PLOS ONE Alerts: New Articles

Leveraging expression quantitative trait loci information in single-cell resolution to identify cell-specific genes for gestational diabetes

2026-07-30T14:00:00Z

by Wenyan Zhu, Xiaowei Wu, Rongkui Hu

Background

Gestational diabetes mellitus (GDM) is a common pregnancy complication with long-term metabolic consequences for both mother and offspring. While genome-wide association studies (GWAS) have identified risk loci, the cell-type-specific genetic architecture remains poorly characterized due to the limitations of bulk-tissue analyses.

Methods

We integrated GWAS summary statistics from FinnGen (12,332 cases, 131,109 controls) with single-cell expression quantitative trait loci (sc-eQTL) data from 12 immune cell types in the OneK1K cohort. Using the OTTERS framework and ACAT-O omnibus testing, we performed single-cell transcriptome-wide association studies (scTWAS) to identify GDM-associated genes. We performed bulk-level TWAS as a sensitivity analysis. To investigate the function of significant genes, we performed functional enrichment.

Results

We detected 14 unique genes significantly associated with GDM across immune cell types (FDR < 0.05), with the strongest signals in CD4⁺ T cells and monocytes. Notably, ERAP1 and ERAP2 showed associations in 10 of 12 cell types (ACAT. P = 2.17 × 10⁻⁵), and RIOK2 emerged as a shared regulator. Gene Ontology analysis consistently highlighted “antigen processing and presentation via MHC class I” as the top enriched pathway (FDR < 10⁻⁵). In contrast, traditional bulk TWAS using GTEx whole blood identified only two genes with nominal associations.

Conclusion

Our sc-TWAS identifies cell-type-specific GDM-associated genes that are not detected in bulk tissue, highlighting dysregulated antigen presentation in peripheral immune cells. Colocalization prioritizes monocytic LNPEP as the primary causal candidate, while associations for ERAP1, ERAP2, and RIOK2 likely reflect complex LD or tissue-specific effects.

The role of neutrophil PD-L1 expression in acute exacerbation of COPD

2026-07-30T14:00:00Z

by Wei Sun, Liyu Zheng, Haibin Li, Li An, Jing Wang, Chao Ren

Background and objective

The elevation of neutrophil-lymphocyte ratio (NLR) has been shown to be critically involved in unfavorable outcomes among patients with chronic obstructive pulmonary disease (COPD). The mechanism underlying NLR changes during COPD progression remains unclear. This study evaluates the association between neutrophil PD-L1 expression and acute exacerbation of AECOPD and examines its correlation with the NLR.

Methods

In this prospective observational study from June 1 to December 30 2024, we enrolled 14 patients with acute exacerbation, 27 with stable conditions, and 9 healthy control subjects. Blood samples were collected for neutrophil isolation, and the CD15⁺CD274⁺ neutrophil percentage was measured using flow cytometry. We also recorded and analyzed smoking history, pulmonary function test results, and blood routine test data.

Results

The percentage of CD15⁺CD274⁺ neutrophils was notably higher in patients with COPD compared to healthy controls and was even more elevated in those experiencing acute exacerbations of COPD (AECOPD) than in patients with stable COPD. This increased percentage was positively correlated with NLR but negatively correlated with FEV₁% (FEV₁ percentage of the predicted value). The AUC of CD15⁺CD274⁺ neutrophil percentage for predicting AECOPD was 0.894 with 95% CI 0.8–0.989 and a ratio above 3.273 (odds ratio 1.386; 95% CI 1.016–1.891; P = 0.039) independently associated with AECOPD.

Conclusion

Peripheral blood neutrophil PD-L1 expression was elevated in AECOPD and independently associated with exacerbation status in this pilot cohort. Larger, multi-center studies with mechanistic validation are required to determine its clinical utility.

Exploratory identification of candidate SNP markers associated with recurrent clinical mastitis in Holstein cattle

2026-07-30T14:00:00Z

by Shiho Miyata, Lijie Fan, Masahiko Ito, Jun Kambe, Satoshi Takemoto, Chunmei Li, Yuki Yamamoto, Kentaro Nagaoka

Mastitis remains one of the most prevalent and economically significant diseases in dairy cattle worldwide. Although somatic cell count (SCC) is widely used as an indicator for mastitis diagnosis, its physiological variability limits its utility for predicting individual susceptibility. In this study, we aimed to identify genomic markers associated with recurrent clinical mastitis by defining mastitis-susceptible cows as those experiencing three or more episodes within a single lactation. Whole-genome resequencing was conducted on 50 Holstein cows (25 mastitis-susceptible and 25 healthy controls), yielding 536,184 high-quality SNPs after stringent quality control. A genome-wide association analysis identified 86 SNPs surpassing the significance threshold (–log₁₀P > 5.0), and seven candidate SNPs were evaluated in an independent cohort of 100 cows. Notably, the majority of candidate SNPs were localized on the X chromosome, suggesting a potential role for X-linked variation in mastitis immune response and disease resistance. While the candidate marker panel combining SNP1, SNP2, and SNP7 demonstrated moderate sensitivity (47%), its high specificity (98%) highlights its potential utility as a preliminary screening tool for identifying individuals at increased risk of recurrent mastitis. These findings provide a foundation for further functional validation and large-scale replication studies, which are essential for implementing effective genomic selection strategies to mitigate mastitis incidence in dairy herds.

Understanding the transition to motherhood among adolescent mothers in rural Pakistan: Implications for mental health

2026-07-30T14:00:00Z

by Amber Hussain, Tanya Park, Zahid Ali Memon, Salima Meherali

Purpose

This study explored how adolescent mothers in Pakistan experience the transition to motherhood and the mental health challenges that arise during this period.

Methods

A focused ethnographic study was conducted with 25 adolescent mothers in Matiari, Sindh. Data were collected through semi‑structured interviews, participant observations, and artifact elicitation. Meleis’ Transition Theory informed the study focus and development of the interview guide. Reflexive thematic analysis guided interpretation, informed by an intersectional lens.

Findings

Five themes described mothers’ experiences: early educational disruption and redirected aspirations; continuous caregiving with uneven support; barriers to maternal healthcare access; emotional distress and psychological strain; and identity transformation. These intersecting challenges contributed to significant mental health strain and highlighted persistent gaps in access to supportive, adolescent-responsive maternal care.

Conclusions

Adolescent mothers navigate motherhood with substantial emotional and practical burdens yet demonstrate meaningful resilience. Findings highlight the need for adolescent‑responsive mental health support, accessible care, routine and confidential distress screening, referral pathways, and supportive educational and community‑based interventions tailored to underserved rural settings.

