with very mild NPDR at baseline and 705 patients with mild NPDR. For the whole sample, mean age was 56 ± 12.8 years, 55% were female, diabetes duration was 13.0 ± 9.1 years, and HbA1c was 8.8 ± 2.1%. Proportions for DR regression were 0.47 (CI = .45 − .50) (from very mild NPDR) and 0.36 (CI = 0.33–0.40) (from mild NPDR). Proportions for any DR progression were 0.27 (CI = 0.25–0.29) (from very mild NPDR) and 0.34 (CI = 0.30–0.38) (from mild NPDR). Multivariable analyses showed that lower HbA1c levels were associated with greater odds of diabetic retinopathy regression in patients with either very mild or mild baseline NPDR, whereas insulin use was associated with lower odds of regression. Shorter diabetes duration was associated with greater odds of regression only among patients with very mild NPDR at baseline. DR regression was more frequent than DR progression particularly for patients initially with very mild NPDR. DR reversal was more likely in early-stage DR. Behavioral modifications such as increased physical activity and weight loss that lower HbA1c and subsequent risks for DR progression are important to emphasize in diabetic eye care. Sevda Dolapcioglu Yunus Emre Akbana İlayda Uzun Gülten Koşar 10.1371/journal.pone.0361042 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Sevda Dolapcioglu, Yunus Emre Akbana, İlayda Uzun, Gülten Koşar</p> While extensive research has examined refugee students’ educational adaptation in host countries, the educational reintegration phase following voluntary return remains underexplored. This qualitative study investigates the linguistic and academic adaptation experiences of Syrian students transitioning from Turkish-medium education in Türkiye to Arabic-medium schooling in Syria after voluntary return. The study addresses an overarching question: how do returnee students experience the linguistic, academic, social, and psychosocial dimensions of this reverse educational transition? Using an exploratory qualitative design, data were collected through a seven-item open-ended written questionnaire from 15 middle-school students who had received several years of formal schooling in Türkiye. Qualitative content analysis revealed that return does not constitute a simple linguistic recovery, but rather a reverse academic transition characterized by profound difficulties with academic Arabic, conceptual transfer, written production, and in-class assessment practices. The findings indicate that students’ challenges were shaped not only by uneven Arabic literacy development but also by curriculum misalignment, pedagogical practices that participants perceived as more teacher-directed, limited peer interaction, and assessment practices that they perceived as unclear. Furthermore, psychosocial pressures, including re-migration-related distress, concentration difficulties, and increased family responsibilities, complicated their academic adaptation. Ultimately, these struggles reflect systemic institutional and contextual mismatches rather than individual deficits. By conceptualizing return as a distinct educational phase, this study contributes to the broader discourses on refugee education and bilingualism. The implications underscore the critical need for academic Arabic bridging programs, background-sensitive assessment frameworks, psychosocially responsive pedagogies, and school-based psychosocial support to ensure equitable reintegration into Arabic-medium schooling. Emma Feng Ming Zhou Carmelo Pirri Xiaoxiao Zhao Juhua Peng Tao Wen Jianhui Fang Chufeng Zhou Carla Stecco Siu Ngor Fu 10.1371/journal.pone.0360981 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Emma Feng Ming Zhou, Carmelo Pirri, Xiaoxiao Zhao, Juhua Peng, Tao Wen, Jianhui Fang, Chufeng Zhou, Carla Stecco, Siu Ngor Fu</p> Suzan Nakasendwa Joan Nankya Mutyoba Alex Riolexus Ario Evans Omondi Brenda Birungi Bashemera Francis Kakooza Letisha Najjemba Joyce Nakatumba Nabende David Guwatudde Agnes Kiragga 10.1371/journal.pone.0360963 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Suzan Nakasendwa, Joan Nankya Mutyoba, Alex Riolexus Ario, Evans Omondi, Brenda Birungi Bashemera, Francis Kakooza, Letisha Najjemba, Joyce Nakatumba Nabende, David Guwatudde, Agnes Kiragga</p> Introduction <p>Stroke is a leading cause of mortality and disability globally, with a disproportionate and growing burden in low- and middle-income Countries. However, evidence on national temporal trends and potential impacts in Uganda remains limited. This study examined trends in stroke cases and deaths in Uganda and forecast of future stroke burden through December 2028.</p> Methods <p>We conducted a retrospective time-series analysis of District Health Information System (DHIS2) from 2016 to 2025. Monthly stroke cases, and deaths were analyzed. Monthly populations of Uganda were estimated using exponential growth interpolation and incorporated as an offset term in Bayesian negative binomial regression models to estimate incidence rate ratios (IRR) at 95% confidence interval (CI). Decomposition analysis using the Kitagawa method was applied to derive contributions from population growth and epidemiological change, based on model estimates. Stationarity and autocorrelation were assessed using the unit root and Ljung–Box tests. Forecasting was performed using the exponential smoothing state-space (ETS) model at 80% prediction intervals (PI).