PLOS https://journals.plos.org/plosone/ customercare@plos.org https://journals.plos.org/plosone/feed/atom All PLOS articles are Open Access. https://journals.plos.org/plosone/resource/img/favicon.ico https://journals.plos.org/plosone/resource/img/favicon.ico 2026-09-29T18:28:58Z Moumita Tanjila Umme Kulsum Shadia Sharmin Rezwan Ul Haque Aubhi Md. Sohel Rana Md. Abu Hasnat 10.1371/journal.pone.0359645 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Moumita Tanjila, Umme Kulsum, Shadia Sharmin, Rezwan Ul Haque Aubhi, Md. Sohel Rana, Md. Abu Hasnat</p> This study examines the determinants of women’s employee engagement in Bangladesh, focusing on socio-cultural influences, organizational culture, leadership support, work-life integration, and career development opportunities. Drawing on a cross-sectional survey of 242 women employees across four industries, the study applies partial least squares structural equation modeling (PLS-SEM) to estimate the associations between these five determinants and women’s employee engagement. Organizational culture, leadership support, and work-life integration are each positively associated with women’s employee engagement, whereas socio-cultural influences and career development opportunities show no direct association. Career development is associated with engagement only where perceived size-related HR infrastructure is high, while perceived industry gender-equity support does not condition the socio-cultural association. Engagement strategies therefore need to be tailored to the organizational setting rather than to the sector. The study extends the Job Demands-Resources model and Social Exchange Theory by specifying a gendered conversion mechanism: workplace resources are associated with engagement only where they are relationally enacted and infrastructurally credible. The findings are relevant to organizations and policymakers, underscoring the need for gender-sensitive leadership practices, flexible scheduling, and equitable access to promotion. The design is cross-sectional, and the sample is non-probabilistic, so the findings are associational rather than causal. The study informs the design of supportive and inclusive workplaces that sustain women’s engagement in the Bangladeshi formal sector. Warangkhana Suwanphoerung Chompunuch Klinmalai Sasivimol Rattanasiri Samart Pakakasama Usanarat Anurathapan Suradej Hongeng Nalinee Chongviriyaphan Nopporn Apiwattanakul 10.1371/journal.pone.0359637 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Warangkhana Suwanphoerung, Chompunuch Klinmalai, Sasivimol Rattanasiri, Samart Pakakasama, Usanarat Anurathapan, Suradej Hongeng, Nalinee Chongviriyaphan, Nopporn Apiwattanakul</p> Ashebr Abrha Solomon Hintsa Ebud Ayele Dagnazgi Freweyni Fisshatsion Goitom Girmay 10.1371/journal.pone.0359619 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Ashebr Abrha, Solomon Hintsa, Ebud Ayele Dagnazgi, Freweyni Fisshatsion, Goitom Girmay</p> Background <p>Severe acute malnutrition remains a major public health problem and a leading cause of under-five morbidity and mortality in low and middle income countries. Although outpatient therapeutic feeding programs are widely used to treat uncomplicated cases, recovery time often remains below SPHERE standards. Evidence on time to recovery and its predictors is limited in Tigray, particularly in post-conflict settings where health services have been disrupted.</p> Objective <p>To determine the time to recovery and identify its predictors among children aged 6–59 months with uncomplicated severe acute malnutrition treated in outpatient therapeutic programs in Adet woreda.</p> Methods <p>A retrospective cohort study was conducted among children aged 6–59 months with uncomplicated severe acute malnutrition treated in outpatient therapeutic programs from March 2023 to February 2024. A total of 479 children were selected by systematic random sampling. Bivariable Cox proportional hazards regression was performed to identify candidate variables, and variables with a p ≤ 0.25 were entered into the multivariable model. Statistical significance was declared at p < 0.05.</p> Results <p>The overall recovery rate was 90.8%, with a median recovery time of 49 days. Independent predictors of recovery time were sex (AHR = 1.27, 95% CI:1.04, 1.54), travel time to health facility (AHR = 0.57, 95% CI: 0.44,0.74), residence (AHR = 0.52, 95% CI: 0.42, 0.64), vomiting at admission (AHR = 2.48, 95% CI: 1.27, 4.83), pneumonia at admission (AHR = 3.06, 95% CI: 1.83, 5.11), admission status (AHR = 0.52, 95% CI: 0.39, 0.71), and admission diagnosis (AHR = 0.54,95% CI:0.36,0.81).</p> Conclusions <p>The recovery rate of children with severe acute malnutrition treated in outpatient therapeutic feeding programs exceed the minimum standard. Early identification and management of medical illnesses, improved access to health facilities, and strengthened collaboration between governmental and nongovernmental organizations are essential reduce recovery time among children receiving outpatient therapeutic programs services.</p> Kurban Kotan Serdar Kırışoğlu 10.1371/journal.pone.0359577 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Kurban Kotan, Serdar Kırışoğlu</p> Choosing an appropriate imputation strategy for clinical datasets requires understanding which missing data mechanism is operative, yet most imputation benchmarks conflate performance across mechanisms. The present work addresses this gap by conducting the first mechanism-stratified comparison of three imputation approaches—CHIT, Multiple Imputation by Chained Equations via BayesianRidge (MICE), and Random-Forest-based Iterative Imputation—across Missing Completely at Random (MCAR), Missing at Random (MAR), and Missing Not at Random (MNAR) conditions. Three health datasets serve as experimental platforms: the Chronic Kidney Disease (CKD) dataset, the Heart Disease Dataset (HDD), and the Mice Protein Expression Dataset (MPED). Domain-knowledge-driven missingness patterns are constructed for each mechanism (Fig 2) at approximately 20–25% overall