Current immunosuppressive treatment and self-reported lifetime stroke history among United States adults: A cross-sectional study

2026-07-30T14:00:00Z

by Muhammad Saad Ansari, Fiza Nisar, Ufaq Reyaz, Mahnoor Fatima, Umair Ahmad Khan, Baseerullah Hadi, Muhammad Talha Khalid

Current immunosuppressive treatment is used for autoimmune, inflammatory, malignant, transplant-related, and other chronic conditions that may carry elevated cerebrovascular burden. Nationally representative evidence on current immunosuppressive treatment status and self-reported lifetime stroke history remains limited. This cross-sectional study used pooled 2023–2024 National Health Interview Survey Adult Sample data. The analytic sample included adults aged 18 years or older with valid survey weights and complete data on exposure, outcome, and selected covariates. The exposure was current self-reported use of medications that weaken the immune system. The outcome was self-reported lifetime stroke history. Survey-weighted logistic regression estimated odds ratios and 95% confidence intervals, accounting for National Health Interview Survey stratification, clustering, and adjusted sampling weights. The final analytic sample included 60,026 adults, representing approximately 250 million United States adults. The weighted prevalence of current immunosuppressive treatment was 4.6%. Stroke history was more common among adults receiving immunosuppressive treatment than among those not receiving treatment (6.0% versus 2.8%). In unadjusted analysis, immunosuppressive treatment was associated with higher odds of stroke history (odds ratio 2.24, 95% confidence interval 1.86–2.70, p < 0.001). After full adjustment for age, sex, race/ethnicity, hypertension, diabetes, smoking status, coronary heart disease, and income-to-poverty category, the association persisted (adjusted odds ratio 1.71, 95% confidence interval 1.40–2.08, p < 0.001). Current immunosuppressive treatment status, likely reflecting both medication exposure and underlying disease burden, was associated with higher odds of self-reported lifetime stroke history among United States adults. Because of the cross-sectional design, broad exposure definition, self-reported outcome, and potential confounding by indication, these findings should be interpreted as an association rather than evidence of causation.

Lessons learned from youth-engaged research methods to conduct qualitative analysis with a transgender and gender-diverse youth advisory board

2026-07-30T14:00:00Z

by An H. Pham, Zoe Webster, Melanie K. Bean, Suzanne Mazzeo, Kym Ahrens, Maria Thomson

Although community-engaged research is becoming more common, youth-engaged research methods, particularly its application to qualitative analysis, remains rare. The Research on Identity Specific Eating Disorder Symptoms (RISES) Project developed, partnered with, and maintained a youth advisory board of five transgender, non-binary, and gender-diverse youth in all stages of a qualitative study, including qualitative analysis. Youth advisory board members contributed to a codebook, coded two to six transcripts each, provided feedback on themes and supporting quotes, and authored this paper. After one year, we achieved a retention rate of 83.3% of all youth advisory board members, and 100% of youth advisory board members trained in qualitative analysis. This paper describes the lessons learned from partnering with and training a transgender, non-binary, and gender-diverse youth advisory board to conduct qualitative analysis.

Trends in the incidence of asthma, atopic dermatitis, and multiple sclerosis before, during, and after the COVID-19 pandemic in a US claims database

2026-07-30T14:00:00Z

by Kexin Zhu, Julie Barberio, Nicole Tsao, Anil Mor, Venkatesh Harikrishnan, Xinyu Li, Sarah-Jo Sinnott

There is limited evidence on how reduced healthcare resource utilization during the COVID-19 pandemic has affected the detection of inflammatory and immunologic diseases. We aimed to describe the observed incidence rates (IRs) of asthma, atopic dermatitis (AD), and multiple sclerosis (MS) before, during, and after the pandemic. Individuals aged ≥6 years were identified in Optum’s de-identified Clinformatics^® Data Mart Database from 2018 to 2022 to make 20 season-based cohorts. Age- and sex-standardized IRs of asthma, AD, and MS were estimated. Incidence rate ratios (IRR) and 95% confidence intervals (CI) were calculated comparing IRs in seasonal cohorts in 2019–2022 to the corresponding timeframe in 2018. Compared to spring 2018, IRs of asthma, AD, and MS in spring 2020 decreased by 14% (IRR: 0.86, 95% CI: 0.84–0.87), 28% (IRR: 0.72, 95% CI: 0.69–0.75), and 23% (IRR: 0.77, 95% CI: 0.68–0.87), respectively. The observed incidence reduction was most profound in children (6–11 years) and adolescents (12–17 years), followed by senior adults (≥65 years). There was no sex difference. IRs returned to or exceeded pre-pandemic levels for AD and MS in summer 2020 and for asthma in spring 2021. COVID-19 led to an apparent decline in incidence for selected inflammatory and immunologic diseases, which was more pronounced for pediatric and senior populations. The observed decrease in incidence likely reflects delayed access to healthcare, resulting in unrecorded (but still occurring) diagnoses for those time periods. Future studies using data that encompass the pandemic period should exercise caution in the design of study and interpretation of incidence or prevalence data.

Spatial intensity modelling of ISIS-related attacks using random forest regression: A GeoAI-based analysis of GTD data (2012–2019)

2026-07-30T14:00:00Z

by A. A. B. D. P. Abewardhana, Rubasin Gamage Niluka Lakmali, Paolo Vincenzo Genovese

Spatial information is of crucial importance to understanding terrorist attacks and for security applications. Conventional risk assessments of terrorism are typically focused on retrospective identification of hotspots and may fail to fully account for complex spatial–temporal patterns. This research proposes an approach to modelling the relative intensity of ISIS/ISIL attacks across space using Random Forest regression, a type of Geospatial Artificial Intelligence (GeoAI). A subset of the Global Terrorism Database (GTD) from 2012–2019 is screened to develop a spatially aggregated data set with geographic coordinates, temporal information and some incident details. The modelling strategy estimates the intensity of events in a grid cell, with values normalized based on the count of previous events, allowing for an analysis of spatial patterns rather than the prediction of future events. Modelling results show that the Random Forest model captures spatial variability in historical attack intensity with a high level of fit (R² = 0.84; RMSLE = 0.213). Analysis of variable importance suggests spatial and temporal features play an important role, but this is contextualised by the spatial construction of the response variable. The research presents a repeatable GeoAI process for modelling spatial patterns of terrorism incidents and offers an interpretable model for exploratory spatial analysis and scenario-based spatial analysis development. The approach is not suitable for real-time prediction, but aids in understanding historical spatial concentration patterns in a complex threat environment.

Prevalence and anatomical distribution of incidental and actionable findings on CBCT scans for implant planning

2026-07-30T14:00:00Z

by Shrey Pandya, Swarna Yerebairapura Math, Justin Kim, Adnan Shah, Saranjeev Lalh, Camila Pacheco-Pereira

Objectives

To determine the prevalence and anatomical distribution of incidental (IF) and actionable findings (AF) on cone-beam computed tomography (CBCT) scans obtained for dental implant planning, and to evaluate their associations with patient demographics and imaging parameters.