</p> Results <p>Trend analysis showed sustained monthly increases in stroke incidence and mortality with IRR; 1.005 (95% CI: 1.004–1.006), and 1.006 (95% CI: 1.005–1.007), respectively (all p < 0.001). The epidemiological effect was approximately twice as large as the population effect, indicating that the majority of the increase in stroke cases and deaths is attributable to rising incidence rates rather than population growth alone. ETS model demonstrated that by December 2028, monthly cases and deaths are projected to reach approximately 927 (80% PI: 709–1,156) and 126 (80% PI: 94–160), respectively.</p> Conclusion <p>Stroke burden in Uganda is projected to continue increase further over the next years in the absence of effective prevention measures. Strengthened primary prevention, expanded acute stroke care capacity, and improved surveillance systems are urgently needed to mitigate the growing health system impact.</p> Luhao Liu Zhengyi He Yixiang Li Shengsheng Lin Songlin Li 10.1371/journal.pone.0360960 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Luhao Liu, Zhengyi He, Yixiang Li, Shengsheng Lin, Songlin Li</p> Contact resistance at metal–two-dimensional semiconductor interfaces is a major factor limiting the performance of emerging two-dimensional electronic devices. Understanding how material thickness influences contact behavior is therefore essential for device optimization. Here, we systematically investigate the layer-dependent contact resistance of MoS₂–Sb interfaces using MoS₂ field-effect transistors with different layer numbers. Contact resistance was extracted using the transmission line method and compared for devices fabricated on SiO₂ and HfO₂ gate dielectrics. The results reveal a pronounced non-monotonic dependence of contact resistance on the MoS₂ layer number. As the layer number increases from one to three, the contact resistance decreases and reaches a minimum value of 308 Ω·μm for trilayer MoS₂, while further increasing the thickness leads to a rise in resistance. Analysis of the electronic band structure and interlayer transport mechanisms indicates that this behavior originates from the competition between bandgap reduction and increasing interlayer transport resistance. In the few-layer regime, bandgap narrowing lowers the Schottky barrier and reduces contact resistance, whereas in thicker layers the growing interlayer resistance dominates carrier transport. These findings provide important insight into thickness-dependent contact physics in two-dimensional semiconductors and offer practical guidance for optimizing contact engineering and channel thickness in next-generation electronic devices. Sara Di Carlo Adrian Salas-Bastos Mariela Castelblanco Castelblanco Muriel Auberson Dongmei Wang Marie Rumpler Malaury Tournier Olivier Staub Lukas Sommer Silvia Ferreira Lopes Ana Jiménez Sànchez Olaia Naveiras Edith Hummler 10.1371/journal.pone.0360958 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Sara Di Carlo, Adrian Salas-Bastos, Mariela Castelblanco Castelblanco, Muriel Auberson, Dongmei Wang, Marie Rumpler, Malaury Tournier, Olivier Staub, Lukas Sommer, Silvia Ferreira Lopes, Ana Jiménez Sànchez, Olaia Naveiras, Edith Hummler</p> In humans, the membrane-bound serine protease prostasin encoded by <i>Prss8</i> is associated with preeclampsia, a gestational hypertension disorder affecting blood supply of the placenta. Deficiency of <i>Prss8</i> in mice resulted in embryonic lethality by embryonic day (E) 14.5 and impaired maturation of placental labyrinth. We found in <i>Prss8</i>^-/- embryos at E11.5 and E12.5 a reduced frequency of both circulating primitive and erythro-myeloid progenitor (EMP)-derived definitive erythroblasts in the yolk sac, placenta and fetal liver. Single-cell RNA sequencing analyses revealed a downregulation of fetal hemoglobin genes and an upregulation of ribosomal genes in primitive erythroid cells of <i>Prss8</i>^-/- embryos, indicating a defective erythroid maturation. We suggest that prostasin regulates primitive erythropoiesis in a cell-extrinsic manner, since its expression was absent in circulating erythroid cells. Indeed, the yolk sac vascular remodeling of <i>Prss8</i>^-/- embryos was impaired as evidenced by reduced vessel branching and junctions, likely affecting placenta vascularization and contributing to embryonic demise. Our findings unveil a novel role for prostasin during developmental erythropoiesis and vascular patterning and provide insight into how <i>Prss8</i> dysregulation may contribute to placental pathologies such as preeclampsia. Thanaset Hiranbandit Wutthichai Jariya 10.1371/journal.pone.0360956 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Thanaset Hiranbandit, Wutthichai Jariya</p> Background <p>Syphilis remains a major global public health concern in various groups, including people in prisons, where the burden is substantial. This study aimed to identify factors associated with syphilis infection among newly admitted prisoners in a province of Thailand.</p> Methods <p>A case–control study was conducted among newly admitted prisoners in three correctional facilities. Cases and controls were randomly selected from newly admitted prisoners who had undergone syphilis screening at prison entry between 01/04/2025 and 30/09/2025. Data were collected using validated data collection instruments, including case record forms and structured questionnaires. Multivariable logistic regression analysis was used to identify factors associated with syphilis infection among newly admitted prisoners, with statistical significance set at <i>p</i>-value < 0.05.