PLOS ONE Alerts: New Articles

Correction: Time and spatial trends in landing per unit of effort as support to fisheries management in a multi-gear coastal fishery

2026-09-08T14:00:00Z

by Pedro Leitão, Luis Sousa, Margarida Castro, Aida Campos

Comparative prevalence of the mercury resistance gene merA in human feces, food, and environmental water from Japan, Vietnam, and Ghana

2026-09-08T14:00:00Z

by Yen Hai Le, Judith Dzifa Azumah, Diep Thi Khong, Thang Nam Nguyen, Cornelia Appiah-Kwarteng, Kazuaki Matsui, Mayumi Yamamoto, Kaori Tanaka, Yoshimasa Yamamoto

In this study, we investigated the prevalence and abundance of the mercury resistance gene merA in human feces, retail chicken meat, and environmental water samples collected from Japan, Vietnam, and Ghana. A real-time PCR assay developed in this study demonstrated high specificity toward merA sequences from more than 12 bacterial species. Using this assay, merA was detected in 6.8% of human fecal samples in Japan (n = 29), in contrast to significantly higher rates observed in Vietnam (70.2%, n = 47) and Ghana (97.4%, n = 39). Similar geographic trends were evident in the chicken meat samples: 18.5% in Japan (n = 27), 66% in Vietnam (n = 91), and 90% in Ghana (n = 10). Environmental water samples showed a consistently high merA detection rate across all countries (75–100%, n = 21), with substantially higher gene copy numbers in Vietnam and Ghana than in Japan. merA was detected in some water samples, even when total mercury concentrations were below the detection limit, indicating that molecular detection may offer greater sensitivity than traditional physicochemical methods. Mercury-resistant bacteria were successfully isolated and cultured, and Citrobacter freundii was identified as the representative strain. Genomic analysis revealed that merA was located on an IncFIB plasmid, flanked by insertion sequences, suggesting its potential for horizontal gene transfer. These findings highlight merA as a promising biomarker for environmental mercury exposure and support the utility of fecal merA analysis as a proxy for assessing mercury-related public health risks.

Correction: Root cause analysis of accidents and examining their interrelations from the perspective of workers, supervisors, and safety officers

2026-09-08T14:00:00Z

by Neda Molamehdizadeh, Gholam Hossein Halvani, Hossein Ebrahimi, Ali Asghar Farshad, Seyedeh Melika Kharghani Moghadam, Tahereh Eskandari

Stakeholder-informed pre-implementation refinement of a pharmacy-led pre-exposure prophylaxis (PrEP) service delivery model in Malaysia

2026-09-08T14:00:00Z

by Yan Nee Gan, Sin How Lim, Frederick L. Altice, Sharifah Khadijah Syed Razif, Mariani Ahmad Nizaruddin, Reena Rajasuriar, Sazali Basri, Joselyn Pang, Andrew Yap, Iskandar Azwa, Rafdzah Zaki

Introduction

In 2024, only 3,451 individuals accessed free oral HIV pre-exposure prophylaxis (PrEP) at government clinics in Malaysia, despite an estimated 354,000 key population members who could benefit from PrEP. To inform pre-implementation refinement of a pharmacy-led PrEP service delivery model, we explored stakeholder perspectives on implementing the model within private community pharmacies in Malaysia.

Materials and methods

A one-day stakeholder consultation was conducted in April 2023 in Kuala Lumpur with 28 stakeholders representing community pharmacies, professional societies, telemedicine providers, non-governmental organizations (NGOs), and HIV implementation science researchers. The meeting began with a review of preliminary findings from formative qualitative research involving key populations, community pharmacists, and PrEP prescribers. Through facilitated discussions, stakeholders identified short- and long-term solutions to implementation barriers. Stakeholder inputs from discussions and structured worksheets were synthesized descriptively to identify recurring implementation considerations that informed refinement of the pilot model.

Results

Key implementation considerations included enhancing awareness and demand generation, ensuring privacy, confidentiality, and affordability, integrating HIV self-testing, using digital checklist-based assessments, simplifying laboratory testing requirements, developing practical workflows supported by a reference guide, strengthening pharmacist training, and fostering cross-sector collaboration. Identified training needs included PrEP fundamentals, eligibility assessment for initiation and continuation, referral procedures, and scenario-based learning. Key competencies included knowledge of HIV and sexually transmitted infections, risk assessment, professional conduct, and person-centered communication. Six study sites were selected, with preparation requirements including HIV self-test kits, PrEP medications, informational materials, trained pharmacists, telemedicine subscriptions, and nearby referral clinics. The consultation informed refinements to the implementation plan.

Conclusions

This stakeholder consultation informed refinement of a pharmacy-led PrEP service delivery model for pilot implementation in Malaysia and identified practical implementation considerations related to privacy, affordability, HIV self-testing, physician-pharmacist coordination, training, and referral systems. The findings may inform future implementation planning for similar urban, private-sector PrEP delivery models.