rates. Eight classifiers—KNN, Logistic Regression, SVC, Decision Tree, Random Forest, Gaussian Naïve Bayes, MLP, and a deep neural network—are trained on imputed data following GridSearchCV optimisation. Across all conditions, CHIT achieves near-perfect or perfect downstream classification, with SVC reaching up to 100% accuracy on the CKD dataset under MNAR, and 98.75% under MCAR and MAR. Competing methods degrade by up to 19.38 percentage points under MNAR, while CHIT’s accuracy remains stable. Two structural properties account for this resilience: an iterative enrichment of the regression training set as records are completed, and a within-record prioritisation of the most data-scarce features for model-based filling. Taken together, these results provide mechanism-specific guidance for imputation selection in health informatics pipelines. Statistical significance of classifier accuracy differences between CHIT and MICE was assessed using McNemar’s test (two-tailed, continuity-corrected chi-square) applied to the exact binary prediction vectors from each experiment [n_test = 80]. Ninety-five percent confidence intervals for all reported accuracy values were computed using the Wilson score method [z = 1.96]. The 42-configuration mean accuracy and standard deviation for CHIT are reported in Supplementary Table S1. Full McNemar results with confidence intervals are in Supplementary Table S2. Nina Xue 10.1371/journal.pone.0359575 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Nina Xue</p> This paper addresses the problem of Lyapunov stability for equilibrium solutions in periodic Hamiltonian systems under degenerate conditions. The degeneracy occurs in resonant cases when the leading coefficient function in the normal form possesses only zeros of high multiplicity, rendering standard criteria inapplicable. By employing Lie normal form theory, we establish two general stability criteria that resolve the stability problem for nearly all such degenerate scenarios. Our results explicitly demonstrate the decisive role of higher-order terms and provide easily verifiable conditions that generalize several known results in the literature. Carmen Arteaga-Jordá María Jesús Yáñez-Galdames Hildegart González-Luis Cristina Oroviogoicoechea María José Hernández-Leal 10.1371/journal.pone.0359546 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Carmen Arteaga-Jordá, María Jesús Yáñez-Galdames, Hildegart González-Luis, Cristina Oroviogoicoechea, María José Hernández-Leal</p> Strategic communication plays a vital role in healthcare organizations undergoing continuous cultural transformation, yet its impact on reinforcing nurses’ professional identity remains underexplored. Nurses’ professional identity—how they perceive and enact their roles shaped by professional values and social interactions—is fundamental to job satisfaction, resilience, collaboration, and retention. This scoping review protocol outlines a study designed to systematically map and synthesize existing literature on the interaction between strategic communication, professional identity, and cultural change in nursing contexts. Following Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a comprehensive search will be conducted across seven bibliographic databases and multiple grey literature sources for records published from 2000 to 2025, with no language restrictions. Studies will be included if they demonstrate an explicit interaction between these three core concepts, rather than their isolated presence. Two independent reviewers will conduct screening and data extraction. Data extraction and analysis will be guided by three established frameworks: a 14-component strategic communication framework, the ISPIN-IBIN nursing professional identity model, and an eight-dimension cultural transformation framework. Data will be analyzed descriptively and thematically to create an evidence map of communication models, strategies, and actions that strengthen nurses’ professional identity and support sustainable cultural transformation. An interpretative layer will also be incorporated to explore relationships between communication practices, identity construction, and organizational change. The review aims to identify implementation challenges, contextual enablers, and gaps in current knowledge. Findings will offer evidence-informed guidance for nursing leadership, education, and policy to embed identity-driven communication strategies in organizational change initiatives. Ultimately, this work seeks to advance theoretical understanding and practical application of strategic communication to support resilient nursing workforces and improve healthcare organizational culture. Hiroki Kono Toshihiro Sashihara 10.1371/journal.pone.0359545 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Hiroki Kono, Toshihiro Sashihara</p> Dendritic cells are classified into conventional dendritic cells (cDCs) and plasmacytoid dendritic cells (pDCs), both of which play critical roles in anti-viral immune responses. Previous studies have reported that dairy consumption of yogurt fermented with <i>Lactobacillus delbrueckii</i> subsp. <i>bulgaricus</i> OLL1073R-1 and <i>Streptococcus thermophilus</i> OLS3059 had the effect of inhibiting viral infections. Recent studies have shown that the activation of both cDCs and pDCs and the decrease of respiratory symptoms were induced by the consumption of this yogurt. However, the components responsible for these effects and the underlying mechanisms remain unclear. Since several reports have shown that cDCs and pDCs were activated by lactic acid bacteria, we hypothesized <i>L</i>. <i>bulgaricus</i> OLL1073R-1 and <i>S. thermophilus</i> OLS3059 induced anti-viral immune responses by activating cDCs and pDCs. Here we demonstrated that both <i>L</i>. <i>bulgaricus</i> OLL1073R-1 and <i>S. thermophilus</i> OLS3059 activate cDCs and pDCs in human peripheral blood mononuclear cells. We also showed that both cDCs and pDCs were necessary for type I interferon production, whereas cDCs, but not pDCs, were essential for enhancing