</p> Results <p>A total of 51 cases and 204 controls were included in the study. In multivariable logistic regression analysis, homosexual or bisexual orientation (adjusted odds ratio [AOR] = 9.59; 95% confidence interval [CI]: 1.81–50.92), a history of sexually transmitted infections (AOR = 38.03; 95% CI: 10.46–138.31), anal intercourse (AOR = 4.47; 95% CI: 1.05–19.12), sexual intercourse without condom use (AOR = 13.82; 95% CI: 3.38–56.43), and injection drug use (AOR = 45.60; 95% CI: 2.88–722.12) were significantly associated with syphilis infection among newly admitted prisoners.</p> Conclusions <p>Prison entry represents a critical opportunity for syphilis screening. Risk-based screening strategies targeting individuals with high-risk sexual behaviors and substance use should be prioritized to reduce syphilis transmission in correctional facilities.</p> Zuojin Li Hao Huang Linlu Dong Xianfeng Zhang Rui Zhou Bo Li Bao Yu 10.1371/journal.pone.0360955 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Zuojin Li, Hao Huang, Linlu Dong, Xianfeng Zhang, Rui Zhou, Bo Li, Bao Yu</p> Hybrid agricultural machines in mountainous orchards operate under low-speed, high-load conditions with coupled gradient and time-varying rolling-resistance disturbances. Their power demand is therefore nonstationary and may change abruptly. Rule-based and instantaneous strategies provide limited preview, whereas model predictive control (MPC) can transmit prediction errors directly to actuator commands and imposes substantial online computation. To address these limitations, a forward model was developed for a power-split hybrid agricultural machine comprising an engine, two electric machines, a traction battery, and a planetary gear set. A predictive-feedforward, multi-objective energy-management strategy was proposed. Short-horizon speed and gradient predictions are normalized, weighted, and saturated to form a bounded load-risk indicator. Rather than entering low-level torque calculation directly, this indicator modifies the dynamic state-of-charge (SOC) safety boundary, power-source mode, and transmission-ratio switching threshold, thereby softly decoupling prediction and execution. Engine high-efficiency operation, two transmission ratios, and actuator constraints are then coordinated for computationally efficient online power allocation. With offline dynamic programming (DP) as a common benchmark, the strategy achieved 93.29–95.59% of the DP performance over cycles C1–C3, exceeding MPC by 1.41–3.19 percentage points and adaptive equivalent-consumption minimization by 3.62–4.99 percentage points. Mean execution time was 0.128–0.191 ms per step, 93.54% lower than that of MPC, while terminal SOC remained near 0.600. No SOC, battery-current, or power-source torque constraint was violated under prediction noise or abrupt equivalent rolling-resistance disturbances. The conclusions apply to maintained, firm orchard lanes with low track slip; soft-soil operation involving high traction, severe sinkage, or substantial slip requires further validation. Bounded load-risk feedforward thus retained short-horizon preview while limiting direct error propagation, providing a practical real-time approach for hybrid agricultural machines with resource-constrained embedded controllers. Yingmei Huang Jianyong Huang Hongmian Jiang Yumei Wei Zhong Lin Baoli Xie 10.1371/journal.pone.0360914 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Yingmei Huang, Jianyong Huang, Hongmian Jiang, Yumei Wei, Zhong Lin, Baoli Xie</p> Cervical intraepithelial neoplasia (CIN) is a precursor to cervical cancer, and early detection of residual or recurrent disease is therefore critical for effective management. This study evaluated whether HPV E6/E7 mRNA status predicts recurrence in patients with CIN who underwent loop electrosurgical excision procedure (LEEP). People’s Hospital of Nanning between January 2019 and July 2022 were included. Patients who underwent LEEP for high-grade cervical lesions at the First Follow-up commenced 4–6 months after LEEP and continued for 24 months; abnormal findings during this period prompted referral for colposcopy or cervical biopsy. Of the 91 patients, 3 (3.30%) experienced recurrence within 24 months. Recurrence rates were similar between patients with preoperative E6/E7 mRNA positivity (3.23%) and negativity (3.45%) (p = 0.956), and between postoperative E6/E7 mRNA status groups (5.26% in the negative group vs. 0% in the positive group; p = 0.814). Although 66.7% of patients shifted from positive to negative E6/E7 mRNA status after LEEP (p < 0.001), this change was not associated with recurrence risk. Preoperative E6/E7 mRNA yielded a sensitivity of 66.67% and specificity of 31.82%, whereas postoperative E6/E7 mRNA showed a sensitivity of 0% and specificity of 97.30%. In conclusion, E6/E7 mRNA status before and after LEEP did not predict recurrence in patients with CIN. Despite a significant reduction in E6/E7 mRNA positivity after surgery, its low sensitivity underscores the need for more effective biomarkers in follow-up care. Yi Chen Yu Liu Juan Zhou Huarong Pu Jinglan Zhang 10.1371/journal.pone.0360911 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Yi Chen, Yu Liu, Juan Zhou, Huarong Pu, Jinglan Zhang</p> Background <p>Pain is common in children with hematologic malignancies. It can be highly distressing and can shape how children feel and function during hospitalization. Children’s pain experiences are influenced not only by disease and treatment but also by developmental level, family context, language, and culture. However, little is known about how Tibetan children with hematologic malignancies experience and communicate pain in clinical settings.</p> Aim <p>We aimed to explore the pain experiences of Tibetan children with hematologic malignancies and to inform culturally responsive pain assessment and nursing care.