Materials and Methods

This retrospective observational study included all consecutive CBCT scans obtained for implant planning (n = 368). A structured, zone-based evaluation protocol was applied, systematically assessing four anatomical regions: (1) cranium and paranasal sinuses, (2) zygomaticomaxillary/orbital complex including the temporomandibular joint, (3) maxillomandibular region, and (4) structures inferior to the mandible. IF were defined as findings unrelated to the implant planning site, and AF were classified based on the oral and maxillofacial radiologist recommendations for further evaluation, referral, or management rather than confirmed clinical outcomes. Associations between IF, AF, CBCT field of view (FOV), age, and sex were analyzed using univariate and multivariable methods.

Results

IF were observed in 257 patients (69.8%) and AF in 199 (54.1%). IF prevalence increased from 50% in patients ≤40 years to 78.8% in those >70 years, and was higher in males than females (76.2% vs. 64.5%; p = 0.01). In univariate analyses, AF were not significantly associated with sex (p = .97) or age (p = .25). However, patients >70 years had higher odds of AF in multivariable analysis, although the overall model was not statistically significant. Zone 2 findings were more common in females than males (21.5% vs. 7.1%; p < 0.001). IF were most common in medium FOV scans (72.2%), whereas AF did not vary by FOV (p = .94). The most prevalent findings involved the maxillary sinus (35.1%), cervical spine (27.4%), tonsils (15.8%), TMJ (11.7%), and vasculature (8.4%).

Conclusions

IF and findings classified as AF based on OMR recommendations were highly prevalent in CBCT scans obtained for implant planning. Approximately half of the scans presented AF (54%). These findings were distributed across multiple anatomical zones and were associated with age and sex, while AF showed no association with FOV.

Current clinical practices in pediatric audiology among audiologists in India

2026-07-30T14:00:00Z

by Twinkle Lijo Kirianthan, Dhanshree R. Gunjawate, Rohit Ravi

Objective

Evidence-based practice is central to audiology; however, adherence to best-practice guidelines varies, particularly in pediatric settings. This study explored current pediatric audiology practices among audiologists in India.

Methods

A cross-sectional survey was conducted using an adapted version of the American Board of Audiology’s Pediatric Audiology Clinical Practice Analysis Survey modified for the Indian context. The survey was distributed electronically via email using contact information available with Rehabilitation Council of India (RCI). Eligible participants held at least a bachelor’s degree in Audiology and Speech-Language Pathology and had a minimum of one year of clinical experience. Participation was voluntary, informed consent was obtained, and confidentiality of responses was ensured. Descriptive statistical analyses were performed. Scale content validity index was calculated to assess content validity of the questionnaire.

Results

A total of 130 audiologists participated, representing a predominantly early-career workforce (mean experience = 4.92 ± 5.41 years). Core pediatric audiology procedures were widely practiced. Newborn hearing screening was considered very important by 66.2% of participants, while 35.4% performed it several times daily. Tympanometry was rated very important by 61.5%, with 40% performing it several times daily. Counselling-related practices were strongly emphasized, with 68.5% rating explanation of test results as very important and 48.5% performing it several times daily. In contrast, advanced procedures demonstrated lower utilization. Cortical evoked potentials were not performed by 35.4% of participants, vestibular assessments by 43.1%, cochlear implant programming by 45.4%, and bone conduction device management by 57.7%.

Conclusions

Indian audiologists consistently provide essential pediatric audiology services; however, gaps persist in specialized diagnostics and rehabilitation. Enhancing infrastructure, professional training, and adherence to evidence-based guidelines is necessary to strengthen pediatric audiological care in India.

You “can’t get away from the social”: Individual, relational, and contextual influences on mental health and substance use-related help-seeking among people in contact with the criminal justice system

2026-07-30T14:00:00Z

by Catriona Connell, Morgan Torrance, Jessica Greenhalgh, Dave Griffiths

Rationale

People in contact with the criminal justice system outside institutional settings have high levels of mental health and substance use problems, contributing to adverse outcomes. Help-seeking behaviour is an important component of optimising access to effective treatment and support that is under-explored in this population. Empirical investigation into the influences on help-seeking for stigmatised health conditions is needed to inform efforts to facilitate help-seeking.

Aim

This study established the individual, relational, and contextual influences on help-seeking for mental health and substance use problems among people in contact with the criminal justice system living in the community, and examined the applicability of existing models and frameworks for understanding help-seeking behaviour in this population.

Methods

We applied framework analysis to qualitative data from a mixed-methods social network analysis study. Our framework drew on help-seeking behaviour and healthcare access models to determine initial categories for help-seeking influences (desire, ability, and context).

Results

Help-seeking was confirmed to result from an interaction between ‘desire to seek help’, ‘ability to seek help’, and ‘help-seeking context’. We show that help-seeking is not an individual behaviour, but strongly affected by relational influences that operate between individuals, across social networks, and via cultural norms. High levels of criminal justice involvement, and mental health and substance use problems in the social networks of people in contact with the criminal justice system shape these influences.

Conclusions and implications

Optimising help-seeking for mental health and substance use problems among people in contact with the criminal justice system living in the community requires critical engagement with, and application of, existing models to ensure sufficient appreciation of relational and contextual influences. Research is needed to develop and test multi-level policy/practice interventions that go beyond individual factors.

Rainy-weather speed limit strategies on highways with variable longitudinal slopes

2026-07-30T14:00:00Z

by Chunjie Li, Guanglin Sun, Xinjian Liu, Haiyuan Sun, Sen Qiu

Rainfall substantially degrades highway traffic safety by reducing pavement friction, shortening driver perception distance, and amplifying the adverse effects of longitudinal grade on vehicle dynamics. To support refined speed management under rainy-weather conditions, this study develops a dynamic safe speed-limit model that jointly accounts for pavement friction, longitudinal slope, and perception distance. An improved Intelligent Driver Model (IDM) is further proposed to represent rainy-weather car-following behavior and speed adaptation. The proposed model was evaluated using the Hangzhou West-Fuxi highway section, and simulation experiments were conducted under different rainfall intensities and slope conditions. Model validation showed that the simulated speeds were consistent with observed speed characteristics, with RMSE values of 2.13–3.08 km/h and MAPE values of 2.31%−4.12%. The safety evaluation results indicated that the proposed speed-limit strategy reduced conflict rates by 7.1%, 73.6%, and 82.4% across the three rainfall scenarios compared with the unrestricted-speed condition. Sensitivity analysis further showed that increasing rainfall intensity reduced the pavement friction coefficient, increased braking distance, and narrowed the safety boundary, particularly on downhill sections. The results indicate that no additional speed restriction is generally required for rainfall intensities of 0–1.0 mm/min, whereas rainfall intensities of 1.0–5.0 mm/min require progressively stricter speed limits. A longitudinal slope of +1% provides the most favorable operating condition, while a −3% slope represents the most adverse case. These findings provide a quantitative basis for adaptive highway speed-limit control under rainy-weather conditions.