effector memory CD4(+) T cell responses to viral antigens when stimulated by <i>L</i>. <i>bulgaricus</i> OLL1073R-1. These findings indicate that anti-viral immune responses induced by consumption of this yogurt are mediated by both <i>L</i>. <i>bulgaricus</i> OLL1073R-1 and <i>S. thermophilus</i> OLS3059 through activation of cDCs and pDCs. Michal Bozděch 10.1371/journal.pone.0359538 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Michal Bozděch</p> Long-term changes in ranking-point production efficiency among female players on the ITF World Tennis Tour Juniors were examined between 2004 and 2025. Year-end ranking data comprised 8,510 player-year observations from 5,919 players aged 12–18 years. Elite status was defined annually using a two-stage data-driven knee-point procedure: players were ordered according to Total Ranking Points (TRP), the knee percentile was identified from the smoothed Total Singles Points profile across this TRP-based ordering, and the threshold was applied to the same percentile scale. Performance efficiency was assessed using Singles PPE, Doubles PPE, and Total PPE, with Total PPE defined as TRP divided by total competitive event exposure. In pooled descriptives excluding 2020–2021, median Singles PPE was 64.62 in elite versus 26.56 in non-elite players; corresponding values were 48.57 versus 29.00 for Doubles PPE and 40.38 versus 17.71 for Total PPE. Positive Year × elite-status interactions were identified in linear player-year models adjusted for age, discipline-specific competitive event exposure, COVID-disrupted seasons, and repeated player observations, corresponding to additional average annual increases of 10.81%, 8.97%, and 9.25%, respectively. However, non-COVID natural-spline models showed that temporal differentiation was non-linear and did not support uniform monotonic widening across 2004–2025. In lagged sensitivity analyses, prior-year elite status was associated with higher subsequent PPE, but Year × prior-year elite-status interactions were not significant in the strict non-COVID specification. Forecasts based on 20 non-COVID annual elite medians projected higher PPE through 2030 under continuation of the observed linear trend, while event-exposure scenarios indicated fewer competitive event exposures associated with fixed TRP benchmarks at higher projected efficiency. These projections should be interpreted as conditional ranking-system scenarios rather than measures of physiological load or individual participation requirements. Overall, structurally defined elite players were characterised by persistently higher ranking-point production efficiency and significantly different, non-linear historical trajectories. Thomas Hormenu Ebenezer Oduro Antiri Eric Awlime-Ableh Juliet Elikem Paku Edward Edem Nartey Shaibu Bukari Adeladza Kofi Amegah 10.1371/journal.pone.0359530 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Thomas Hormenu, Ebenezer Oduro Antiri, Eric Awlime-Ableh, Juliet Elikem Paku, Edward Edem Nartey, Shaibu Bukari, Adeladza Kofi Amegah</p> Background <p>The prevalence of cardiometabolic diseases like obesity, hypertension, diabetes, and dyslipidaemia is increasing rapidly, particularly in low- and middle-income countries (LMICs). Informal workers in Ghana, who account for the majority of the national workforce, contribute significantly to the country’s socioeconomic growth. Often, their work predisposes them to cardiometabolic diseases. This study examines the cardiometabolic burden, its associated factors, and the diagnostic heterogeneity among this unique population.</p> Methods <p>This study used cross-sectional data on 948 informal workers (traders, fisherfolk, artisans, farmers, and drivers) in the Cape Coast Metropolis, Ghana. Sociodemographic, lifestyle, anthropometric, and biochemical data were obtained in accordance with standard procedures. Multiple diagnostic criteria were used to characterise diabetes, prediabetes, and obesity. Diagnostic concordance was evaluated using Venn diagrams and UpSet plots, and independent associated factors were identified using multivariate logistic regression.</p> Results <p>The prevalence of obesity, hypertension, prediabetes, and diabetes was 45.46%, 40.19%, 29.54%, and 13.40%, respectively. Women and middle-aged adults (45–59 years) were most impacted. There was significant heterogeneity in classification criteria, with just 9.28% of obese participants and 2.36% of diabetic participants being diagnosed by all diagnostic criteria. While the absence of childhood obesity was associated with lower odds of obesity (aOR = 0.43, 95% CI: 0.30–0.61), diabetes (aOR = 0.64, 95% CI: 0.42–0.99), and hypertension (aOR = 0.63, 95% CI: 0.46–0.88), older age (≥60 years) was strongly associated with obesity (aOR = 2.54, 95% CI: 1.51–4.32) and hypertension (aOR = 4.82, 95% CI: 3.06–7.68). Low physical activity was significantly linked to hypertension (aOR = 1.73, 95% CI: 1.16–2.62), and elevated triglycerides were associated with diabetes (aOR = 2.16, 95% CI: 1.21–3.75) and hypertension (aOR = 1.84, 95% CI: 1.13–3.04).</p> Conclusions <p>The burden of cardiometabolic diseases among Ghana’s informal workers is disproportionately high and diagnostically diverse. The findings emphasise the critical need for sex- and occupation-sensitive health interventions, life-course prevention strategies, and context-specific diagnostic guidelines to reduce cardiometabolic disease risk among informal workers in LMICs.