</p> Methods <p>We used a descriptive phenomenological design. From February to March 2026, we purposively recruited 15 Tibetan children with hematologic malignancies from a pediatric hematology-oncology ward in Sichuan, China. Data were collected through play-based, semi-structured face-to-face interviews with children and analyzed using an adapted version of Colaizzi’s phenomenological method.</p> Results <p>Four themes were identified: (1) cultural and spiritual interpretations of pain, including silent endurance and religious or traditional coping; (2) linguistic and communicative constraints in pain expression, including limited Mandarin vocabulary and indirect expression of discomfort; (3) family-centered dimensions of pain experience, including emotional security through family presence, relational continuity through family accompaniment, and familiar family-based comfort practices; and (4) hospitalization-related disruptions to everyday social life, including disrupted schooling and peer contact and concerns about illness disclosure and social isolation.</p> Conclusions <p>The findings suggest that culturally responsive pain assessment may benefit from child-centered communication, attention to indirect and nonverbal expressions of pain, and recognition of the supportive role of family relationships and familiar comfort practices.</p> Xiaoxue Sun Qinqin Wang Wei Zheng 10.1371/journal.pone.0360909 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Xiaoxue Sun, Qinqin Wang, Wei Zheng</p> Objective <p>To address the occupational exposure risks caused by instantaneous steam overflow when opening the top cover of hatch-type boiling disinfectors in the central sterile supply department, this study developed an interlocked centrifugal exhaust system (ICES) characterized by operational simplicity and high adaptability.</p> Methods <p>The ICES was assembled using a centrifugal fan, Hall effect switch, instant relay, time-delay relay, solid-state relay, and piping. The system achieved automatic start/stop of the fan based on the open‑or‑closed status of the top cover. A self-controlled design was adopted on one hatch-type boiling disinfector. Temperature was measured at the chamber edge (T1) and at the technician’s facial position (T2). Airborne particle counts were also measured at the technician’s facial position. Measurements were performed under conditions with and without the ICES enabled. Data were analyzed using the Wilcoxon signed-rank test.</p> Results <p>After enabling the ICES, T1 and T2 decreased by 20.89% and 31.31%, respectively. The median temperature at T2 was 21.5 °C, which was close to the ambient temperature. The reduction ratios for airborne particle counts of six different sizes at the technician’s facial position ranged from 53.09% to 67.83%. All differences between groups were statistically significant (all P < 0.001).</p> Conclusion <p>The ICES effectively reduces steam overflow upon the top-cover opening of hatch-type boiling disinfectors and lowers the risk of occupational injury. With advantages such as wide installation adaptability, imperceptible operation, and convenient maintenance, it provides a stable and reliable solution for the safety retrofitting of existing hatch-type boiling disinfectors.</p> Lianshuai Zheng Xiaolun Xu Xueyuan Rong Jian Luo Guoqing Chen Cheng Zhao 10.1371/journal.pone.0360813 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Lianshuai Zheng, Xiaolun Xu, Xueyuan Rong, Jian Luo, Guoqing Chen, Cheng Zhao</p> Pregnancy is accompanied by substantial physiological adaptations that may alter maternal micronutrient concentrations. A prospective longitudinal pregnancy-neonatal cohort of 51 healthy pregnant women was established at 6–8 weeks of gestation in Lianyungang, Jiangsu, China, confirmed by fetal heart and bud on B-ultrasound. Pregnancy complications, outcomes, and neonatal health at day 42 were confirmed. Forty-three women who completed all assessments and had uncomplicated pregnancies with favorable maternal and neonatal outcomes were included in the final analysis. Whole-blood trace elements and serum vitamins were quantified during the first trimester (12.3 ± 0.9 weeks), second trimester (25.6 ± 1.2 weeks), and third trimester (32.7 ± 2.3 weeks) using ICP-MS and UHPLC-MS/MS. The results showed that copper, calcium, and vitamin D peaked in the second trimester, whereas iron, zinc, magnesium, and lead reached their nadir in the second trimester. Meanwhile, manganese and vitamins E and K increased progressively throughout gestation. In contrast, several B vitamins showed an overall downward trend, while vitamin B12 remained relatively stable. These findings demonstrate clear trimester-specific changes in maternal micronutrient levels during healthy pregnancy. Given the relatively small sample size, these longitudinal data provide preliminary evidence to inform the establishment of region-specific and trimester-specific reference intervals and deficiency thresholds for micronutrients in healthy pregnant women. Mahugnon Maxime Obe Cokou Patrice Kpadé Alphonse Singbo Terence Epule Epule Vincent Poirier 10.1371/journal.pone.0360792 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Mahugnon Maxime Obe, Cokou Patrice Kpadé, Alphonse Singbo, Terence Epule Epule, Vincent Poirier</p> The economic valuation of ecosystem services in agriculture and agroforestry is crucial for sustainable development. However, valuation methods vary significantly across contexts. Using the PRISMA framework, we