Earth pressure analysis of inclined support structures adjacent to existing structures

2026-07-30T14:00:00Z

by Chucai Peng, Xuhui Fu, Weiwei Wang, Rui Yin

This study investigates the earth pressure acting on inclined support structures adjacent to existing structures by combining laboratory physical model tests with theoretical derivation. Five groups of model tests were conducted at a constant width-to-height ratio of 0.95, with support inclination angles of 0°, 5°, 10°, 15°, and 20°. Particle image velocimetry (PIV) and multi-point earth pressure monitoring were employed to reveal the failure surface development in the finite soil mass and the distribution characteristics of earth pressure behind the wall. Based on the assumptions of straight failure surfaces and circular-arc major principal stress trajectories, the finite soil mass was divided into several zones. Force equilibrium equations were established for horizontal differential elements in each zone, and theoretical models for earth pressure intensity, resultant force, and the point of application of the resultant force were derived. The theoretical results were generally in good agreement with the experimental results and reasonably reflected the distribution characteristics of passive earth pressure in the finite soil mass under inclined support conditions. In particular, the theoretical predictions were in good agreement with the measured values in the principal compression zone in the middle and lower portions of the soil mass. The measured earth pressures at the upper monitoring points were markedly lower because of local wall-soil separation, the inability of cohesionless sand to transmit tensile stress, and wall-soil contact relaxation. Within the experimental validation range, the resultant earth pressure decreased and its point of application generally shifted upward as the support inclination angle increased. In contrast, an increase in the soil friction angle caused the point of application to shift downward. The findings of this study can provide a theoretical reference for the design of inclined support structures in projects adjacent to existing structures.

Verbascoside triggers apoptosis and ferroptosis in NSCLC by targeting BCAT2

2026-07-30T14:00:00Z

by Ruijuan Li, Bin Li, Ping Wang

Background

The treatment of non-small cell lung cancer (NSCLC) has challenges such as drug resistance and recurrence. Concurrently, the induction of apoptosis and ferroptosis is a promising therapeutic strategy. This study aimed to investigate whether the natural product, verbascoside, induces apoptosis and ferroptosis in NSCLC cells by targeting BCAT2.

Methods

Bioinformatic analysis was used to predict the potential targets of verbascosides. Stable cell lines with BCAT2 knockdown and overexpression were constructed. The effects of verbascoside on NSCLC were evaluated in vitro and using a mouse xenograft model.

Results

Bioinformatics screening and molecular docking identified BCAT2 as a potential target of verbascoside, with a significantly stronger binding energy (−7.8 kcal/mol) than another candidate, PARP1. In vitro and in vivo experiments confirmed that BCAT2 knockdown significantly inhibited NSCLC cell viability, induced apoptosis and ferroptosis, and induced mitochondrial damage. Conversely, BCAT2 overexpression produced opposite effects. Verbascoside treatment inhibited BCAT2 expression in a concentration-dependent manner, recapitulating the apoptotic, ferroptotic, and mitochondrial damage phenotypes induced by BCAT2 knockdown; however, BCAT2 overexpression significantly reversed these effects of verbascoside. In an animal model, treatment with verbascoside significantly suppressed tumor growth and activated apoptosis and ferroptosis in tumor tissues by downregulating BCAT2.

Conclusions

Verbascoside can induce apoptosis and ferroptosis in NSCLC by directly targeting and inhibiting BCAT2, leading to mitochondrial dysfunction. This finding not only reveals BCAT2 as a novel target of verbascoside but also confirms its ability to induce apoptosis and ferroptosis in NSCLC cells.

Editorial Note: Enhanced audience sentiment analysis in IoT-integrated metaverse media communication

2026-07-30T14:00:00Z

by The PLOS One Editors

Longitudinal omics study of transcriptional dynamics in Lactobacillus crispatus

2026-07-30T14:00:00Z

by SiLing Ren, Huimin Jiang, Xiaohua Liu, Daju Zhou, Liping Liu, Lan Wang, Yi Lan, Yi Xiao, Liangdan Tang

Background

The vaginal microbiome is an important component of female reproductive health. Community State Type I (CST-I), which is dominated by Lactobacillus crispatus, is generally considered to be closely associated with a healthy vaginal microecological state. Although the taxonomic composition of CST-I communities remains relatively stable, the transcriptional dynamics of Lactobacillus crispatus across different phases of the menstrual cycle remain unclear.

Methods

A healthy reproductive-age woman with a stable CST-I vaginal microbiome was enrolled in this longitudinal study. Vaginal secretion samples were collected at six non-menstrual time points throughout a menstrual cycle. Third-generation full-length 16S rRNA gene sequencing and metatranscriptomic sequencing were performed. Differential transcript expression analysis, KEGG pathway enrichment analysis, and Mfuzz time-series clustering were applied to systematically characterize the transcriptional dynamics of the vaginal microbiome across different phases.

Results

Full-length 16S rRNA gene sequencing confirmed that Lactobacillus crispatus remained the dominant species at all six sampling time points, with no substantial changes in overall community composition. However, metatranscriptomic analysis revealed pronounced phase-specific transcriptional reprogramming. During the pre-ovulatory phase, pathways involved in DNA replication, biosynthesis, and central carbon metabolism were upregulated. On the first day after ovulation, pathways associated with carbohydrate utilization, quorum sensing, and redox homeostasis were selectively upregulated. During the mid-to-late luteal phase, pathways related to cell proliferation and growth were generally downregulated, whereas pathways involved in cofactor biosynthesis, the pentose phosphate pathway, and D-amino acid metabolism showed increased expression. Mfuzz clustering further revealed distinct phase-specific functional transitions in L. crispatus that were absent in non-L. crispatus lactobacilli.

Conclusion

The ecological dominance of Lactobacillus crispatus is maintained not solely through numerical abundance, but also through rhythmic and phase-specific transcriptional regulation. Dynamic functional remodeling and metabolic plasticity may represent important mechanisms underlying its long-term persistence and ecological dominance within healthy CST-I vaginal communities.

Primary cesarean section in Sub-Saharan Africa: A systematic review and meta-analysis using the Robson Ten-Group Classification System

2026-07-30T14:00:00Z

by Kindu Yinges Wondie, Endalk Birrie Wondifraw, Miteku Andualem Limenih, Berihun Agegn Mengistie, Getie Mihret Aragaw, Nuhamin Tesfa Tsega, Zelalem Nigussie Azene

Background

The overuse of cesarean sections, mainly of primary procedures, is a major contributor to perinatal mortality in Sub-Saharan Africa. The Robson Ten-Group Classification System is the global standard for cesarean section rate. Evidence on the pooled primary cesarean section rate using this system in Sub-Saharan Africa SSA remains limited.

Materials and methods

A systematic review and meta-analysis were conducted. PubMed, Scopus, ScienceDirect, Google Scholar, Google, and ResearchGate were searched for studies published between 2001 and February 22, 2025. Data were extracted into Microsoft Excel and analyzed using Stata 17. A random-effects model was applied to calculate the pooled rate. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Publication bias was assessed using a Doi plot and the Luis Furuya-Kanamori index. Heterogeneity was assessed using the I² statistic.