</p> Fatima Umar Rizwana Maqbool Muhammad Ahsan Khan Bushra Sadia 10.1371/journal.pone.0359528 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Fatima Umar, Rizwana Maqbool, Muhammad Ahsan Khan, Bushra Sadia</p> Inositol tetrakisphosphates kinase (<i>ITPK</i>) plays a vital role in regulating cellular responses to abiotic stress, plant hormone signaling and various other aspects of plant growth and development. Additionally, it is also involved in phosphorous, inositol phosphate metabolism and synthesize phytic acid which is the main phosphorous storage form in seeds. While essential for plant physiology, high phytic acid levels reduce the bioavailability of minerals such as Fe and Zn, which impact nutritional quality negatively. Despite its importance, the <i>ITPK</i> gene family remains largely unexplored in bread wheat. In this study, we conducted a comprehensive genome-wide analysis, including phylogenetic analysis and expression profiling, of the <i>ITPK</i> gene family in wheat. We systematically examined gene structure, chromosomal distribution, motif and domain conservation, promoter analysis, synteny analysis, protein modeling and protein-protein interaction of <i>ITPKs</i>. A total of 15 <i>ITPK</i> genes have been identified in wheat (<i>T. aestivum</i>). The <i>TaITPK</i> genes were distributed on chromosome number 1, 4, 5 and 7 in all the three genomes A, B and D. Comparative phylogenetic analysis resolved four major groups, with wheat <i>ITPK</i> sequences represented in Groups I, III, and IV, whereas Group II contained no wheat sequence. The conserved domain and motif analysis showed the presence of Ins134_P3_kin domain at N-terminus and CPase_L_D2 in C-terminus of protein. String based protein interaction analysis suggested <i>ITPK</i> genes interact with Inositol polyphosphate multi kinase (<i>IPK1</i>) and Inositol-pentakisphosphate 2 kinase (<i>IPK2</i>) which were also involve in synthesis of phyti acid. Furthermore, in-silico expression analysis of <i>ITPK</i> genes revealed their preferential tissue-specific and growth stage expression, especially after anthesis of wheat. Preliminary qRT-PCR profiling of selected <i>TaITPK</i> genes revealed treatment-dependent relative expression patterns under FeSO₄ and ZnSO₄ supplementation. The current study has identified 15 <i>ITPK</i> genes present in hexaploid wheat genome. Their evolutionary, structural, and expression analyses provide a foundation for further functional characterization of this gene family in wheat. The PLOS One Staff 10.1371/journal.pone.0359524 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Staff </p> Edward M. Sterling Yu-Chun Kao Benjamin J. Marcek Wesley W. Bouska Mark W. Fritts Cody A. Henderson Katharine Lieder Joseph W. Amundson Bryon G. Rochon Emily K. Pherigo 10.1371/journal.pone.0359517 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Edward M. Sterling, Yu-Chun Kao, Benjamin J. Marcek, Wesley W. Bouska, Mark W. Fritts, Cody A. Henderson, Katharine Lieder, Joseph W. Amundson, Bryon G. Rochon, Emily K. Pherigo</p> Silver Carp (<i>Hypophthalmichthys molitrix</i>) have invaded Midwestern USA river systems, including the Upper Mississippi River, where this population poses broadly documented ecological and economic threats. To assess this population, we conducted a standardized fisheries-independent investigation along nearly 700 river kilometers of the Upper Mississippi River using electrified dozer trawls with a stratified-random sampling design. Data collected included Silver Carp relative abundance, size, and age at 14 locations between Pool 18 and the Ohio-Mississippi River confluence. We used empirical data to estimate demographic baselines and test whether relative abundance, body condition, length, age distribution, and growth varied within and among locations fragmented by physical structures. We found that demographic rates varied broadly across the sample area but were similar in several adjacent locations. Demographic rates supported aggregating locations with similar demographic characteristics into Meaningful Monitoring Units (MMUs), where demographic variability was relatively low within each unit, but differed among MMUs. Specifically, the Upper Mississippi River can be divided into four MMUs: the Open River, Pool 26, Pools 20–25, and Above Lock and Dam (L&D) 19. Demographic rates for these MMUS serve as baseline estimates for assessing population change and these MMUs represent a reasonable spatial scale for Silver Carp management and control, as well as fisheries-independent monitoring to measure population changes from ongoing management efforts. Although a definitive characterization would require further investigation, our findings suggest patterns consistent with source–sink dynamics within the study area: the Open River and Pool 26 exhibited traits consistent with source populations, whereas Pools 20–25 and Above L&D 19 exhibited traits consistent with sink populations. The observed variability in demographic rates for Silver Carp across a broad geographic area provides a comprehensive baseline for Silver Carp demography and reveals potential management implications in a river system fragmented by physical structures. Nicolette Christodoulakis Daeria O. Lawson Jessyca Silva Jack Young Laura N. Anderson Harriette G. C. Van Spall Carmen H. Logie Lawrence Mbuagbaw 10.1371/journal.pone.0359403 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Nicolette Christodoulakis, Daeria O. Lawson, Jessyca Silva, Jack Young, Laura N. Anderson, Harriette G. C. Van Spall, Carmen H. Logie, Lawrence Mbuagbaw</p> Objectives <p>Gender disparities in methodological studies are largely unexplored. We aimed to examine gender representation between first and last authorship positions in methodological research in health science.</p> Methods <p>We searched for methodological articles as part of a large study focused on creating a methodological study reporting checklist. We extracted the names of the first and last authors of all included studies and determined their gender using Genderize.io, classifying authors as women if the gender probability was ≥ 60%. Our primary outcome was the proportion of studies with women in leadership roles (first or last author as separate outcomes). Secondary outcomes included the proportion of studies with both or either the first or last authors as women. We examined associations between women’s leadership and country income level, World Health Organization region, number of authors on the study team, and publication year.