PLOS ONE Alerts: New Articles

Editorial Note: Environmental justice and power plant emissions in the Regional Greenhouse Gas Initiative states

2026-05-01T14:00:00Z

by The PLOS One Editors

Editorial Note: A high-quality severe combined immunodeficiency (SCID) rat bioresource

2026-05-01T14:00:00Z

by The PLOS One Editors

Correction: Exploring episodic specificity induction on divergent thinking in children

2026-04-30T14:00:00Z

by The PLOS One Staff

Correction: When the source is a bot: How people adapt their evaluation strategies to assess AI-generated content

2026-04-30T14:00:00Z

by Shakked Dabran-Zivan, Inbal Klein-Avraham, Ayelet Baram-Tsabari

Correction: Measuring trade costs and analyzing the determinants of trade growth between Cambodia and major trading partners: 1993–2019

2026-04-30T14:00:00Z

by Borin Keo, Bin Li, Waqas Younis

C-terminal S-acylation governs membrane distribution, interaction dynamics and function of a plant Rho GTPase

2026-04-30T14:00:00Z

by Amir Akerman, Orit Gutman, Keren E. Shapira, Efraim Lewinsohn, Yoav I. Henis, Shaul Yalovsky

Rho of Plants (ROPs) are plant-specific Rho GTPases that regulate diverse cellular processes. Based on their C-terminal motifs, ROPs are classified as type I or type II. Type-II ROPs lack the canonical CaaL prenylation motif and can be palmitoylated in vitro, yet in vivo evidence for their S-acylation and functional significance has been limited. Here, we investigated the membrane association, lipid modifications and function of the Arabidopsis type-II ROP, ROP10. Confocal microscopy, biochemical fractionation and fluorescence recovery after photobleaching (FRAP) analyses showed that wild-type (WT) ROP10 associates with the plasma membrane in an activation- and Cys199/205-dependent manner, with Cys160 further stabilizes membrane association. Unlike type-I ROPs, the constitutively active (CA) rop10CA mutant displayed reduced membrane affinity. Gas chromatography-mass spectrometry confirmed S-acylation of ROP10 by palmitic and stearic acids. Overexpression of WT ROP10 disrupted cell polarity, an effect abolished in the rop10^C160S mutant, establishing Cys160 as essential for polarity control. These results provide in vivo evidence for S-acylation of type-II ROPs and indicate divergence from type-I ROPs through partitioning into distinct plasma membrane subdomains.

Risk of nephrotoxicity among dry cleaning workers exposed to perchloroethylene: A comparative cross-sectional study in Addis Ababa, Ethiopia

2026-04-30T14:00:00Z

by Philemon Mohammed Seid, Wossen Habtu, Meaza Gezu Shentema, Teferi Abegaz

Perchloroethylene, a chemical commonly used in the dry-cleaning sector, presents a potential risk to kidney health. This study measured urinary and blood nephrotoxic biomarkers among dry cleaners compared to hotel laundry workers to assess PCE’s impact. A multi-center comparative cross-sectional study was conducted with 164 randomly selected participants from 21 dry-cleaning shops and 26 hotel laundries. Data were collected through biological samples and structured questionnaires and with tests for statistical significance. The result showed that majority of the employees were females in both groups and the risk of nephrotoxicity was higher in dry cleaners as compared to hotel laundry workers. We found a significant mean difference in three biomarkers namely, Total Protein (TPU) with a Median & IQR value of (102 mg/dl &70.75 mg/dl) and (54.5 mg/dl &27.25 mg/dl), Urinary creatinine with a Median & IQR value of (193 mg/dl & 111.06 mg/dl) and (142.93 mg/dl & 78.17 mg/dl) and Urinary Calcium with a Median & IQR value of (2.60 mmol/l & 2.94 mmol/l) and (0.835 mmol/l & 0.79 mmol/l) for the exposed and the control groups respectively. However, a significant difference was not found in urinary protein to creatinine ratio, urinary sodium, Blood urea nitrogen and S. creatinine between the two groups, but higher value of sodium above range and higher BUN within range was observed in dry cleaners and factors like employment duration, PCE spillage, handling frequency, sex, and poor ventilation correlated with immediate symptoms. In conclusion, dry cleaners are at greater risk of kidney damage linked to PCE exposure, warranting implementation of safety measures and regular health monitoring to protect workers.

Streptococcus didelphis infection in free-ranging white-eared opossum (Didelphis albiventris) and Brazilian common opossum (Didelphis aurita): pathology, microbiologic, and genomic characterization

2026-04-30T14:00:00Z

by Daniel Oliveira dos Santos, Yasmin Gonçalves de Castro, André Duarte Vieira, Bruna Hermine de Campos, Lucas dos Reis de Souza, Nayara Ferreira de Paula, Vasco Azevedo, Bertram Brenig, Caio de Castro Cunha Figueiredo, Letícia Neves Ribeiro, Janaína Ribeiro Duarte, Vinícius Henrique Barbosa Amaral, Carlyle Mendes Coelho, Herlandes Penha Tinoco, Marcelo Pires Nogueira Carvalho, Ayisa Rodrigues de Oliveira, Rodrigo Otávio Silveira Silva, Renato Lima Santos

Marsupials of the genus Didelphis are highly adapted to urban environments and are widely distributed in the Americas. Streptococcus didelphis is a bacterium that has been isolated from, and associated with disease, in the Virginia opossum (Didelphis virginiana) and the white-eared opossum (Didelphis albiventris). This study describes pathological changes associated with S. didelphis infection in white-eared opossums (Didelphis albiventris) and Brazilian common opossums (Didelphis aurita) as well as microbiological and genomic characterization of isolates. Ten opossums underwent necropsy and had ulcerative dermatitis of probable traumatic origin had S. didelphis was isolated from cutaneous lesions (n = 16) or systemic sites (n = 4). In contrast, 34 free-ranging opossums that were captured had negative culture results for S. didelphis from nasal swabs. Other lesions in opossums naturally infected with S. didelphihs included splenitis (7/10), myocarditis (6/10), interstitial nephritis and pyelonephritis (7/10), and myositis (4/10). Most isolates were susceptible to the antimicrobial drugs tested and none of them were able to form biofilm in vitro. Whole genome analysis of six isolates revealed no resistance determinants, virulence factors or plasmids, and the isolates showed high genomic similarity.