Results

The pooled facility‑based primary cesarean section rate, derived from 25 institution‑based studies (213,117 births; predominantly secondary and tertiary hospitals), in Sub-Saharan Africa was 18.7% (95% CI: 16.2–21.4; 95% prediction interval: 8.4%−36.8%). Robson Groups 1 and 2 were the largest contributors (47.5%), with Group 1 alone accounting for 37.1%. In both nulliparous and multiparous women, primary cesarean section was more common after spontaneous labor than after induction or elective procedures. Significant heterogeneity was observed across studies (I² = 99.64%, p < 0.001). No evidence of publication bias was found (LFK index = −0.27).

Conclusion

The facility‑based primary cesarean section rate in Sub-Saharan Africa exceeded the WHO global reference, with Robson Groups 1 and 2 being the largest contributors. High rates of prelabor cesarean and elevated rates following spontaneous labor raise concern for possible overuse, but unmeasured comorbidities and referral bias cannot be excluded. Stricter adherence to evidence-based protocols, routine use of the Robson classification for clinical audits, and linkage with indication‑level data are essential for improving obstetric care.

Environmental footprint of in-center hemodialysis in Türkiye: A national, scenario-based analysis of water, energy, and waste

2026-07-30T14:00:00Z

by Berrak Itır Aylı, Mehmet Emin Demir, Arzu Akgül, Hatice Şahin

Background

Hemodialysis (HD) is a life-sustaining but resource-intensive therapy, consuming large volumes of water and electricity and generating substantial waste. This hybrid modeling study quantified the environmental footprint of in-center HD in Türkiye using national registry data, published parameters, and measured facility-level data from two Turkish dialysis centers.

Methods

A hybrid modeling approach combined published per-session resource parameters with measured facility-level data from two Turkish hemodialysis centers (4,000 sessions/month combined). Literature-derived parameters (493 L water/session at 42% RO recovery, 6.2–19.6 kWh electricity/session, 1.5–8.0 kg waste/session) were scaled nationally for 2023 (9.27 million sessions). Measured Turkish data (390 L water, 10.8 kWh electricity, 1.19 kg hazardous waste per session) provided empirical calibration. GHG emissions were calculated using Türkiye-specific (0.494 kg CO₂e/kWh for electricity) and international conversion factors.

Results

Using literature parameters, annual national estimates include 4.57 million m³ water, 57.5–181.8 GWh electricity, and 13.9–74.2 kt waste, with total GHG emissions ranging from 45.3 to 171.1 kt CO₂e/year. Measured Turkish facility data yielded lower per-session water consumption (~390 L vs. 493 L, a 21% reduction) and hazardous waste generation (1.19 vs. 1.5 kg/session under good segregation), while electricity consumption (mean 10.8 kWh/session) aligned with the moderate literature scenario. Electricity was the dominant emission source (63–72%), followed by waste incineration (up to 47% with poor segregation).

Conclusion

In-center HD in Türkiye imposes a substantial yet modifiable environmental burden. Measured Turkish facility data demonstrated that actual water consumption is meaningfully lower than international estimates, highlighting the importance of locally validated parameters. Waste segregation and electricity decarbonization represent the highest-impact intervention points for reducing the sector’s carbon footprint.

Socioeconomic equity in maternal health services use in Bangladesh: The role of service readiness in health facilities during the period 2001–2016

2026-07-30T14:00:00Z

by Karar Zunaid Ahsan, Gustavo Angeles, Siân L. Curtis, Peter Kim Streatfield, Kavita Singh

Background

Equity in health service utilization refers to equal treatment for equal health needs, regardless of socioeconomic status. In low- and middle-income countries, inequity in maternal health service use remains a pressing issue in the pursuit of universal health coverage by 2030. This study examines whether socioeconomic equity in the use of key maternal health services—antenatal care (ANC) from a medically trained provider, facility delivery, and management of complications—improved faster in districts with high facility readiness than elsewhere in Bangladesh between 2001 and 2016.

Methods and findings

We analyzed data from three rounds of the Bangladesh Maternal Mortality and Health Care Survey and corresponding Bangladesh Health Facility Survey rounds. These datasets were linked at the district level and pooled for the years 2001, 2010, and 2016. Using an adaptation of the Difference-in-Differences (DID) model based on linear probability models, we estimated whether poor-nonpoor gaps in maternal health service utilization changed differently over time in districts with high facility readiness than in districts with lower readiness. Bangladesh achieved substantial improvements in overall maternal health service use during the study period. However, these gains were not equitably distributed. Socioeconomic equity improved modestly for ANC and complication management but worsened significantly for facility deliveries. The gap between nonpoor and poor women widened more in high facility readiness districts than in low readiness districts (p < 0.05). Additionally, equity in ANC use improved among women living within one hour of a private facility (p < 0.05).

Conclusions

This is the first systematic investigation of the role of facility readiness in maternal health equity in Bangladesh using nationally representative data. Despite overall progress, persistent and, in some cases, widening socioeconomic inequities were observed—especially in facility-based delivery. These findings highlight the need for targeted policy action to ensure that improvements in service readiness translate into more equitable maternal healthcare access and outcomes.

Determinants of parental traditional medicine use for children during COVID-19 in Dire Dawa city administration, Eastern Ethiopia, 2023/24: Mixed community based cross-sectional study design

2026-07-30T14:00:00Z

by Mohammed Kebede, Gudeta Kusheta, Mehammedamin Jemal, Kedir Abdurehman, Netsanet Melkamu, Yakob Tadese

Introduction

Globally, 85% of the population uses traditional medicine. Ethiopia is a country with various traditional medicinal practices. However, various studies also reported traditional medicine used in children by their parents has had adverse outcomes and hospitalized them with complications. Various studies had also reported that traditional medicine use was high during COVID-19. Despite the fact that, children are particularly vulnerable population, limited studies exists regarding the prevalence, types, and determinants of parental TM use during COVID-19. In addition the existing studies were also confined to quantitative methods. Therefore, this study uses a mixed study design to explore indigenous methods of traditional medicine knowledge acquisition, preservation, preparation, storage, and dosage of herbs; barriers of disclosure; and prevalence of concomitant use.

Methods

A community-based concurrent mixed study design was conducted among 941 randomly selected parents from Dec 01/2023 to March 01/2024. The data was cleaned, coded, and entered in Epi-Data version 4.6 and transferred to Stata version 14.1 for analysis. Finally, an AOR with a 95% CI was computed, and variables with a p-value < 0.05 in the multivariable analysis were taken as significant factors. The qualitative data was collected from 16 selected key informants by in-depth face-to-face interviews and analyzed by using thematic analysis.