Beyond traditional criteria: CRP and fibrinogen as biomarkers of metabolic syndrome in ART-treated people living with HIV and their association with HIF-1α rs11549465

2026-09-08T14:00:00Z

by Nemanja Đorđević, Jovan Ranin, Ivana Gmizić, Biljana Ljujić, Marko Marković, Ivan Rajković, Jovana Ranin, Ivana Raković, Sofija Sekulić Marković, Biljana Popovska Jovičić

Metabolic syndrome (MS) is highly prevalent among people living with HIV (PLWH) receiving antiretroviral therapy (ART) and is driven by persistent low-grade inflammation. Hypoxia-inducible factor 1 alpha (HIF-1α) polymorphisms may influence inflammatory pathways underlying MS. This study investigated the association of the rs11549465 HIF-1α polymorphism with inflammatory markers and MS in PLWH receiving ART. We conducted a multicenter case-control study including 116 PLWH treated at two University Clinical Centers in Serbia. Participants were classified according to NCEP ATP III criteria. Genotyping was performed by Real-Time PCR using TaqMan assays. C-reactive protein (CRP) and fibrinogen levels were significantly higher in participants with MS (p < 0.05). ROC analysis demonstrated their potential as biomarkers of MS with cut-off values of 1.85 mg/L for CRP and 2.49 g/L for fibrinogen. Age significantly correlated with CRP and Neutrophil/Lymphocyte ratio (p < 0.05). Elevated CRP and fibrinogen levels were associated with hypertension, hypertriglyceridemia, and other MS-abnormalities (p < 0.05). The HIF-1α rs11549465 CT + TT genotype was associated with higher IL-6 levels among participants with MS (p = 0.026). CRP and fibrinogen may complement existing MS criteria in identifying PLWH at increased risk of cardiovascular disease and diabetes. These findings highlight the role of chronic inflammation and genetic variability in metabolic complications of HIV.

Expression of Concern: An Efficient Hybrid Job Scheduling Optimization (EHJSO) approach to enhance resource search using Cuckoo and Grey Wolf Job Optimization for cloud environment

2026-09-08T14:00:00Z

by The PLOS One Editors

Autism and ADHD social media short-form video content: A systematic review protocol

2026-09-08T14:00:00Z

by Vasileia Karasavva, Amori Yee Mikami

Rationale

Social media platforms have made information about mental health more accessible than ever, with over 60% of young adults using social media as a primary information source. Content about neurodiversity issues, including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), is highly popular online. Researchers and mental health professionals have expressed concerns over the lack of vetting and potential spread of misinformation on social media. To date, there has been no synthesis of the literature examining the scientific accuracy of short-form video content about ADHD and ASD, and the downstream impacts of this content.

Objectives

1) Describe the popularity and characteristics of ADHD and ASD short-form video content, 2) Evaluate the extent to which it follows clinical guidelines, 3) Explore its impacts on stigma, treatment- and diagnosis-seeking, and symptom perceptions.

Methods

This protocol is designed in accordance with the 2020 Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. PsycINFO, PubMed, and SCOPUS will be used for the literature search. Qualitative, quantitative, and mixed-methods peer-reviewed research published in English by June 1, 2026, will be considered. Once duplicate studies are removed, pairs of independent reviewers will determine eligibility first through the review of titles and abstracts and then full text review. Descriptive and thematic analysis methods will be used to analyze extracted data.

Conclusion

Findings from this work can provide a better understanding of the social media content about ADHD and ASD and the ways it may impact viewers.

Pre-registration

A protocol of this systematic literature review will be registered with Open Science Framework Registries.

The hospital as the only place to live: Long-term hospital stays in a tertiary hospital for infectious diseases in Manaus, Brazilian Amazon

2026-09-08T14:00:00Z

by Talyson Aparício Gomes, Joseir Saturnino Cristino, Rafaela Nunes Dávila, Bianca Leite Pereira, Milena Gomes Ferreira, Giulia Lória Aquino, Amanda Braga Cunha, Felipe Nery Braga, Érica da Silva Carvalho, Jacqueline Sachett, Felipe Gomes Murta, Vinicius Azevedo Machado, Wuelton Monteiro

Long-term hospital stays represent a growing challenge for health systems, especially in tertiary hospitals that receive patients with clinically complex pathologies. This phenomenon is often related to social factors, such as abandonment, absence of caregivers and fragility of support networks, and the difficulty of relocation to intermediary institutions. This study aimed to understand the experiences and perceptions of family caregivers and health professionals about prolonged hospital stays in a referral hospital for tropical and infectious diseases in the Brazilian Amazon. This is a qualitative, exploratory study that is based on interviews with ten health professionals and eight family members of patients hospitalized for more than or equal to 180 days. The data were analyzed via thematic analysis. The analyzed cases show an overlap of vulnerabilities, including comorbidities, HIV/AIDS infection and fragility in family ties. The stigma associated with HIV/AIDS and the families’ poor financial conditions hinder care after discharge, making the hospital the only possible space for these patients to stay. The analysis identified five major themes: (1) social hospitalization and institutional dependence; (2) dynamics of family and social ties; (3) routine care and impacts on the lives of caregivers; (4) clinical complexity and obstacles that impede hospital discharge; and (5) the need for public policies and infrastructure. It is concluded that, in the absence of alternatives outside the hospital and effective intersectoral policies, the hospital begins to play a role beyond that of clinical care, and functions as a place to stay and the only space for social bonds for individuals in situations of extreme social vulnerability.