The effect of environmental variations on the production of the principal agricultural products in Colombia

2026-04-30T14:00:00Z

by Carlos Felipe Cortés-Cataño, Yennifer Foronda-Tobón, Jairo Armando Paez-Ricardo, Jairo Enrique Parra-Herrera, Mario Julian Cañon-Ayala

Differential effects of caffeine, acute aerobic exercise, and placebo on mental fatigue

2026-04-30T14:00:00Z

by Ali Shirzad, Nathan Frewen, Anisa Morava, Nader Elshawish, Harry Prapavessis

Mental fatigue negatively affects the productivity and health of the general population. Mental fatigue manifests following sustained mental activity and is defined by subjective feelings of inhibition and objective decrements in mental performance. Caffeine is one of the most common stimulants used to mitigate mental fatigue. However, regular caffeine consumption may be associated with several side effects and potential dependence. The efficacy of acute aerobic exercise as an alternative mental fatigue intervention remains ambiguous. Thus, the present study utilized a randomized crossover design to compare the efficacy of the three treatments in mitigating mental fatigue in 26 adult caffeine consumers. The three treatments included: 1) 20 minutes of moderate-intensity cycling, 2) consumption of 2.5 mg/kg of caffeine, and 3) consumption of placebo (0.67 g corn starch). Treatments were administered prior to a mental fatigue-induction task (30-minute Stroop task). Participants and the experimenter were both blinded to the administration of caffeine or placebo. Objective (Psychomotor Vigilance Task) and subjective (visual analog scales) mental fatigue measures were taken prior to and following the mental fatigue-induction task. We hypothesized that in the placebo condition, participants would demonstrate greater mental fatigue following a 30-minute Stroop task relative to baseline. Further, mental fatigue induction will be mitigated in the acute exercise and caffeine consumption conditions to a similar degree. Participants reported significantly greater mental fatigue following a 30-minute Stroop task (p < 0.001, d = −0.735). Comparison of the placebo and caffeine consumption did not exhibit a reliable difference (all p’s > 0.05). Contrary to our hypothesis, mental fatigue was not mitigated following acute exercise (p = 0.499). Further investigations are warranted to explore the potential of varying exercise intensities and durations in mitigating mental fatigue.

Ivermectin inhibits ER, HER2, and TGF-β pathways in ER-positive and endocrine-resistant breast cancer cells

2026-04-30T14:00:00Z

by Kitiya Rujimongkon, Patthamapon Adchariyasakulchai, Chanoknun Boonyaratsewee, Kantasorn Horpratraporn, Wannarasmi Ketchart

Ivermectin (IVM), initially developed as an antiparasitic drug, has recently demonstrated notable anticancer activity in several malignancies, including breast cancer. Our previous work showed that IVM inhibited cell proliferation and invasion in breast cancer cells, primarily through modulation of the Wnt signaling pathway. Preliminary results further indicated that combining IVM with tamoxifen enhanced its antiproliferative effects in endocrine-resistant breast cancer cells, suggesting a potential role in overcoming drug resistance. To further clarify IVM’s mechanism in the context of endocrine resistance, this study investigated its effects on estrogen receptor-positive (ER⁺) and endocrine-resistant breast cancer cells. IVM significantly suppressed estrogen-induced proliferation and downregulated key resistance-associated markers, including ER and HER2. Additionally, IVM treatment markedly reduced ERK, a downstream effector linked to HER2 and TGF-β signaling. This inhibition was accompanied by a decrease in phosphorylated SMAD2 (pSMAD2) within the TGF-β pathway, while levels of SMAD4—a factor associated with favorable prognosis in endocrine resistance—were maintained. Collectively, these findings highlight IVM’s potential as a repurposed therapeutic agent, with the dual capacity to prevent endocrine resistance in ER⁺ breast cancer and to enhance anti-hormonal therapies in resistant cases.

Mortality predictors, hepatic involvement patterns, and the steatotic liver paradox in 1,484 hospitalized Dengue patients

2026-04-30T14:00:00Z

by Aryalakshmi Sreemohan, Arif Hussain Theruvath, Ambily Baby, Cyriac Abby Philips, Tharun Tom Oommen, Santhichandra Pai, Salini Baby John, Jaicob Varghese, Rizwan Ahamed, Ajit Tharakan, Philip Augustine

Background and objectives

Dengue fever represents a major global health burden with hepatic involvement occurring in up to 90% of hospitalized patients. This study aimed to determine in-hospital mortality predictors, characterize clinical outcomes across graded hepatic injury phenotypes, and validate prognostic scoring systems in hospitalized dengue patients. A primary focus was assessing the impact of pre-existing liver conditions on disease trajectory and survival.

Methods

A retrospective cohort analysis was conducted on 1,484 patients with laboratory-confirmed dengue infection admitted to a tertiary-care center between 2021 and 2024. Patients were stratified by hepatic status into those with pre-existing chronic liver disease, non-chronic steatotic liver involvement, and no liver involvement. Multivariable logistic regression identified independent mortality predictors, while unsupervised clustering distinguished clinical phenotypes. The performance of physiological and liver-specific prognostic scores was evaluated against clinical outcomes.