systematically reviewed 146 studies, combined effect sizes through meta-analytic modeling, and conducted spatial autocorrelation analyses to explore geographic patterns. Market price valuation (MPV) and contingent valuation (CVM) are the most used methods in ecosystem service assessments, accounting for 25.8% and 20.8% of studies, respectively. The CVM and life cycle impact assessment (LCIA) approaches play a key role in interdisciplinary research, connecting all ecosystem service categories. Analysis revealed extreme heterogeneity and significant publication bias for cultural (CULT), provisioning (PROV), and regulating (REG) services. Valuation outcomes are strongly influenced by the choice of methods (such as MPV and benefit transfer methods) and unit standardization practices, with effect sizes decreasing when values are standardized to United States dollars per ha per year (USD/ha/year). Spatial autocorrelation was minimal, indicating the importance of local context in the valuation results. Temporal trends indicate episodic changes in the relative effectiveness of valuation approaches. Empirically, MPV showed greater robustness (18%) than CVM, which exhibited greater sensitivity to data constraints (16%). These findings highlight the need to prioritize data quality and context specificity within standardized valuation frameworks to improve policy relevance and comparability in ecosystem service assessments, particularly for underrepresented CULT and supporting (SUP) services. Virginia Zweigenthal Nicola Christofides Thembelihle Dlungwane Sogo France Matlala Mathildah Mpata Mokgatle Abraham Opare Sean Mark Patrick Nikki Schaay Maylene Shung-King Takalani Tshitangano Laetitia Rispel 10.1371/journal.pone.0360789 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Virginia Zweigenthal, Nicola Christofides, Thembelihle Dlungwane, Sogo France Matlala, Mathildah Mpata Mokgatle, Abraham Opare, Sean Mark Patrick, Nikki Schaay, Maylene Shung-King, Takalani Tshitangano, Laetitia Rispel</p> The Master of Public Health (MPH) degree is a key qualification for public health practice in low- and middle-income countries. Graduates entering practice should possess a range of competencies to address complex health issues in managerial, technical or research positions. As competencies of graduates exiting South African MPH programs are unknown, a consortium of academics from South African universities conducted an on-line survey of alumni exiting between 2012−2016, to determine their self-reported public health competencies and their recommendations for improving academic programs. Competencies were explored in 11 domains, through three lenses – their reported usefulness at work; perceptions whether they were obtained through MPH programs; and graduates’ confidence in their application. Over 80% of this cohort of 221 graduates, mostly in their mid-30’s, largely from South Africa and sub-Saharan Africa, needed the competencies in all 11 domains at work, which were felt to be largely obtained from the MPH, and most were confident using them. However, one fifth were not confident in crisis management and 13% were not confident in health promotion. On average 30% reported they did not obtain either crisis management or leadership skills from the MPH. Respondents recommended changes to course content and organization included more experiential learning, mentorship and faculty advocacy for graduate employment. In the absence of country-wide governance for public health education, the study is a first step towards developing core-competencies for South African programs. Findings can be factored into MPH program reviews with attention given to enhancing leadership, crisis management and monitoring and evaluation training into existing courses. Additionally, more experiential learning could fill identified gaps in problem-solving and project management skills. Producing a ‘fit for purpose’ public health workforce requires alignment of education objectives with health workforce systems in country contexts to ensure a seamless transition between learning and working. P K Anand Manjula Singh Purbita Banerjee Seema Sahay Sampada Bangar Braj Raj Ghosh Manjeet Singh Chalga Anurag Pappu VNR Das Sarika Gupta Amber Kumar Dhruvendra Pandey 10.1371/journal.pone.0360758 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by P K Anand, Manjula Singh, Purbita Banerjee, Seema Sahay, Sampada Bangar, Braj Raj Ghosh, Manjeet Singh Chalga, Anurag Pappu, VNR Das, Sarika Gupta, Amber Kumar, Dhruvendra Pandey</p> Background <p>Tuberculosis is a major public health challenge in India, contributing to one-fourth of global burden of TB disease. Comorbidities in uninfected individuals make them vulnerable to TB disease. This study estimates the self-reported prevalence of tuberculosis and selected vulnerability factors (HIV, current smoking, silicosis, occupational silica-dust exposure, diabetes mellitus and persistent cough >2 weeks) among the rural demography of six districts in India, with the aim of informing targeted active case finding under the National Tuberculosis Elimination Programme (NTEP).</p> Methods <p>The study conducted was a community-based cross-sectional survey carried out across six districts of India. Two blocks from each district was selected randomly followed by randomly selected villages under each block. A universal sampling technique was followed for including all the households of the randomly selected villages. The data were collected through a pre-tested semi-structured questionnaire schedule via face-to-face interviews at all the eligible households of the study sites. Descriptive analysis was performed, and the results were obtained in the form of frequencies and percentages.