</p> Results <p>Of the 1,375 included studies, the genders of 1,332 first authors and 1,334 last authors were determined. Among first authors, 675 (50.7%) were women, and 657 (49.3%) were men, indicating no gender difference. Among last authors, 486 (36.4%) were women, and 848 (63.6%) were men, with a statistically significant difference (χ² = 98.23, p < 0.001). Studies with women last authors had fewer listed co-authors than those with men (t = −3.63, p < 0.001; risk difference = −27.14%, 95% CI −32.50% to −21.77%). In adjusted models, women’s last authorship was negatively associated with number of authors (adjusted odds ratio [aOR]=0.93, 95% CI 0.90–0.97). Publication year was associated with both women first (aOR=1.03, 95% CI 1.01–1.05) and last (aOR=1.05, 95% CI 1.02–1.07) authorship.</p> Conclusions <p>Our findings highlight a gender disparity in last authorship positions, with men more often in these roles. The association between women last authorship position and smaller author teams may reflect differences in collaborative structure and access to leadership opportunities in larger-scale methodological research. Addressing these disparities can help foster more inclusive research environments, especially within methodological research.</p> The PLOS One Editors 10.1371/journal.pone.0359376 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359366 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> João Vitor Barrio Rafael Santana Batista Cabral Sonia Regina Maciel Rodrigues da Silva Audêncio Victor Maria Elizabeth Araújo Ajalla Cláudia Du Bocage Santos-Pinto Everton Falcão de Oliveira 10.1371/journal.pone.0359337 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by João Vitor Barrio, Rafael Santana Batista Cabral, Sonia Regina Maciel Rodrigues da Silva, Audêncio Victor, Maria Elizabeth Araújo Ajalla, Cláudia Du Bocage Santos-Pinto, Everton Falcão de Oliveira</p> In Brazil, regional disparities in cardiovascular disease (CVD) mortality persist, with no population-based study having examined CVD mortality at the municipal level in the Central-West region. This study analysed the epidemiological profile, temporal trends, spatial distribution, and socioeconomic correlates of CVD mortality in Campo Grande, Mato Grosso do Sul, Brazil (2013–2022). A population-based ecological study used data from the Brazilian Mortality Information System. Five CVD groups were analysed: ischaemic heart disease (IHD), heart failure (HF), arrhythmias (ARR), cardiomyopathies (CMP), and inflammatory heart diseases (INF). Temporal trends were assessed using Poisson, Prais-Winsten, and Joinpoint regression. Spatial distribution was examined through Kernel Density Estimation and Local Indicators of Spatial Association (LISA). Socioeconomic correlates were assessed using Spearman’s correlation with neighbourhood-level indicators. Of 59,392 registered deaths, 8,148 (13.7%) were CVD-related. IHD was the dominant cause (79.5%), with males accounting for 59.3% of deaths (IRR 1.59; 95% CI 1.46–1.74) and individuals aged ≥60 years representing 75.2%. Overall crude CVD mortality increased by 26.1% over the study period, with an estimated mean annual increase of 2.5% (APC + 2.5%/year; 95% CI 1.7–3.3; p < 0.001) and significant acceleration after 2019. A striking proportion of IHD deaths occurred outside hospital settings (67.3%), with home deaths alone surpassing hospital deaths (43.9% vs. 32.7%). Spatial analysis identified significant high-high mortality clusters in central-western neighbourhoods and low-low clusters in eastern neighbourhoods (13 and 5 neighbourhoods, respectively; Global Moran’s I = 0.555, p < 0.001), with cluster patterns varying by disease group. Socioeconomic correlates showed a consistent pattern across most CVD groups, with higher mortality in more socioeconomically advantaged neighbourhoods, except for inflammatory heart disease, which showed the opposite pattern. This first municipal-level CVD mortality analysis in Central-West Brazil identified significant spatiotemporal heterogeneity and a high burden of out-of-hospital IHD deaths, providing actionable evidence for geographically targeted cardiovascular prevention strategies. Ondřej Kuchynka Andrei Kovalchuk Mia Nußbaumer Ekaterina Sviridova Tomáš Fessl Alexey Bondar 10.1371/journal.pone.0359304 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Ondřej Kuchynka, Andrei Kovalchuk, Mia Nußbaumer, Ekaterina Sviridova, Tomáš Fessl, Alexey Bondar</p> Heterotrimeric G proteins are key signal transducers in all eukaryotic cells. Anchored to the inner leaflet of the plasma membrane, they transmit and amplify extracellular chemical and physical signals downstream of G protein-coupled receptors. Despite numerous available studies, many biophysical aspects that regulate G protein signaling, including membrane mobility, remain poorly understood. Here, using single-molecule imaging, we show that different subtypes of heterotrimeric G proteins containing Gβ₁γ₂ subunits exhibit high diversity in their membrane mobility. We demonstrate that the nature of the Gα subunit plays a major role in defining the mobility of such heterotrimers. Our results indicate that heterotrimers containing Gα₁₂ and Gα₁₃ subunits exhibit markedly reduced mobility compared to those containing Gα_i/o and Gα_s subunits. These findings identify subtype-specific lateral membrane mobility of G proteins as a factor that can affect their signaling dynamics in living cells. The PLOS One Editors 10.1371/journal.pone.0359265 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359264 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359262 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359260 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359257 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> The PLOS One Editors 10.1371/journal.pone.0359255 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by The PLOS One Editors </p> Vanessa C. Heron John B. Whitlam David H. Murray Nicky Boulter Peter Mount Suet-Wan Choy Marina Katerelos Kathy Paizis 10.1371/journal.pone.0359105 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Vanessa C. Heron, John B. Whitlam, David H. Murray, Nicky Boulter, Peter Mount, Suet-Wan Choy, Marina Katerelos, Kathy Paizis</p> Aim <p>To assess the feasibility of a novel methodology for quantifying kidney-specific cell-free DNA (ks-cfDNA) and explore whether levels differed between individuals with preeclampsia (PE) and normotensive pregnant controls (NP).