Results

The overall in-hospital mortality rate was 5.1%, with 13.1% requiring intensive care admission. Independent predictors of mortality included severe dengue classification, intensive care unit admission, elevated neutrophil-to-lymphocyte ratio, and hypoalbuminemia, with albumin emerging as the strongest single biomarker for risk prediction. Paradoxically, patients with steatotic liver disease demonstrated improved survival compared to those without pre-existing liver disease, supporting an “obesity paradox” in this tropical infection context, whereas decompensated cirrhosis was associated with markedly adverse outcomes. The Albumin-Bilirubin grade successfully stratified hepatic risk, and the Simplified Acute Physiology Score-3 significantly outperformed the Sequential Organ Failure Assessment for predicting mortality in critically ill patients. Four distinct clinical phenotypes with differential mortality ranging from 3.0% to 100% were identified.

Conclusions

Hypoalbuminemia serves as a critical, accessible prognostic marker in dengue fever. Pre-existing liver pathology demonstrates divergent impacts on outcomes, with steatotic liver disease potentially conferring survival advantage contrary to traditional metabolic risk assumptions. These findings support the utility of liver-specific scoring systems for acute risk stratification in dengue-endemic regions.

A digestive cartridge reduces intestinal injury in a murine model of necrotizing enterocolitis

2026-04-30T14:00:00Z

by Sarah Z. Wang, Djanira Fernandes, Savas T. Tsikis, Thomas I. Hirsch, Amy Pan, Mikayla Quigley, Valeria Ruiz, Scott C. Fligor, Carter R. Petty, Greta Loring, Stephen Davia, Juhye Kang, Mark Puder

Background

Formula feeding is associated with necrotizing enterocolitis (NEC), a life-threatening gastrointestinal illness affecting premature infants. The presence of undigested fat in enteral formula may mediate NEC severity. The immobilized lipase cartridge (ILC) is an FDA-cleared digestive device that hydrolyzes triglyceride fat in formula into readily absorbable free fatty acids and monoglycerides. We hypothesized that use of a new ILC prototype designed to support increased feeding frequency in infants will reduce NEC mortality and disease severity in a murine model.

Methods

NEC was induced in C57BL/6J mice from post-natal day 4–6 via oral gavage of lipopolysaccharide-containing formula 4x/day and hypoxia (5% O₂) exposure 2x/day. Littermates were randomized to one of five groups: dam-fed (normal controls), ILC-digested formula, placebo-processed formula, NEC + ILC-digested formula, NEC+placebo-processed formula. Weights and mortality were measured daily. Mice were euthanized on P7 for assessment of NEC severity.

Results

Normal controls had better survival rates than formula-fed and NEC mice. The NEC + ILC group exhibited lower clinical and histologic severity scores compared to the NEC+placebo group on masked evaluation.

Conclusion

The administration of formula pre-digested by the ILC improved clinical sickness, gut appearance, and histologic severity of NEC compared to placebo. These findings support further investigation of the ILC as a non-invasive, preventive therapy for NEC in humans.

Characteristics and dynamics of malaria vectors around the Soum dam in Nanoro Health District, Burkina Faso

2026-04-30T14:00:00Z

by Hamidou Ilboudo, Elodie Doda Gricela Sanon, Domonbabele François de Sales Hien, Fadilah Traoré, Helle Hansson, Bérenger Kaboré, Marc Christian Tahita, Karim Derra, Eli Rouamba, Ismaïla Bouda, Toussaint Rouamba, Michael Alifrangis, Hermann Sorgho, Pascal Magnussen, Halidou Tinto

Malaria is endemic in Burkina Faso, with seasonal transmission during the rainy season. Environmental changes such as dam construction may influence mosquito ecology and malaria transmission; however, entomological data from this area remain limited. This study aimed to characterize malaria vector dynamics, including species composition, blood meal sources, and sporozoite infection rates, in five villages at varying distances from the Soum dam located in the Nanoro Health District catchment area in Burkina Faso. From March 2022 to February 2023, mosquitoes were collected monthly via pyrethrum spray catches (PSCs) targeting indoor resting vectors. Mosquitoes were identified morphologically via taxonomic keys. PCR analyses were performed to identify species within the Anopheles gambiae complex, determine blood meal sources, and assess Plasmodium falciparum infection. A total of 11,378 Anopheles mosquitoes were collected, including 3,432 males (30.1%) and 7,948 females (69.9%). An. gambiae s.l. was the most abundant species (86.5%), followed by An. funestus (10.6%). Within the An. gambiae complex, 91.5% were An. coluzzii, 8.3% An. arabiensis, and 0.2% An. gambiae sensu stricto. The vector density was highest in Soum (49.7%) and decreased with distance from the dam. The overall sporozoite rate was 6.2%, with higher rates in Seguedin (9.5%) and Soala (8.7%). Among the tested mosquitoes, 34.7% fed on humans, 14.2% on animals, and 23.6% on both. Anopheles coluzzii was the predominant vector and showed moderate anthropophilic behavior. Despite higher vector density near the dam, infection rates were greater in distant villages, highlighting the complexity of vector dynamics in dam-associated areas and the need for localized control strategies.