Result

The prevalence of parental TM use for children was 87.6%. Sibling relation to child (AOR: 0.45, 95% CI, 0.01–0.77), religion (AOR: 0.11, 95% CI, 0.04–0.29), parental TM use for themselves (AOR: 6.55, 95% CI, 1.67–25.69), easy accessibility (AOR: 2.72, 95% CI, 1.16–6.40), safety & efficacy (AOR: 4.53, 95% CI, 2.3–13.61), and TM skill in the family (AOR: 0.47, 95% CI, 0.19–0.84) were determinants of TM utilization. Lack of awareness, misperception of TM, lack of trust in HCP and negative judgment from HCP were the main-barriers for non-disclosure of TM use.

Conclusion

This result indicated traditional medicine use was high; nearly 9 out of 10 parents had used TM for their children during COVID-19. There was high concomitant utilization (90.6%) and high non-disclosure rate (98.1%) of traditional medicine use to health workers. Hence, it is better to give priority to strengthening the implementation of TM policy and manage accordingly.

A comparative study of Korean and Chinese learners’ strategy use in request-refusal continuous dialogue speech acts

2026-07-30T14:00:00Z

by Liang Xu, Xiao Wu

In daily communications, the use of speech acts that may threaten others’ faces, such as request and refusal, is inevitable. By methods of DCT with 24 coherent request-refusal scenarios as well as optimized classification of request and refusal strategies, differences in request-refusal continuous dialogue speech acts between Native Korean (NK) and Chinese Korean language learners of intermediate level (CKLI) and advanced level (CKLA) were examined. There were statistically significant differences in frequencies of NK, CKLA, and CKLI using request and refusal strategies in different scenarios. Overall, NK used more categories and numbers of strategies than CKLI. The gap between NK and CKLI might narrow as language proficiency increases. Furthermore, not only the single influence factor that affected strategy choice but also the interactions between these factors, suggesting that people might behave differently when faced with complex scenarios consisting of multiple factors. This study also proposes a new research methodology that inserts factors affecting strategy choice into individual scenarios, designs multiple independent scenarios with the same factors, and analyses the effects of these factors and their interactions on strategy choice. The results of the associated analysis could be used to assist in the development of a detailed instructional plan.

Association of troponin-defined myocardial injury with adverse long-term survival among patients with chronic kidney disease

2026-07-30T14:00:00Z

by Fei Ma, Enhong Han, Jianjun Gao

Objective

Chronic kidney disease (CKD) is associated with increased mortality, however, the impact of troponin-defined myocardial injury within this population remains poorly understood. This study aimed to investigate the associations between troponin-defined myocardial injury and long-term mortality in CKD patients.

Methods

This observational study analyzed 22,772,953 weighted records of adult CKD patients from National Health and Nutrition Examination Survey (1999–2004) databases. Myocardial injury was defined by at least one elevated high-sensitivity troponin (hs-cTn) assay, present in 26.6% of the cohort. Cox regression models adjusted for baseline characteristics and comorbidities were used to assess the associations between troponin-defined myocardial injury and all-cause and cardiovascular mortality. Sensitivity analyses excluding patients with known cardiovascular disease (CVD) were performed to evaluate the robustness of the findings.

Results

Patients with troponin-defined myocardial injury were older and had a higher prevalence of CVD, hypertension, diabetes, as well as a lower estimated glomerular filtration rate (eGFR), compared with those without troponin-defined myocardial injury. Over a median follow-up of 11.6 years, survival was significantly worse among patients with troponin-defined myocardial injury at 1, 5, 10, and 15 years. The adjusted hazard ratios (aHR) for all-cause mortality and cardiovascular mortality in patients with troponin-defined myocardial injury were 1.81 (95% CI 1.51–2.17) and 2.03 (95% CI 1.47–2.79), respectively. Sensitivity analysis excluding records with pre-existing CVD showed similar trends, with an aHR of 1.86 (95% CI 1.56–2.21) for all-cause mortality and 2.44 (95% CI 1.83–3.24) for cardiovascular mortality.

Conclusion

As a marker for troponin-defined myocardial injury, hs-cTns were independently associated with worse long-term survival among CKD patients. However, the observational design precludes causal inference, and single time-point troponin measurements limit the assessment of dynamic changes in myocardial injury.

Design and validation of an immersive virtual rehabilitation system for individuals with vestibular disorders: A feasibility study

2026-07-30T14:00:00Z

by Abdulaziz Ibrahem-Altwijri, Sergio Albiol-Pérez, María-Dolores Cortés-Vega, Cristina García-Muñoz, Rocio Sasián Ramírez de Arellano, José-Antonio Gil- Gómez, José-Antonio Lozano-Quilis, María Jesús Casuso-Holgado

Background

Vestibular rehabilitation is an essential part of managing balance disorders, but traditional exercises can often be repetitive and demotivating for patients. This can reduce adherence and limit treatment outcomes.

Objective

This study aimed to assess the feasibility, usability, patient satisfaction, and safety of DizzyVR, an immersive virtual reality system designed to support vestibular rehabilitation. Preliminary data on its potential effects on clinical outcomes were also collected.

Methods

A prospective, single-arm feasibility study was conducted with ten participants diagnosed with various vestibular disorders. Each participant completed eight weekly sessions using DizzyVR. Feasibility was assessed through session attendance and completion rates. Usability, satisfaction, and safety were measured using the System Usability Scale, the User Satisfaction Evaluation Questionnaire, and the Simulator Sickness Questionnaire. Clinical measures included the Dizziness Handicap Inventory (DHI), Timed Up and Go (TUG) test, Activities-specific Balance Confidence (ABC) scale, and Functional Gait Assessment (FGA).

Results

Ten participants completed the training, with a high adherence rate (91.25%). Usability scores indicated good ease of use, and satisfaction scores were high. Mild adverse events such as nausea or disorientation were reported by three participants, but improved over time. Exploratory pre–post changes were observed in gait speed (TUG: p = 0.002), balance confidence (ABC: p = 0.007), and gait stability (FGA: p = 0.012). While DHI scores demonstrated a trend toward improvement, the change did not reach statistical significance (p = 0.081). Overall, participants reported feeling safe and expressed willingness to recommend and reuse the system.

Conclusions

The findings suggest that DizzyVR is a feasible, usable, and well-accepted tool that may complement conventional vestibular rehabilitation. The system appears to support patient motivation and safe participation while showing promising exploratory changes in balance and gait. Further studies with larger samples, control groups, and longer follow-up are recommended to confirm and expand on these promising preliminary results.

Navigating the potassium dilemma: a qualitative study of nephrologists’ strategies for renin–angiotensin–aldosterone system inhibitor preservation and hyperkalaemia management in Spain

2026-07-30T14:00:00Z

by Nicolas Gimenez-Stamminger, Ceu Mateus, Thomas Mason, Andrew Harding

Background

Hyperkalaemia is a common complication among patients with predialysis chronic kidney disease (CKD) and a leading reason for modifying or discontinuing renin–angiotensin–aldosterone system inhibitor (RAASi) therapy despite its proven cardiorenal benefits. Although newer potassium binders may improve potassium control while enabling RAASi use, real clinical practice remains poorly characterised. This study explored how nephrologists in Spain manage hyperkalaemia in patients with predialysis CKD (stages 3–5), with particular emphasis on RAASi continuation.