</p> Background <p>Cell-free DNA (cfDNA) is released during cell death and circulates in bodily fluids, including urine. cfDNA quantities reflect the degree of organ injury. As PE is associated with hypertension and kidney injury, we hypothesised that urinary ks-cfDNA would be elevated in PE.</p> Methods <p>In this single-centre prospective case-control study urine samples were collected from 20 women with PE and 20 NP controls. Digital PCR was used to quantify three kidney-specific epigenetic targets (ks-et): ks-et1 (pan-kidney marker), ks-et2 (renal proximal tubular epithelial cell (RPTEC) and podocyte marker) and ks-et3 (RPTEC marker). The beta-actin gene (ACTB) represented total cfDNA (t-cfDNA).</p> Results <p>ks-et2 and ks-et3 were higher in the PE group. Median ks-et2 was 231 copies/mL (IQR 65–383) versus 62 copies/mL (IQR 29–215) in NP controls (<i>P</i> = 0.028). Median ks-et3 was 81 copies/mL (IQR 28–199) in PE versus 20 copies/mL (IQR 9–81) for NP participants (<i>P</i> = 0.047). ks-et1 and t-cfDNA showed non-significant increases in PE. Fractional ks-et quantities normalised to t-cfDNA did not differ between groups. Urinary creatinine levels were higher in the PE group (10.9 mmol/L (IQR 4.1–15.3) versus 3.9 mmol/L (IQR 2.3–5.6), <i>P</i> = 0.005). Urine creatinine demonstrated the highest AUC (0.76, 95% CI 0.59–0.92).</p> Conclusion <p>This exploratory study found that quantification of urinary ks-cfDNA was feasible and that absolute quantities of ks-cfDNA markers ks-et2 and ks-et3 were elevated in PE. Consistent with previous studies, urinary creatinine was a good predictor of PE and outperformed ks-cfDNA in discriminating between preeclamptic and normotensive pregnancies. Further studies are needed to determine the clinical utility and predictive ability of ks-cfDNA in PE.</p> Kohei Matsuoka Yuichiro Miki Ryota Kawai Masaki Nishiyama Yuki Seki Kenji Kuroda Hiroaki Kasashima Mami Yoshii Tatsuro Tamura Masatsune Shibutani Takahiro Toyokawa Ayumi Shintani Kiyoshi Maeda 10.1371/journal.pone.0359100 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Kohei Matsuoka, Yuichiro Miki, Ryota Kawai, Masaki Nishiyama, Yuki Seki, Kenji Kuroda, Hiroaki Kasashima, Mami Yoshii, Tatsuro Tamura, Masatsune Shibutani, Takahiro Toyokawa, Ayumi Shintani, Kiyoshi Maeda</p> Background <p>Japan’s rapidly aging population has led to an increase in elderly patients undergoing gastrectomy for gastric cancer. However, the impact of postoperative complications on survival in patients aged ≥80 years remains unclear. This study aimed to evaluate the association between postoperative complications and survival outcomes in patients aged ≥80 years with gastric cancer.</p> Materials and methods <p>We retrospectively analyzed 61 patients aged ≥80 years who underwent gastrectomy with D2 lymph node dissection between 1999 and 2020. Postoperative complications were classified according to the Clavien-Dindo (CD) classification into a “no or minor complication group” (CD Grade ≤ II, including no postoperative complications) and a “major complication group” (CD Grade ≥ III), and the impact of postoperative complications on survival outcomes were assessed. A subgroup analysis excluding macroscopic type 4 was also performed.</p> Results <p>Postoperative complications occurred in 24 patients (39.3%), of which 8 (13.1%) experienced major complications. Patients in the major complication group had a significantly longer postoperative hospital stay, while other baseline characteristics were similar between groups. Kaplan–Meier analysis showed a trend toward poorer OS in the major complication group (P = 0.063), and recurrence-free survival (RFS) was significantly worse in this group (P = 0.004). Multivariate analysis showed that postoperative complications of CD grade ≥ III were independently associated with poorer OS (HR 2.51; 95% CI 1.01–6.24; P = 0.049). Subgroup analysis in patients without type 4 also showed significantly worse OS in the major complication group (P = 0.036).</p> Conclusion <p>This study showed that postoperative complications were associated with poorer OS and RFS even in patients aged ≥80 years with gastric cancer. Future large-scale studies are needed to further clarify this association and optimize treatment strategies for this population.</p> Isabela Fernanda Rodrigues de Oliveira Suelen Marçal Nogueira Flávio Manoel Coelho Borges Cardoso Gabriel Barg Gustavo De Conti Teixeira Costa Emilio Villa-González Priscilla Rayanne e Silva Matias Noll 10.1371/journal.pone.0359001 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Isabela Fernanda Rodrigues de Oliveira, Suelen Marçal Nogueira, Flávio Manoel Coelho Borges Cardoso, Gabriel Barg, Gustavo De Conti Teixeira Costa, Emilio Villa-González, Priscilla Rayanne e Silva, Matias Noll</p> This study aims to evaluate, through a longitudinal research, the association between lifestyle habits, modifiable risk behaviors, and mental health with quality of life (QoL) among professionals of the Federal Network of Professional, Scientific, and Technological Education (education professionals) in Brazil. A total of 600 professionals (including teachers and administrative technicians) were longitudinally evaluated in 2022 and 2023. Four validated questionnaires were used: the WHOQOL-bref to assess quality of life (QoL), the DASS-21 for mental health, the Back-PEI for physical activity, and PeNSE for dietary markers. The statistical analysis included Relative Risk (<i>RR</i>) tests and adjusted analysis using a Poisson regression model with robust variance. The main findings indicate that women exhibit poorer QoL in the physical domain (<i>RRadj</i> = 1.19, p = 0.005) and psychological domain (<i>RRadj</i> = 1.14, p = 0.045). Being employed and over 60 years old is a protective factor for