Single-cell RNA sequencing of healthy and diseased rat temporomandibular joint condyle cartilage

2026-04-30T14:00:00Z

by Sara Trbojevic, Xudong Dong, Robert Lafyatis, Michael S. Gold, Juan M. Taboas, Alejandro J. Almarza

Osteoarthritis is a degenerative joint disease that disrupts the cellular homeostasis within cartilage tissues, promoting further disease progression that can lead to debilitating pain. Cartilage of the temporomandibular joint (TMJ) is unique among diarthrodial joints because they are of neural crest origin, rather than the mesoderm germ layer. TMJ cartilage also has different cellular architecture, where it is composed of a superficial fibrous layer, a proliferative layer, and a fibrocartilage layer overlying subchondral bone. Understanding of the cytopathological changes that occur during TMJ osteoarthritis (TMJOA) could potentiate therapies to mitigate disease progression and repair diseased tissues. Here, we analyzed the unique cell populations present in healthy and OA-induced condylar cartilage of adult rats through single-cell RNA-sequencing. TMJOA was established via our previous rat model to study the changes in the cellular composition of the condyle in response to OA. Several cell types could be uniquely identified, and the prominent matrix producing cells were fibroblasts and chondrocyte subsets. Our trajectory and pseudotime analysis revealed three cell fates stemming from a fibrochondrocyte-like population and two chondrocyte cell fates that stem from a shared progenitor population. We also found that Pleiotrophin is uniquely expressed in the proliferative zone by cells with a chondrocyte progenitor phenotype. In OA cartilage, differential gene expression in the fibroblast group revealed responses to inflammation, possibly through activation of chondrocyte differentiation. The chondrocyte group was highly metabolically active, indicative of rapid repair or remodeling. Cell-cell signaling analysis revealed that chondrocyte and chondrocyte progenitor communication became highly activated. Additionally, intracellular pathways that may contribute to cellular dysfunction and tissue remodeling were highly active, while pathways related to tissue catabolism appeared less active.

Enhanced convolutional block attention module with Learnable Gated Fusion (LGF-CBAM) for cocoa pod disease identification

2026-04-30T14:00:00Z

by Henry Techie-Menson, Michael Asante, Yaw Marfo Missah, Gaddafi Abdul-Salaam, Stephen Opoku Oppong

Accurate detection of cocoa pod diseases is vital to reducing yield losses and supporting sustainable agriculture. Although deep learning models have shown promise in plant disease classification, their performance often varies between datasets due to limitations in feature extraction and generalisation. This study introduces a Learnable Gated Fusion Convolutional Block Attention Module (LGF-CBAM) integrated with a ResNetV2-101 backbone to improve discriminative feature learning and improve robustness in cocoa disease classification. Unlike the standard CBAM, which processes attention modules sequentially, LGF-CBAM adaptively balances the importance of spatial and channel cues through trainable gating parameters normalized with a softmax function. Incorporating LGF-CBAM provided outstanding results on the Cocoa_Pod_Disease_Gh dataset, achieving 98.95% accuracy along with F1 and PPV scores of 99.11%. The cross-dataset evaluation confirmed robustness, with accuracies of 98.53% on Cocoa Diseases (YOLOv4), 97.96% on Black and Borer Pod Rot, and 96.19% on Cacao Diseases in Davao. Although greater variability in the Coffee and Cocoa dataset reduced accuracy to 94.00%, the model still maintained strong adaptability under diverse conditions. These findings establish LGF-CBAM as a state-of-the-art framework that outperforms all other referenced systems, offering high accuracy, stability, and generalization. In general, this research contributes to a novel attention-based deep learning framework that can support early and reliable identification of cocoa pod diseases, providing a scalable solution for precision agriculture.

The Healthy Smoker Paradox: Socioeconomic status as a fundamental cause of reversed anemia risk among Yemeni youth

2026-04-30T14:00:00Z

by Radfan Saleh Abdullah, Naif Taleb Ali, Mansour Abdelnabi H. Mehdi

Background

While tobacco smoking biologically elevates hemoglobin through chronic hypoxia, this study investigates an unexpected paradoxical reversal in conflict-affected Yemen, testing whether socioeconomic status may override biological pathways in extreme resource-limited settings.

Methods

We conducted a multi-center cross-sectional study of 600 Yemeni university students (aged 18–25). Data on smoking, socioeconomic proxies, and hematological parameters were collected. We employed multivariate logistic regression, causal mediation analysis with bootstrapping, and E-value sensitivity analysis.

Results

Non-smokers had substantially higher odds of abnormal hemoglobin (adjusted Odds Ratio [aOR] = 11.25, 95% CI: 3.45--36.70, p < 0.001) and abnormal Mean Corpuscular Hemoglobin Concentration (aOR = 3.41, 95% CI: 1.58--7.35, p = 0.002) compared to smokers. Mediation analysis suggested that 38% of smoking’s total effect on hemoglobin was mediated through nutritional pathways (indirect effect = 0.24, 95% CI: 0.08--0.45). The paradoxical association was significantly stronger among students from lower socioeconomic backgrounds (interaction p = 0.012) and females. E-value analysis (E = 4.32) indicated that substantial unmeasured confounding would be needed to explain away this association.

Conclusion

These findings suggest a “healthy smoker” paradox in a humanitarian crisis context, where smoking status may serve as a proxy for higher SES and better nutritional access. This is consistent with the hypothesis that fundamental social causes can reverse established biological risk associations in contexts of extreme deprivation.

Integrated cross-organ transcriptomic analysis uncovers conserved gene signatures predictive of allograft rejection

2026-04-30T14:00:00Z

by H. C. Poorvi, P. K. Vinod

Long-term transplant success is limited by allograft rejection, a complex process traditionally studied on an organ-specific basis. To establish a unified framework beyond organ-specific studies, we performed a network-based systems biology analysis of transcriptomic data from 672 liver, kidney, and heart transplant biopsies to identify a conserved, pan-organ molecular framework of rejection. By constructing and comparing organ-specific gene co-expression networks, we identified a consensus, six-module immune cascade that captures the hierarchical nature of the alloimmune response. In addition, we also uncovered a highly conserved 24-gene cell cycle signature consistently upregulated in rejecting allografts, implicating cellular proliferation as a core feature of rejection pathology. From this framework, we derived a 172-gene immune signature and applied machine learning models to assess its predictive performance, achieving accuracy comparable to established benchmarks. We further refined this to a minimal, high-performance 20-gene immune signature (AUC > 0.96). Both the immune and cell cycle signatures demonstrated robust, pan-organ utility when independently validated in a lung transplant cohort (n = 243). Collectively, these findings define a pan-organ molecular framework for rejection and highlight cell cycle dysregulation as a conserved hallmark, offering a foundation for standardized, cross-organ diagnostic platforms to improve allograft surveillance and patient outcomes.