Methods

Semi-structured interviews were conducted with 12 practising nephrologists across Spain who routinely manage hyperkalaemia in patients with predialysis CKD. Interviews were transcribed verbatim and analysed using ATLAS.ti. A codebook-based thematic analysis was performed, with codes iteratively refined into 15 sub-themes and grouped into five overarching themes.

Results

Five themes were identified: (1) hyperkalaemia was managed using a structured clinical algorithm incorporating dietary, metabolic, diuretic, and pharmacological strategies, to preserve RAASi therapy where possible; (2) newer potassium binders (patiromer and sodium zirconium cyclosilicate) were viewed as effective and better tolerated than traditional resins, supporting greater RAASi continuity; (3) system-level barriers, including visado requirements, regional formulary variation, and fragmented communication across specialties, limited timely use of newer binders were perceived to contribute to RAASi discontinuation; (4) patient engagement, underpinned by clear communication, trust, and nursing-led education, facilitated adherence, although clinician-level nutrition expertise varied; and (5) hyperkalaemia management affected patients’ daily functioning and emotional well-being, yet formal assessment of health-related quality of life (HRQoL) was infrequent.

Conclusions

Nephrologists in Spain prioritised preservation of RAASi therapy when managing hyperkalaemia in predialysis CKD. Although newer potassium binders supported this objective, their use was limited by access and care coordination challenges. Streamlined access pathways, improved multidisciplinary communication, and routine HRQoL assessments may enable more patient-centred and guideline-concordant care. These implications reflect qualitative clinician perspectives rather than evidence of clinical or economic effectiveness.

From manual counting to YOLO: Using computer vision to automate large-scale fecundity assays in C. elegans

2026-07-30T14:00:00Z

by Linyao Peng, Hongyi Shui, Anne Nicole Janisch, Sarah Dede Hesse, Victoria Kathleen Feist, Amanda Kyle Gibson

Fecundity measurements play a crucial role in life history research, providing insights into reproductive fitness, population dynamics, and environmental responses. In the model nematode Caenorhabditis elegans, fecundity assays are widely used to study development, aging, and genetic or environmental influences on reproduction. C. elegans hermaphrodites have large numbers of offspring (>100), so manual counting of viable offspring is time-consuming and susceptible to human error. Automated counting methods have the potential to enhance throughput, accuracy, and precision in data collection. We applied computer vision to 9972 images of broods from individual C. elegans hermaphrodites from several strains under multiple treatments to capture variation in fecundity. We trained models using You Only Look Once (YOLO) versions v8 to v11 (large and extra-large variants) to detect and count viable offspring, then compared the model results to estimates from manual counting. The best-performing model, YOLO v11-L, detected offspring with high accuracy after fine-tuning, achieving 92.6% recall and 94.9% precision. Manual counts differed from verified ground-truth counts by an average of 2.16 offspring per image, compared to 0.9 for the trained computer vision model. In addition, we detected significant effects of counter identity, experimental block, and their interaction on manual counts. Computer vision counts were not affected by these biases and outperformed manual counting in both speed, consistency, and accuracy. We demonstrate that computer vision can be a powerful tool for fecundity assays in C. elegans and provide a pipeline for applying this approach to new image sets. More broadly, applying computer vision to digital collections can advance ecological and evolutionary research by accelerating the study of fitness and life history. In practice, this reduces months of manual counting to about 2 hours on a consumer GPU, lowering barriers to large-scale fecundity assays.

The promise of deep urine proteomics for diagnosis of cancer, neurologic, and metabolic diseases

2026-07-30T14:00:00Z

by Bogdan Budnik, Hossein Amirkhani, Klaus Weinberger, Saharnaz Nedjat, Mohammad H. Forouzanfar, Ashkan Afshin

Introduction

Urine offers a noninvasive and low-cost source of disease biomarkers, yet most proteomic studies have targeted single conditions. Using deep proteomic profiling and machine learning, we evaluated whether urinary protein signatures distinguish early-stage cancer, neurologic, and metabolic diseases from healthy controls.

Methods

This case–control diagnostic accuracy study analyzed urine samples from the Ukraine Association of Biobank (UAB), collected during routine medical check-ups. The study included 22 patients each with kidney, bladder, melanoma, prostate, ovarian, endometrial, and cervical cancers; 22 with multiple sclerosis (MS); 22 with metabolic dysfunction–associated steatohepatitis (MASH); and 66 healthy controls, yielding 264 samples analyzed in September 2023. Proteomic assays were performed using the Olink Explore 3072 platform, with laboratory personnel blinded to disease status. Urine proteomes were profiled to identify disease-specific protein signatures. The primary outcome was diagnostic accuracy of multiprotein urine panels for each disease compared with healthy controls, expressed as the area under the receiver operating characteristic curve (AUC), along with sensitivity and specificity calculated at a prespecified threshold.

Results

Expected sex‑specific differences (KLK3, MSMB higher in males; KLK8, KLK13 higher in females) supported assay validity. Three expression patterns were observed: (1) few strong, symmetric signals in melanoma and endometrial cancer; (2) asymmetry with many up‑regulated proteins in cervical, ovarian, and prostate cancers and in MS; and (3) broad up‑regulation in kidney and bladder cancers and in MASH. Multiprotein models outperformed single proteins, plateauing at five to seven. Maximum AUCs ranged from 0.88 (MS) to 0.98 0.97 (ovarian cancer), with AUCs ≥ 0.95 for seven of nine diseases. Some proteins (e.g., C9orf40, PPY) showed cross‑disease importance.

Conclusions

Urine proteomics identified disease‑related signals across cancer and metabolic conditions and may enable accurate, noninvasive classification using multiprotein panels, but given the exploratory design and its limitations, the reported accuracies should be regarded as upper-bound estimates requiring prospective validation.

Walking the tightrope of justifiable decision‑making: An exploratory qualitative study identifying barriers and solutions to efficient safety reporting

2026-07-30T14:00:00Z

by Jemima Thompson, Macey L. Murray, Matthew R. Sydes, Annabelle South, Sharon B. Love

Background

Safety reporting is integral to clinical trial conduct, aiming to protect the rights and safety of trial participants and future patients. Over time, reporting safety events has become increasingly complex, leading to inefficiencies which place extra burden on trial staff and potentially impact patient safety. Attempts have been made to streamline these processes. However, effecting change in practice is challenging. Changes to UK trial regulations introduced in 2025 may reduce inefficiencies. To incorporate these changes effectively, we need to understand what barriers exist for their implementation. This study aimed to identify barriers and solutions to efficient safety reporting processes from the perspective of staff working at registered academic trials units in the UK, with a view to developing recommendations to enable the delivery of more efficient safety reporting practices.