QoL in the psychological domain (<i>RRadj</i> = 0.67; p < 0.05). The regular consumption of ultraprocessed foods is a risk factor for QoL all domains (<i>RRadj</i> > 1.15, p < 0.05). Irregular consumption of vegetables/greens (<i>RRadj</i> > 1.11, p < 0.05) and fruits (<i>RRadj</i> > 1.10, p < 0.05) indicated a risk of low QoL. Participants with low frequency or no physical activity had a higher risk of worse quality of life scores across all domains (<i>RRadj</i> > 1.20; p < 0.001). Exposure to television for 5 hours or more during the day was a risk factor for low QoL in the physical domain (<i>RRadj</i> = 1.33, p = 0.005) and social relationships (<i>RRadj</i> = 1.32, p = 0.003). Computer use was not associated with QoL (p > 0.05). Higher frequency of alcohol consumption was associated with higher scores in the social relationships domain (<i>RRadj</i> = 0.83, p = 0.037). Regarding mental health, depressive, anxiety, and stress symptoms were associated with low QoL across all domains (<i>RRadj</i> > 1.33, p < 0.01) in both men and women. The results of this longitudinal study may encourage healthier lifestyle habits and support public policies aimed at improving the well-being of education professionals. Kiran Roest Catherine Kelly Tracy Marshall Emily Whales Lisa Taylor Rachel Hatfield Kate Bunyan Luke Dawson Steve Roest Julia Newton 10.1371/journal.pone.0358999 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Kiran Roest, Catherine Kelly, Tracy Marshall, Emily Whales, Lisa Taylor, Rachel Hatfield, Kate Bunyan, Luke Dawson, Steve Roest, Julia Newton</p> Objectives <p>To evaluate the proof-of-concept feasibility of identifying individuals at high risk of cardiovascular disease through community-based PocDoc Healthy Heart point-of-care screening in a large, ethnically diverse, disadvantaged real-world cohort in the United Kingdom.</p> Methods <p>Proof-of-concept, non-randomised, non-interventional real-world cardiovascular disease risk case finding study in adults aged 18 years or older in real-world communities across the United Kingdom. Main outcome measures were identification of individuals with high risk of cardiovascular disease, defined as QRISK3 score ≥10%; and individuals meeting the criteria for weight loss, smoking cessation, or hypertension management services.</p> Results <p>A total of 4,256 individuals (mean age 49 years, 57% male, 31% body mass index ≥30 kg/m²) were included in the Primary Cohort. The Targeted Outreach and Workplace sub-cohorts comprised 1,970 and 756 individuals, respectively. In the Primary Cohort, 35% (1,486/4,256) had high (>5.0 mmol/L) total serum cholesterol, 10% were smokers, 10% met criteria for weight loss services and 19% met criteria for hypertension management services. QRISK3 scores were generated for individuals who had not previously had a cardiovascular disease event (~90% of screened individuals). A QRISK3 score ≥10% was found in 20% (784/3,842) of individuals in the Primary Cohort, 26% (457/1,743) in the Targeted Outreach sub-cohort, and 6% (41/701) in the Workplace sub-cohort. In the Primary Cohort, 60% (472/784) of individuals with a QRISK3 score ≥10% were not being treated with a lipid-lowering therapy at the time of testing.</p> Conclusions <p>In this proof-of-concept study, community-based point-of-care screening identified individuals with elevated cardiovascular risk and unmet cardiovascular risk management needs. These findings are hypothesis-generating and provide the rationale for further controlled studies with systematic follow-up and health-economic analyses to evaluate whether this approach can deliver improved clinical and system-level outcomes.</p> Trial registration <p>ClinicalTrials.gov NCT06258005</p> Qi Cheng Qunxing Li Delu Yin 10.1371/journal.pone.0358983 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Qi Cheng, Qunxing Li, Delu Yin</p> Background <p>Patients with ST-segment elevation myocardial infarction (STEMI) continue to show substantial inflammatory heterogeneity after reperfusion therapy, and recovery trajectories may differ markedly across patients. Compared with traditional diagnostic models, characterizing the dynamic immune trajectory from acute inflammation toward recovery may better identify programs associated with impaired resolution. This study aimed to construct an immune recovery-failure framework that is transferable across cohorts and anchored by single-cell data.</p> Methods <p>We integrated six public GEO peripheral-blood bulk transcriptome cohorts and one public single-cell RNA-seq dataset. An acute-to-recovery immune axis was constructed from directionally concordant longitudinal and cross-sectional contrasts, and a recovery-failure phenotype was defined in the discovery longitudinal cohort from paired transcriptomic features. An 18-gene monocyte-associated module was then derived using bulk recovery-failure associations, monocyte specificity, monocyte-state differences, and pseudotime information. External cohorts were used to evaluate temporal transfer and baseline-to-follow-up associations rather than definitive clinical prediction, and the single-cell dataset was used for donor-aware cell-type anchoring and exploratory state-level interpretation.</p> Results <p>Among 81 STEMI patients who met the longitudinal definition criteria, unsupervised stratification classified 35 as recovery-failure patients and 46 as recovery-sufficient patients. We constructed an 18-gene monocyte-associated recovery-failure module. The module distinguished the two transcriptomically defined groups in the discovery cohort and declined from the acute phase toward recovery in external longitudinal cohorts. Baseline module burden was associated with later composition-adjusted inflammatory burden, but this was interpreted as a baseline-to-follow-up association rather than clinical event prediction. At the single-cell level, donor-aggregated lesion-associated shifts were largest in monocytes, and the module decreased along the acute-high-to-recovery-biased monocyte pseudotime direction. In 1,000 matched random monocyte-gene modules, the observed module showed a higher aggregate recovery statistic than nearly all random signatures.