Epidemiology and trends of animal bites in Khoy County, Northwest Iran: A retrospective study (2021–2024)

2026-04-30T14:00:00Z

by Parviz Shahmirzalou, Hassan Ebrahimpour Sadagheyani

Background

Animal bites are a significant global public health concern because they can lead to rabies, a disease with a very high case fatality. Therefore, this study aimed to describe the demographic and epidemiological characteristics of animal bite cases and to examine temporal trends in their incidence in Khoy County, Northwest Iran, from 21/03/2021–19/03/2024.

Methods

This registry-based, retrospective longitudinal study included all animal bite cases recorded in Khoy County between 21/03/2021 and 19/03/2024. Data on demographic characteristics, post-exposure preventive actions, and vaccination status were extracted. Analyses comprised descriptive statistics, chi-square tests in SPSS V17, trend analysis, time-series regression, and a 12-month forecast in Minitab V22.

Results

The mean age of bite victims was 31.23 years. The incidence of animal bites per 100,000 population in 2021–2024 was 371.39, 503.23, 506.02, and 397.45, respectively. Dogs accounted for 91% of bite incidents, and the most common circumstances leading to bites were sudden animal attacks, provoking the animal, hunting, and self-defense. Monthly counts revealed a clear 12-month seasonal variation, with the highest incidence occurring in summer and early autumn. The forecasting model predicted that late spring and summer of 2024 would be the peak periods for animal-bite incidence.

Conclusion

Due to the high rate of animal bites in Khoy County, it is advisable to focus on educating at-risk groups about prevention and encouraging prompt medical attention for post-exposure rabies prophylaxis when bites happen.

Implementation fidelity of Ethiopia’s Malaria test-and-treat guideline amid a resurgence in Amhara Region: A mixed-methods study

2026-04-30T14:00:00Z

by Mastewal Worku Lake, Kassahun Alemu Gelaye, Mulusew Andualem Asemahagn, Kindie Fentahun Muchie, Hailemariam Awoke Engedaw, Muluken Azage Yenesew

Background

Ethiopia has experienced a marked malaria resurgence in recent years, with the Amhara Region disproportionately affected. Although Ethiopia’s national strategy emphasizes test-before-treat and a public–private mix, implementation fidelity of the malaria test-and-treat guideline during resurgence has not been well characterized. This study assessed fidelity to malaria diagnosis and treatment guidelines in public and private health facilities in the Amhara Region within this resurgence context.

Methods

We conducted a convergent parallel mixed-methods study from February to March 2025 in 53 health facilities (38 public, 15 private) in Amhara Region. The facility was the unit of analysis; one provider primarily responsible for malaria case management was interviewed per facility (n = 53). Implementation fidelity was operationalized using Carroll’s framework across three domains: content (adherence to key diagnostic/treatment steps), coverage (proportion of suspected cases tested before treatment, extracted from facility registers), and frequency (self-reported consistency of testing for febrile patients in the preceding month). Domain scores were standardized to 0–100 and averaged with equal weights to form a composite fidelity score; ≥ 75% indicated high fidelity. To explain quantitative patterns, we conducted 32 in-depth interviews and analyzed data using inductive thematic analysis with CFIR-informed interpretation. Quantitative analysis used nonparametric tests and parsimonious multivariable linear regression, with prespecified sensitivity analyses excluding the self-reported frequency domain.

Results

Overall mean implementation fidelity was 64.3% (SD 12.1); 40% of facilities had high fidelity (≥75%), and 13% scored <50%. Public facilities had higher fidelity than private facilities (median 67% [IQR 60–77] vs 63% [IQR 56–70]; Wilcoxon rank-sum p = 0.041). In multivariable analysis, higher fidelity was associated with higher participant responsiveness (β = 3.4, p < 0.001), stronger facilitation strategies (β = 2.8, p < 0.001), and lower perceived intervention complexity (reverse-coded; β = 2.1, p < 0.001). Interviews indicated that fidelity gaps were driven by diagnostic and treatment deviations (including non–species-specific prescribing), inconsistent counseling and follow-up mechanisms, supply constraints, and patient pressure, with challenges more frequently emphasized in private facilities.

Conclusions

Implementation fidelity to Ethiopia’s malaria test-and-treat guideline in Amhara during resurgence was moderate, with lower fidelity in private facilities. Provider responsiveness, facilitation strategies, and lower intervention complexity were identified as factors associated with implementation fidelity. Strengthening supportive supervision and mentorship with explicit inclusion of private facilities, improving supply reliability, and simplifying decision supports may improve adherence during resurgence.