Method

This was an exploratory, observational, qualitative focus group study of trials unit staff across the UK. Verbatim transcripts of the focus group discussions were analysed using Reflexive Thematic Analysis.

Results

Twenty-three CTU staff participated in four focus groups. One over-arching theme was generated from the analysis, “Walking on a tightrope: Making justifiable decisions”. Participants felt that they were performing a balancing act between efficient, risk-proportionate safety reporting and risk-aversion. Possible solutions included clarification of expectations and improved transparency, and improved training and knowledge building.

Discussion

Despite efforts to streamline safety reporting processes, problems persist with the implementation of risk-proportionate approaches. Concerns that decisions will be deemed inadequate and impact patient safety and well-being make decision-making a difficult balancing-act. Confident decision-making by trial practitioners can be facilitated through access to resources and training provided by regulators, supported by tools and case studies. Trials unit level actions, such as mentoring schemes or platforms to share knowledge and learning, can support knowledge building and confidence development.

Genomic epidemiology of Group B Streptococcus colonization among pregnant women in Japan, 2021–2023

2026-07-30T14:00:00Z

by Chizu Nishi, Hirofumi Ohtaki, Masaki Karino, Hiromi Uekita, Ayumi Sano, Tetsuya Kobayashi, Susumu Kaino, Yoshiki Sakamoto, Satoshi Nakano

Group B Streptococcus (GBS) colonization in pregnant women is a major risk factor for neonatal diseases; however, molecular epidemiological studies on GBS in Japan remain limited. We characterized 219 GBS isolates recovered from vaginal screening cultures at a general hospital in Osaka Prefecture, Japan between 2021 and 2023. Capsular type, clonal complex/sequence type (CC/ST), virulence factors (pilus islands, Alp family, Srr1/Srr2, and HvgA), and antimicrobial resistance determinants were analyzed using whole-genome sequencing. The predominant lineages were CC19 (27.9%), CC23 (21.9%), and CC1 (21.0%), whereas the hypervirulent CC17 lineage accounted for only 5.5% of isolates. Capsular type Ia, III, and V comprised >60% of the isolates. PI-1/PI-2a (58.0%) was the predominant pilus profile, and rib (35.2%) was the most frequent Alp family gene. The hypervirulence-associated markers hvgA and srr2 were confined to capsular types III/CC17 and IV/CC452. All isolates were susceptible to β-lactams and vancomycin, whereas resistance to macrolides, clindamycin, and levofloxacin was observed at varying frequencies. These findings provide a pre-vaccine molecular baseline for maternal GBS carriage in Japan and highlight srr2-positive CC452 as a potential emerging lineage of concern.

Influence of a complex mycotoxin detoxifier on growth performance, liver health, inflammation, and redox status of broilers fed a diet contaminated with multiple mycotoxins

2026-07-30T14:00:00Z

by Nampetch Puengpong, Thaweesak Songserm, Konkawat Rassmidatta, Joan Torrent, Alireza Khadem, Arnau Vidal, Christos Gougoulias, Nithikarn Chanaksorn, Kazeem D. Adeyemi, Yuwares Ruangpanit

This study investigated the effects of a complex mycotoxin detoxifier (CMD) on growth performance, liver health, inflammation, and redox status of broilers fed a diet contaminated with multiple mycotoxins. A total of 432 one-day-old male Ross 308 broiler chicks were randomly allocated to one of three treatments, with eight replicates per dietary group for 37 d. The treatment included: a basal diet without mycotoxin, positive control, PC; a basal diet contaminated with 80 ppb Aflatoxin + 900 ppb fumonisins + 30 ppb deoxynivalenol + 80 ppb Zearalenone, negative control, NC or NC supplemented with CMD (sodium bentonite, sepiolite, yeast cell wall, and β-glucans) at 1 and 0.5 kg/ton in the starter and finisher diet respectively. Compared with the PC and CMD groups, NC birds showed higher feed intake and poorer feed efficiency during days 1–10 (p < 0.05), although these differences were not observed thereafter. Newcastle disease antibody titer was reduced in NC birds but restored by CMD supplementation (p < 0.05). Birds receiving CMD also exhibited higher IL-10 concentrations than both PC and NC birds (p < 0.05). Furthermore, CMD supplementation reduced macroscopic fatty liver scores and liver inflammation (histopathological lesions) compared with the NC group (p < 0.05). In conclusion, dietary exposure to multiple mycotoxins caused only transient impairment of growth performance but adversely affected immune response and liver health. Supplementation with CMD at 1.0 and 0.5 kg/ton during the starter and finisher phases, respectively, alleviated several of these adverse effects in broiler chickens.

Suicidal ideation, mental health services, and barriers to care among syringe services program clients who use opioids

2026-07-30T14:00:00Z

by Kiran Paudel, Kamal Gautam, Sherry Pagoto, Ran Xu, Jeffrey A. Wickersham, Frederick L. Altice, Sandesh Bhusal, Md. Safaet Hossain Sujan, Michael Copenhaver, Chenglin Hong, Roman Shrestha

Introduction

People who use opioids (PWUO) experience a disproportionately high burden of suicidal risk. Syringe services programs (SSPs) are a critical point of contact for this population, providing low-threshold, harm-reduction services. However, gaps persist in understanding suicidal risk among individuals attending SSPs and the extent to which such risk is associated with mental health service utilization in this setting. This study aimed to assess the prevalence and specific risk factors for suicidal ideation (SI) in PWUO, as well as their use of and barriers to accessing mental health services.

Methods

We conducted a cross-sectional survey between April and June 2024 among PWUO (N = 199) who were utilizing services in the SSP in New Haven, Connecticut. We used the ninth item from the Patient Health Questionnaire (PHQ-9) scale, which assesses passive thoughts of death and self-harm in the past two weeks, as a proxy measure for the SI. Additionally, participants reported their use of and barriers to accessing mental health services in the past six months. Bivariate and multivariable logistic regression were conducted to examine factors associated with SI.

Results

Approximately 84% of participants met the criteria for opioid dependence, and more than two-thirds (71.9%) were currently receiving medication for opioid use disorder. Over one-third of the sample reported SI in the past two weeks (34.7%). Additionally, over one-third of participants (36.2%) reported unmet mental health needs, and 84.4% reported experiencing at least one barrier to accessing mental health services. Individuals with depressive symptoms (aOR: 5.4; 95% CI: 2.5–11.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1–0.6) were less likely to report SI in the past two weeks.

Conclusion

Our study showed a high prevalence of SI among SSP clients who use opioids and a low use of mental health services due to access barriers. These findings support incorporating a brief suicide risk screening and referral options within SSPs and other settings serving PWUO and addressing key access issues like cost and transportation that can prevent timely linkage to mental health services.