</p> Conclusions <p>We propose a STEMI immune recovery-failure framework derived from public peripheral-blood transcriptomes, evaluated across independent longitudinal datasets, and linked to monocyte state variation in a public single-cell context. The framework is does not evidence of a causal mechanism or a validated hard-endpoint prediction model; rather, it provides a reproducible transcriptomic description of impaired inflammatory resolution that should be tested prospectively and experimentally.</p> Herni Susanti Novitri Nurimani Asha Penny Bee Heni Dwi Windarwati Budi Anna Keliat Atik Puji Rahayu Amy Blakemore Afni Handayani Mochamad Ali Sodikin Helen Brooks 10.1371/journal.pone.0358869 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Herni Susanti, Novitri Nurimani Asha, Penny Bee, Heni Dwi Windarwati, Budi Anna Keliat, Atik Puji Rahayu, Amy Blakemore, Afni Handayani, Mochamad Ali Sodikin, Helen Brooks</p> Introduction <p>Depression and anxiety remain major, largely unaddressed drivers of disability in low- and middle-income countries (LMICs), where scarce resources and persistent stigma constrain access to care. Scalable solutions are urgently needed. Low-intensity psychological interventions, delivered by trained non-specialists offer a promising pathway to close the treatment gap. This study examines the prospective acceptability of these interventions in Java, Indonesia, an exemplar of an under resourced health system, to guide targeted cultural adaptation and inform optimal implementation.</p> Methods <p>Using a qualitative descriptive design guided by the Theoretical Framework of Acceptability (TFA), we conducted semi-structured interviews (n = 33) with people experiencing anxiety and depression and 21 focus groups with families (n = 34), health workers (n = 36), and community/religious leaders (n = 37) across 12 sites in Java. Data were collected in Bahasa/local languages, transcribed, translated, and analysed using TFA informed Framework Analysis. 5% of translations were independently back-verified. Stakeholder workshops and advisory panels shaped study design and interpretation.</p> Results <p>Low mental health literacy and stigma undermined intervention coherence and affective attitude, with many conflating LIPIs with general counselling. Help-seeking was often delayed until distress became severe, reflecting limited understanding of mental health problems and available support. Despite these challenges, strong perceptions of effectiveness and positive affective attitudes were driven by cultural values of self-reliance and community support. Concerns centered on ethicality, particularlyprivacy risks and fear of social judgment, alongside undercertainty regarding the role of traditional healers and the burden associated with time and workload demands. Trust in lay health workers was high in rural areas but more variable in urban contexts.</p> Conclusion <p>Findings highlight that cultural, structural, and interpersonal factors shape anticipated intervention acceptability. While stigma and low literacy remain barriers, strong perceived need and cultural alignment suggest the potential for promising subsequent uptake. Addressing privacy, role clarity, and logistical burden through tailored adaptations and partnerships is critical. This study offers one of the first theoretically framed qualitative explorations of LIPI acceptability in Southeast Asia, highlighting culturally congruent pathways for subsequent LMIC implementation.</p> Anne L. Buffardi Paul Pascall Jones Lucien Begault 10.1371/journal.pone.0358689 2026-09-29T14:00:00Z 2026-09-29T14:00:00Z <p>by Anne L. Buffardi, Paul Pascall Jones, Lucien Begault</p> Despite decades of research documenting the effects of poor housing on health, there is much less evidence of the effectiveness of different housing interventions to improve health outcomes. Moreover, existing research tends to focus on a specific population group or aspect of housing. This scoping review aimed to identify the range of policy instruments and interventions that could improve health by improving housing quality, stability, affordability and availability, with a focus on interventions being implemented in practice, including those not published in the academic literature. For each intervention, we documented aims, effects, actor roles, cost, housing domain, target population, city and country. Based on 37 evidence reviews and reports, we identified 327 unique interventions, with economic and social regulation (e.g., regulating pricing and private rented sector practices, changing planning processes) and direct or contracted provision (e.g., providing and upgrading social housing) much more common than other policy instruments. Evidence on effectiveness varied considerably, with more outcomes reported for physical modifications, economic regulation and tax policy, and limited evidence on social housing, public information, social regulation, effects on health outcomes and measures along multiple stages of a change pathway. Thirty-two types of actors were involved in authorising, financing, implementing and/or enforcing interventions, spanning public and private sectors and levels of government. Intervention costs were infrequently stated and varied substantially, with multiple reviews noting the mismatch between those who finance, implement, benefit and save. This scoping review uncovered more interventions and a wider range of policy instruments than identified in previous systematic reviews, suggesting an important and underutilised role for the grey literature in identifying existing programmes and highlighting evidence gaps. Taking advantage of these natural experiments, embedding more robust evaluation into current interventions and comparing the effectiveness of different policies that aim to achieve similar outcomes offer the opportunity for research to better inform housing policy and maximise its potential to improve health.