Type 1 and Type 2 diabetes in the UK press: A diachronic corpus-based analysis

2026-04-30T14:00:00Z

by Sara Vilar-Lluch, Dawn Knight

News coverage of diabetes has been observed to promote diabetes stigma of both Type 1 (T1D) and Type 2 (T2D) diabetes, and to foreground individual responsibility over health outcomes. Adopting a corpus-based approach to discourse analysis, this study examines trends in media reporting around T1D and T2D in mainstream UK news media between 2020–2024. We consider: the linguistic representation of T1D/T2D; whether news reports include representations that could promote misunderstandings of T1D/T2D and contribute to perpetuating stigma; and whether language use aligns with recommendations in guidelines on diabetes communication. UK news coverage of T1D/T2D adopts medical and free will discourses while omitting references to social determinants of health (SDH) that can condition development and management of health conditions. While the medical discourse can help mitigate stigma, omitting references to SDH foregrounds individual agency and responsibility in adopting health-preventive behaviours while overlooking inequalities that may contribute to develop T2D or interfere with T1D/T2D management. Language recommended by the guidelines is increasingly adopted, but reduction in dispreferred language is less marked. References to diabetes ‘in general’, and references to diabetes in close context with unrelated conditions are common, leading to potential misunderstandings. Recommendations to improve communication include continuing the use of language recommended in diabetes guidelines and reducing uses of dispreferred language; referring to diabetes types to prevent misunderstandings; and taking special care when referring to other conditions to avoid inaccurate inferences of causality or similarity.

Comparative efficacy of trauma scoring for predicting in-hospital mortality in elderly patients in China and Thailand: A multicenter retrospective study

2026-04-30T14:00:00Z

by Rui Lu, Ploytip Jansiriyotin, Tanyamon Kittidumkerng, Natthida Owattanapanich, Kaweesak Chittawatanarat

Background

With global population aging, trauma prediction models are essential for elderly patients, yet established scoring systems lack validation in Asian populations. This study evaluates clinical characteristics, mortality risk factors, and the predictive efficacy of trauma scoring systems in elderly trauma patients in China and Thailand.

Methods

This multicenter retrospective cohort study included trauma patients aged ≥65 years admitted to four Level 1 trauma centers between 01/01/2023 and 31/12/2023. The analyzed variables included demographics, clinical data, and trauma scores (ISS, NISS, RTS, TRISS, GTOS). Multivariable logistic regression and ROC curve analysis were performed.

Results

Among 963 patients (median age 73 years; 50.6% female), in-hospital mortality was 7.9%. Independent risk factors included age, cancer history, INR, blood transfusion, GCS, and all trauma scores. TRISS had the highest predictive value (AUC = 0.871), followed by GTOS (0.852) and RTS (0.839), all outperforming ISS and NISS.

Conclusion

Age, comorbidities, and trauma scores are significant predictors of in-hospital mortality in elderly trauma patients. TRISS, GTOS, and RTS offer superior prognostic performance, aiding early identification and management of high-risk individuals.

Brain activity in Cluster N and the hippocampus in non-migratory zebra finches completing a spatial orientation task using magnetic compass information

2026-04-30T14:00:00Z

by Madeleine I.R. Brodbeck, Rachel Muheim, Atticus Pinzon-Rodriguez, Scott A. MacDougall-Shackleton

The songbird brain region called Cluster N has been implicated as important for low-light vision and/or the perception of Earth’s magnetic field for migratory orientation. This region of the visual Wulst is active in migratory songbirds under dim light conditions and an intact Cluster N is necessary for magnetic compass orientation in a nocturnally migrating songbird species. Given that magnetic field information is useful for orientation outside of a migration context, it is likely that Cluster N processes magnetic compass information more generally. Zebra finches (Taeniopygia guttata) can use magnetic compass cues to find food in a plus maze, even though they are not nocturnal migrants. Our objective was to determine if Cluster N is active when zebra finches use their magnetic compass to orient in a plus maze. Zebra finches were tested under three conditions: i) a static magnetic field that reliably indicated the food location, ii) a sweeping magnetic field, or iii) a vertical magnetic field. The latter two conditions did not provide any directional information. Brains were collected following the task and processed to label the immediate early gene zenk. We found elevated Zenk immunoreactivity in the forebrain region defined as Cluster N in other species and in the hippocampus. We found no differences in Zenk between the three magnetic field conditions, providing no conclusive evidence for whether Cluster N is involved in the processing of magnetic compass information. In conclusion, our results are consistent with the idea that Cluster N is not a brain area restricted to nocturnally migrating songbirds, but that it is also found in non-migratory birds carrying out a spatial orientation task, possibly involving magnetic compass cues, under dim light conditions.

Perianal lidocaine application during unsedated colonoscopy: A double-blind randomized controlled trial

2026-04-30T14:00:00Z

by Jiankun Wang, Yuwen Tao, Rui Wu, Lili Zhao, Li Liu, Zhining Fan, Wentao Fan

Background and Aims

nsedated colonoscopy is often associated with patient discomfort and may increase procedural difficulty for endoscopists. This study aimed to investigate the influence of perianal lidocaine application on the comfort level of patients and endoscopic operations during unsedated colonoscopy.

Methods

122 patients aged 18–40 years were enrolled and randomly allocated to colonoscopy with 2% lidocaine (experiment group, n = 61) or normal saline (control, n = 61) smeared around the anus. The primary outcomes were anal pain score and abdominal pain score during and after colonoscopy, assessed using a visual analogue scale (VAS). Secondary outcomes included cecal intubation time, polyp detection rate, adenoma detection rate, and adverse events.

Results

There was no statistical difference between groups in terms of abdominal pain scores during unsedated colonoscopy. Abdominal pain scores after colonoscopy were significantly lower in the lidocaine group than in the saline group. (P < 0.001). However, the lidocaine group had significantly lower anal pain scores during and after colonoscopy (P < 0.001) and a shorter cecal intubation time (P < 0.001). Polyp and adenoma detection rates were higher in the lidocaine group (P < 0.05). Junior endoscopists achieved greater improvements in these outcomes compared to senior endoscopists.

Conclusion

Perianal application of lidocaine may reduce anal pain and may improve procedural efficiency during unsedated colonoscopy, particularly among junior endoscopists.