</p> Results <p>The ultimate data consisted of 82,636 individuals, with males at 52% and females at 47%. 77% of the study population were 15 years of age or older. This study analyzes a large dataset. The TB prevalence was around 150 per lakh of the population, while the prevalence of HIV-reactive individuals, current smokers, silicosis, occupational exposure to silica dust, diabetes mellitus and cough of greater than two weeks is found in 0.9%, 5%, 1.2%, 1.1%, 1.4% and 4% respectively.</p> Discussion and conclusion <p>The study highlights TB status and selected TB-vulnerable groups. The study has a large sample size, and it follows multipronged approach to study selected vulnerable population groups. This data may improve targeted active case finding among the high-risk groups as outlined by NTEP and provide better TB control strategy outcome at high TB burden settings.</p> Elhaitham Yasir Awad Musa Amar Yasir Awad Musa 10.1371/journal.pone.0360756 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Elhaitham Yasir Awad Musa, Amar Yasir Awad Musa</p> Cardiovascular disease (CVD) remains the leading cause of death worldwide. While clinical scores provide modest predictive accuracy, the electrocardiogram (ECG) is rarely leveraged for prognosis. Artificial intelligence (AI) and deep learning now enable extraction of high-dimensional features from ECG waveforms for predicting cardiovascular outcomes. Our objective was to systematically evaluate the prognostic performance of AI-enabled ECG models for predicting all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACE). We searched PubMed, Cochrane CENTRAL, IEEE Xplore, and Google Scholar through November 2025 for studies using AI/ML models with 12-lead or single-lead ECGs to predict all-cause mortality, cardiovascular mortality, or MACE in adults (≥18 years old). Eligible studies included adults (≥18 years) using ECG as primary input. Two reviewers independently screened and extracted data. Narrative synthesis was conducted due to heterogeneity. Thirteen studies were included (~5.9 million patients). Eleven reported all-cause mortality (8 short-term: 30-day to 1-year), four reported cardiovascular mortality, and eight assessed MACE (4 composite MACE, 4 individual components). Models predominantly used convolutional neural networks [CNNs] on raw ECG waveforms. C-statistics ranged 0.70–0.89 for mortality prediction. Definitions and follow-up durations varied, limiting direct comparison. AI-ECG models demonstrate strong potential for predicting mortality and cardiovascular events with consistent performance and scalability. However, prospective validation and standardization are essential before clinical implementation. Sungbae Jo 10.1371/journal.pone.0360753 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Sungbae Jo</p> This cross-sectional secondary analysis examined medical rehabilitation use and regional bypass among Korean children and adolescents with registered disabilities, using a two-stage access framework that distinguished entry into medical-institution rehabilitation from out-of-region use after entry. We analyzed public-use data from the 2023 National Survey on Persons with Disabilities, restricting the sample to respondents younger than 19 years (n = 399; weighted national estimate, 88,611). Weighted descriptive statistics and modified Poisson regression with robust standard errors were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Overall, 50.0% had no medical-institution rehabilitation use, 31.5% used in-region rehabilitation, and 18.6% used out-of-region rehabilitation; among rehabilitation users, 37.1% reported out-of-region care. In stage 1, non-developmental disability type was associated with higher medical rehabilitation use (PR, 1.61; 95% CI, 1.28–2.03), whereas eup/myeon residence was associated with lower use (PR, 0.66; 95% CI, 0.46–0.94). In stage 2, province residence (PR, 2.13; 95% CI, 1.38–3.27) and non-developmental disability type (PR, 1.74; 95% CI, 1.13–2.69) were associated with out-of-region use, while male sex was associated with lower out-of-region use (PR, 0.62; 95% CI, 0.42–0.92). The most common reason for non-use was use of non-medical facilities (27.4%); better treatment and absence of nearby medical institutions were leading reasons for out-of-region care. Pediatric medical rehabilitation access involves challenges to both non-use and out-of-region use, with implications for local entry support, regional capacity-building, and cross-sector service integration. Zuohao Chen 10.1371/journal.pone.0360747 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Zuohao Chen</p> This study employed a Cumulative Link Mixed Model (CLMM) to examine the relationship between Japanese learners’ filler use and OPI (Oral Proficiency Interview) level ratings. The results showed no significant association with proficiency for the <i>i</i>(い)-group, <i>u</i>(う)-group, <i>ano</i>(あの)-group, and <i>eeto</i>(ええと)-group fillers. In contrast, the <i>a</i>(あ)-group, <i>e</i>(え)-group, <i>o</i>(お)-group, and <i>n</i>(ん)-group fillers were significantly negatively associated with higher proficiency, while the use of <i>maa</i>(まあ)-group and <i>sono</i>(その)-group fillers was significantly positively associated with higher proficiency. Furthermore, an analysis of <i>maa</i>(まあ)-group and <i>sono</i>(その)-group fillers based on their functions and discourse roles showed that turn-internal <i>maa</i>(まあ) and inferential/re-presenting <i>sono</i>(その) require at least two clauses to be produced. This indicates a connection with paragraph-level language production, which is one of the criteria for ‘Text Type’ in OPI assessment. It was also found that the use of these fillers with such functions is significantly positively associated with higher proficiency. On the other hand, for fillers such as <i>ano</i>(あの) and <i>eeto</i>(ええと), as well as <i>maa</i>(まあ) used in adjacency pairs, no significant increase with proficiency was observed, confirming that their use is not associated with paragraph-level production. The use of fillers linked to paragraph-level production can be considered one of the key linguistic factors that can help explain the relationship between filler use and the development of oral language proficiency. Delong Zhang Yubo Ma Hongan Wu 10.1371/journal.pone.0360733 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Delong Zhang, Yubo Ma, Hongan Wu</p> Early-stage defects in wind turbine bearings often generate weak impulsive signatures that are easily obscured by strong background noise, posing a significant challenge to accurate extraction of fault-related features. To overcome this limitation, a novel concave sparsity-assisted time-reassigned multisynchrosqueezing transform (CSA-TMSST) is developed to improve the extraction of weak fault-related signatures. First, a non-convex sparse optimization model incorporating the generalized minimax-concave (GMC) penalty is established to reconstruct fault impulsive components from the raw signal. The introduced GMC-based sparse regularization enhances signal sparsity, enabling the accurate extraction of impulsive fault signatures. Subsequently, TMSST is employed to characterize the reconstructed signal in the time-frequency (TF) domain, yielding a more concentrated time-frequency representation (TFR). Furthermore, the iterative reassignment mechanism is utilized to enhance the concentration of TF energy distribution, thereby yielding a clearer TFR of transient fault features. Finally, characteristic fault frequencies are identified via spectral analysis. The results demonstrate that CSA-TMSST is capable of extracting weak fault-related signatures and producing high-quality TFRs under strong noise conditions, confirming its effectiveness and superiority. Zedai Wang Chao Tang 10.1371/journal.pone.0360731 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Zedai Wang, Chao Tang</p> Artificial intelligence-generated content (AIGC) is increasingly embedded in short-video platforms, where algorithmic recommendation systems expose users to high volumes of rapidly produced synthetic media. Although prior research has examined generative AI from the perspectives of creativity, productivity, and technology adoption, less is known about how ordinary users evaluate repeated exposure to AI-generated short videos. This study develops and tests an appraisal-based model of AI content fatigue, distinguishing perceived AIGC saturation from users’ appraisals of low-quality prevalence, narrative homogenization, and content overload. A cross-sectional online survey was conducted among Chinese short-video users in May 2026. After excluding invalid responses, 513 valid questionnaires were analyzed using confirmatory factor analysis and structural equation modeling. The adjusted structural model showed acceptable fit to the data, χ²(1321) = 1991.541, χ²/df = 1.508, CFI = .946, TLI = .929, IFI = .947, and RMSEA = .031. Perceived AIGC saturation was positively associated with perceived low-quality prevalence, perceived narrative homogenization, and perceived content overload. Perceived low-quality prevalence had the largest estimated coefficient, followed by perceived content overload, whereas perceived narrative homogenization was not supported under bootstrap inference. AI content fatigue was negatively associated with satisfaction and continued viewing intention. Bootstrap analyses indicated selected path-specific indirect associations from perceived AIGC saturation to AI content fatigue, satisfaction, and continued viewing intention. Indirect pathways through perceived low-quality prevalence and perceived content overload were supported, whereas those through perceived narrative homogenization were not. The findings indicate that fatigue in AIGC-rich short-video environments is not simply a response to AI-generated content itself. It is more closely related to users’ appraisals of content quality, repetitiveness, and cognitive burden. The study contributes to social media fatigue research by conceptualizing AI content fatigue as a content-specific evaluative state and offers implications for platform governance, AIGC labeling, recommendation diversity, and quality-sensitive moderation. Xiang Wang MingXing Li Jia Du YU Yao Jiabei Jiang 10.1371/journal.pone.0360722 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Xiang Wang, MingXing Li, Jia Du, YU Yao, Jiabei Jiang</p> The deepening integration of generative AI into design education is driving a paradigm shift in human-computer AI collaboration (HAIC) -from mere tool assistance toward intelligent synergy. However, its dual impact on the competency development of design students and the underlying mechanisms remain insufficiently understood. Grounded in the Theory of Stress Appraisal, this study constructs a research model to examine the double-edged sword effect of HAIC on Design Competence (DC), introducing teacher AI Leadership (AIL) as a moderating variable. The aim is to reveal the psychological mechanisms and boundary conditions through which HAIC influences DC. Employing