A service provider perspective in Irish horseracing on the availability of retirement specific support services for professional jockeys and perceived barriers and facilitators to their use

2026-04-30T14:00:00Z

by Laura Langton, Sarah Jane Cullen, Giles Warrington, Jennifer Pugh, Adrian McGoldrick, Ciara Losty

Retirement can come at any time in horse racing due to the unpredictable nature of the sport. Preplanning for the retirement transition in sport has been reported to lead to faster adjustment to retirement and better transition for athletes. The purpose of this study was to highlight the current support services available to Irish horseracing jockeys to aid with career transitions and to a) explore perceived barriers and b) perceived facilitators to their use. Semi-structured interviews were conducted with 11 representatives from various racing bodies including the Irish Horse Racing Regulatory Board (IHRB), Horse Racing Ireland (HRI), Racing Academy Centre of Education (RACE), Irish Jockeys Trust (IJT), The Jockeys Association (JA), Injured Jockeys Fund (IJF), Equipp and The Jockeys Pathway. Questions included, demographic information, perceptions of current use of support services, perceptions of barriers preventing jockeys from using support services and perceived facilitators to the use of support services in the future. Reflexive thematic analysis was used to analyse qualitative data that included inductive and deductive approaches. The higher order themes identified as barriers to use of transition support services, were the culture within the Irish horseracing industry, and insufficient cross organisation communication. Higher order themes relating to facilitators of engagement were accessible further education opportunities for jockeys, normalising career planning and the development of an exemplar support service for jockey career transitions. Normalising career planning and implementing an exemplar support programme for retiring jockeys is vital to ensure jockey wellbeing needs are met as they transition at the end of their racing career.

Exercise intensity and shooting position modulate fixation behavior and 2-point shooting accuracy in elite female basketball players: An eye-tracking study

2026-04-30T14:00:00Z

by Xiaokun Zhang, Sunnan Li, Chunzhou Zhao

Visual attention plays a crucial role in basketball shooting, yet how it adapts under varying exercise intensities and from different shooting positions remains poorly understood, especially in elite female athletes. This study examined the effects of exercise intensity (low, moderate, high) and shooting position (left 45°, 90°, right 45°) on fixation behavior and 2‑point shooting accuracy in elite female basketball players. Twenty‑two players from a championship‑winning university team performed two‑point shots from three positions under three intensity conditions, each defined by heart‑rate zones (%HRmax). Fixation metrics (number of fixations, fixation duration, distribution) were recorded using Tobii Glasses 3. Data were analyzed using two‑way repeated‑measures ANOVA and generalized linear mixed‑effects models (GLMMs) with a binomial distribution for trial‑level accuracy; Pearson correlations are reported descriptively. Exercise intensity significantly influenced all fixation metrics. High intensity led to increased fixations across all areas of interest (hoop, backboard, net) and longer total fixation duration, indicating higher cognitive load. Moderate intensity was associated with the lowest total number of fixations and shortest duration, reflecting efficient visual processing. Shooting position also affected fixation: the 90° position attracted the most fixations and longest duration on the hoop (F = 4.56, p = 0.017, ηp2 = 0.19, 95% CI [0.02, 0.37]), while the 45° positions shifted attention toward the backboard. Fixation duration on the hoop positively correlated with accuracy under high intensity (r = 0.499, p = 0.021, 95% CI [0.10, 0.76]), whereas number of fixations negatively correlated with accuracy across intensities. Moderate intensity promotes optimal visual‑attentional control and shooting accuracy in elite female athletes, whereas high intensity disrupts fixation stability and increases cognitive load. Position‑specific adaptations in visual strategy were also observed. These findings support the use of intensity‑ and position‑based visual training to enhance shooting performance under realistic game conditions.

How does law and policy support providers of NHS healthcare in England to respond to harm experienced by patients during the course of their treatment and care: A scoping review

2026-04-30T14:00:00Z

by Naomi Assame, Susan Greenhalgh, John Tingle, Gillian Yeowell

Introduction

Many countries have implemented laws and policies to help healthcare providers address patient harm. However, there is limited research on their effectiveness, especially in the context of England#39;s National Health Service (NHS). This scoping review asks: How does law and policy support NHS healthcare providers in England respond to harm?.

Methods and analysis

A scoping review methodology was applied to map and summarise the literature to date. MEDLINE, CINAHL, and Westlaw were searched to identify potentially relevant literature that had been published between 2000 and 2025. Literature was included if it addressed care delivery in England#39;s NHS and healthcare providers’ responses to patient harm. Two reviewers independently screened the literature identified from the search against the eligibility criteria. A grey literature search of the citations within the included records was then conducted to identify relevant law and policy that supports providers of NHS healthcare in England to respond to patient harm. A total of 121 records were reviewed: 63 peer-reviewed and 58 pieces of grey literature. Data were charted using a standardised data extraction form. Themes were developed through a combination of thematic and content analysis, then presented as a narrative synthesis.

Conclusion

The first of its kind, this scoping review identified English laws and policies that support NHS healthcare providers in England to respond to patient harm. It revealed the incongruent yet interdependent relationship that exists between England’s legal systems, healthcare policies and the promoted NHS values. The scoping review highlighted how organisational culture can overshadow law and policy and be the defining factor in how providers of NHS healthcare in England respond to patient harm. The impact of law and policy in curating organisational culture and response to patient harm is an area requiring further research.

Ethics

Ethics approval was not required for this review.

Mechanistic modelling of highly pathogenic avian influenza: A scoping review revealing critical gaps in cross-species transmission models

2026-04-30T14:00:00Z

by Manting Wang, Elda K. E. Laison, Tanya Philippsen, Sajjad Ghaemi, Juxin Liu, Iain Moyles, Anthony Signore, Junling Ma, Bouchra Nasri

Background

Highly pathogenic avian influenza (HPAI) viruses, particularly subtypes such as H5N1 and H7N9, have caused widespread outbreaks in wild birds, poultry, livestock and occasionally humans, raising concerns about cross-species transmission and pandemic potential. Effective control and surveillance strategies require a thorough understanding of HPAI transmission dynamics, which can be supported by mathematical modelling.

Objective

This scoping review aimed to identify mechanistic models used to study HPAI transmission. Specifically, we sought to categorize model types, describe their application contexts (e.g., wild birds, poultry, livestock, and humans), and highlight modelling gaps relevant to understanding and mitigating the risks of HPAI spread.

Methods

Following PRISMA guidelines and the PRISMA extension for scoping reviews (PRISMA-ScR), we conducted systematic searches of PubMed and Web of Science to identify peer-reviewed studies employing deterministic and stochastic models to analyze HPAI transmission. Eligible articles published between January 2023 and June 2025 were screened and grouped by model structure, host populations, transmission pathways, and modelling objectives.

Results

After screening, 30 studies published after 2023 were included in this scoping review. Compartmental models were the most common (26 studies), with 16 deterministic and 10 stochastic approaches. These models were primarily used to describe transmission among wild birds, poultry, livestock, and humans and to evaluate interventions such as culling, vaccination, and movement restrictions. Agent-based models (2 studies) captured individual-level interactions and spatial heterogeneity, while network models (2 studies) represented contact structures and transmission pathways between farms or species.

Conclusions

Currently, mechanistic modelling of HPAI is dominated by compartmental approaches, including both deterministic and stochastic formulations, whereas agent-based and network models remain relatively underused. Although most studies focus on transmission in wild birds and poultry, and in some cases spillover infections to humans, few explicitly examine infection dynamics in livestock or in transmission between livestock and humans, despite the importance of livestock (e.g., cattle) as potential intermediaries in human infection. Key gaps persist in the integration of empirical data, representation of multi-host interactions, and evaluation of realistic intervention strategies. Addressing these limitations is essential to improve predictive accuracy and to strengthen the role of modelling in informing HPAI surveillance and control.

Unraveling the role of ChREBP in lung adenocarcinoma: Expression, regulatory networks, and potential functional impact

2026-04-30T14:00:00Z

by Athisake Ruangpracha, Chanachai Sae-Lee, Pitaksin Chitta, Harald Grove, Pranisa Jamjuntra, Warisa Amornrit, Prapat Suriyaphol, Chanitra Thuwajit, Naravat Poungvarin

Carbohydrate Response Element Binding Protein (ChREBP) is a transcription factor known to regulate glucose metabolism and other metabolic processes in various tissues, but its role in lung adenocarcinoma (LUAD) remains poorly understood. In this study, we investigated ChREBP expression and its role in regulating gene expression in LUAD cell lines. Using RT-qPCR, we assessed the expression of ChREBP-α and ChREBP-β isoforms in NCI-H1975, NCI-H1650, and NCI-H2228 LUAD cell lines. The NCI-H1975 cells exhibited the highest levels of both ChREBP isoforms, with a particularly pronounced expression of ChREBP-β. To explore the regulatory role of ChREBP, we generated NCI-H1975 cells with inducible expression of a dominant-negative mutant of human ChREBP (dnChREBP). Overexpression of dnChREBP led to a significant reduction in colony formation and impaired cell migration. Transcriptome analysis revealed 57 upregulated genes and 593 downregulated genes in dnChREBP-expressing cells compared to control cells. Functional annotation and gene set enrichment analysis revealed that the enriched genes were associated with cancer-related processes, including cell proliferation and epithelial-to-mesenchymal transition (EMT). Gene network analysis highlighted 17 downregulated hub genes, with 8 of these genes being associated with EMT. Interestingly, ChREBP and its transcriptionally regulated genes, including 4 top downregulated genes, 5 top upregulated genes, and 5 hub genes identified in NCI-H1975 cells overexpressing dnChREBP, showed significant prognostic value, as their expression levels correlated with overall survival in LUAD patients. Our findings suggest that ChREBP regulates distinct transcriptional programs in LUAD cells and ChREBP and its regulatory network may play a potential role in LUAD progression and patient outcomes.

Effects of mindful breathing meditation on stereotype expression in two randomized controlled double-blinded trials

2026-04-30T14:00:00Z

by Elena Vieth, Lisa von Stockhausen

Models of stereotypes and discrimination propose the involvement of attentional control and executive functioning in successfully suppressing discriminatory behavior. A practice that has been shown to improve cognitive control, potentially even after short training durations, is mindfulness meditation, and beneficial effects on stereotype activation and the expression of discriminatory behavior have been reported. In two randomized controlled double-blinded trials, the effects of short mindful breathing meditation trainings (45 minutes in total in Experiment 1, 80 minutes in Experiment 2) on the expression of stereotype-biased behavior were contrasted with relaxation trainings of equal length (progressive muscle relaxation; active control) and listening to podcasts (passive control). Stereotype expression was assessed with the Shooter Task in Experiment 1 and with the Avoidance Task in Experiment 2. Joined analyses of response latencies and accuracy by drift diffusion modeling showed that breathing meditation increased the effect of stereotype bias on decision-making in both experiments by heightening response conflict in stereotype-incongruent trials. At the same time, relaxation reduced biased decision-making in stereotype-incongruent trials. Contrary to our hypothesis, the findings suggested that short trainings in mindful breathing meditation were not beneficial for reducing the effect of stereotype-bias on decision making and that mechanisms outside of cognitive control affected response behavior following the meditation as well as relaxation training. Implications for research in the field are discussed.