a questionnaire survey, this study conducted an empirical investigation involving 483 design students in East China. Data analysis was performed using SPSS 24.0 and Amos 23.0, encompassing reliability and validity tests, regression analysis, and Bootstrap mediation analysis. The results indicate that HAIC influences DC through dual pathways: it positively enhances DC by fostering Challenge Appraisal (CA) (β = 0.283, p < 0.01), which in turn positively predicted competence development (β = 0.363, p < 0.01), yielding a significant indirect effect of 0.103 (p < 0.01). Simultaneously, HAIC triggered Hindrance Appraisal (HA) (β = 0.271, p < 0.01), which negatively predicted competence development (β = −0.229, p < 0.01), yielding a significant indirect effect of −0.062 (p < 0.01). This constitutes a partial mediating mechanism characterized by “one positive, one negative” effect. Furthermore, Teacher AIL exhibits an asymmetric moderating effect: it significantly buffers the positive impact of HAIC on HA (β = −0.112, p < 0.01), indicating that high AIL can mitigate cognitive load and anxiety arising from technological uncertainty, yet it does not significantly amplify the positive pathway via CA (β = 0.001, p > 0.05). The findings suggest that the impact of HAIC on DC is not linear but rather a dialectical process contingent upon individual cognitive appraisal. The core value of Teacher AIL lies in “risk mitigation” rather than “creativity stimulation,” offering a theoretical foundation for the intelligent transformation of educational design. At the practical level, it is imperative to facilitate from knowledge deliverers to cognitive facilitators in AI-augmented design education. By systematically developing AI instructional competencies and reforming assessment systems, educators can guide students toward establishing a healthy relationship with HAIC, thereby achieving the synergistic advancement of technological empowerment and humanistic literacy. Hao Liu Aochuan Sun Yu Deng Yihan Li Jiayu Hu Zhengtang Liu 10.1371/journal.pone.0360683 2026-10-16T14:00:00Z 2026-10-16T14:00:00Z <p>by Hao Liu, Aochuan Sun, Yu Deng, Yihan Li, Jiayu Hu, Zhengtang Liu</p> Introduction <p>Mitochondrial dysfunction is central to type 2 diabetes mellitus (T2DM) pathogenesis, driving insulin resistance and pancreatic β-cell dysfunction. Age-related mitochondrial impairment worsens this in older adults, yet evidence on mitochondrial interventions for this group is limited. This protocol outlines a systematic review and conditional network meta-analysis of randomized controlled trials evaluating mitochondrial interventions in adults aged 60+ with T2DM.</p> Objective <p>The primary objective of this systematic review and conditional network meta-analysis (NMA) is to evaluate the comparative efficacy and safety of diverse mitochondrial-related interventions, including pharmacological agents, nutritional supplements, and lifestyle modifications, relative to placebo, standard care, or no intervention, on mitochondrial function biomarkers in adults aged 60 years or older with type 2 diabetes mellitus (T2DM). Interventions with mitochondrial effects are operationally defined as those whose primary mechanism is known to target mitochondrial pathways or those that are explicitly evaluated for their effects on direct markers of mitochondrial function in the trial.The secondary objectives are: (1) to assess the impact of these interventions on glycemic and metabolic control outcomes including glycated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), body weight, and body mass index (BMI); (2) to conduct a conditional NMA to compare and rank the relative efficacy of different intervention categories if the evidence network is sufficiently connected and clinically coherent; and (3) to explore potential sources of heterogeneity (e.g., intervention duration, baseline HbA1c levels) via prespecified subgroup and sensitivity analyses.</p> Methods and analysis <p>Prepared per PRISMA-P, the review will follow PRISMA 2020 and PRISMA-NMA if applicable. Registered with PROSPERO (ID: CRD420251145356), searches will cover PubMed, Embase, Cochrane CENTRAL, Web of Science, and Scopus from inception to April 2026. Focused on T2DM, mitochondrial function/dysfunction, and interventions, age eligibility will be assessed during full-text screening. Primary analysis includes trials with participants aged 60+ or extractable data for this group; sensitivity analyses will include those with mean/median age ≥ 60. Two reviewers will handle screening, data extraction, and bias assessment using RoB 2.Analysis will focus on trials reporting mitochondrial function outcomes, categorized by biological domain, tissue source, and assay method. Glycemic control, geriatric health, and safety are secondary outcomes. Network meta-analysis will be conducted if a connected evidence network exists; otherwise, pairwise meta-analysis or narrative synthesis will be used. Random-effects models will be employed, with heterogeneity assessed via subgroup analysis and meta-regression. If significant heterogeneity persists, a Synthesis Without Meta-Analysis (SWiM) framework narrative review will be done. Evidence certainty will be appraised using GRADE and CINeMA.</p> Ethics and dissemination <p>Ethics approval is not required for this systematic review as the systematic review will include only previously anonymised data from primary studies. Dissemination of the findings of the final systematic review will occur through publishing in a peer-reviewed journal. PROSPERO registration number CRD420251145356</p>