Ketogenic diet–induced changes in hepatic drug metabolism with potential implications for ozanimod pharmacokinetics in mice

2026-09-08T14:00:00Z

by Veronika Frybortova, Stefan Satka, Lenka Jourova, Pavel Anzenbacher, Iveta Zapletalova, Michal Kraus, Klara Kostovcikova, Miloslav Kverka, Eva Anzenbacherova

Ketogenic diet (KD) is increasingly considered as an adjunctive therapeutic approach across a range of diseases, but its effects on the pharmacokinetics of concomitantly administered drugs remain unclear. Such interactions may be particularly relevant in multiple sclerosis, where KD is being explored as a complementary strategy alongside disease-modifying therapies, such as ozanimod. We therefore investigated whether KD affects ozanimod metabolism and pharmacokinetics and explored potential factors that may contribute to such effects. Specific pathogen-free female C57BL/6 mice were fed either a control diet containing 10% of calories from fat or a ketogenic diet containing 90% of calories from fat for 4 weeks. Metabolic, inflammatory, and hormonal parameters were determined in plasma. Gut microbiota composition was analyzed by whole-metagenome shotgun sequencing. In parallel, hepatic cytochrome P450 (CYP) enzymes were evaluated by mRNA expression and activity together with ozanimod pharmacokinetics. KD induced the expected metabolic adaptation to ketosis and led to a significant increase in plasma cholesterol accompanied by changes in gut microbiota composition. Other metabolic and inflammatory parameters showed only modest changes. In addition, KD altered the expression and activity of hepatic CYP enzymes, including enzymes involved in ozanimod metabolism: CYP1A activity and mRNA expression were significantly increased in KD-fed mice, whereas lower CYP2C activity was observed in pooled samples and CYP3A activity showed a non-significant trend toward lower values. Ozanimod exposure tended to be higher in KD-fed mice, resulting in an approximately 17% increase in area under the concentration–time curve, although this effect did not reach statistical significance. In conclusion, our findings demonstrate that KD altered the expression and activity of hepatic CYP enzymes and revealed a non-significant trend toward increased ozanimod exposure. These observations highlight the potential importance of considering dietary interventions as a factor contributing to variability in drug response.

Sustained hypotension during shoulder arthroscopy is associated with postoperative nausea and vomiting

2026-09-08T14:00:00Z

by Rili Yu, Xia Yang, Juan Chen, Fan Zhang

Background

Postoperative nausea and vomiting (PONV) is a common and distressing complication following shoulder arthroscopy. Although hypotension is known to trigger nausea, the specific association between sustained intraoperative hypotension (SIH) during shoulder arthroscopic surgery and PONV has not been well characterized. This retrospective study aimed to investigate whether SIH is independently associated with PONV.

Methods

We retrospectively analyzed data from 306 patients who underwent shoulder arthroscopy between March 2018 and January 2024. SIH was defined as a ≥ 20% decrease in mean arterial pressure (MAP) from baseline persisting for at least 60 minutes during the controlled hypotension phase. Univariate logistic regression analysis and multivariate exact logistic regression analysis were performed to identify factors associated with the occurrence of PONV. PONV severity was compared between the SIH and non-SIH groups using the chi-square test.

Results

PONV occurred in 96 patients (31.37%). Univariate logistic regression analysis revealed that females, smoking, history of motion sickness and/or PONV, and SIH were related to the occurrence of PONV (all p < 0.05). Multivariate logistic regression analysis revealed that females (adjusted OR: 3.966, 95% CI: 2.149–7.317, p < 0.001), smoking (adjusted OR: 0.232, 95% CI: 0.107–0.501, p < 0.001), history of motion sickness and/or PONV (adjusted OR: 32.393, 95% CI: 3.801–276.051, p = 0.001), and SIH (adjusted OR: 2.198, 95% CI: 1.289–3.749, p = 0.004) were independently associated with the occurrence of PONV. Additionally, patients with SIH exhibited significantly higher severity grades for both nausea (p = 0.002) and vomiting (p = 0.007).

Conclusion

SIH due to controlled hypotension during shoulder arthroscopic surgery was independently associated with PONV. SIH may serve as a clinically relevant predictor for PONV.

Effect of adherence to nutrition guidelines and use of fortification of feeds on the growth of late preterm neonates

2026-09-08T14:00:00Z

by Isabella DeStefano, Adanna Ibeku, Krystal Hunter, Melissa Micallef, Alla Kushnir

“Late preterm” or “LPT” neonates are generally defined as infants born between 34 0/7 and 36 6/7 weeks gestation and constitute approximately 74% of all preterm births. While much effort has been put into evaluating the nutritional needs of early preterm or low birthweight infants, there is a shortage of research on the nutritional needs of LPT infants. This work examined how adherence to current nutrition guidelines and how the use of fortification of feeds affected the growth of LPT neonates in the first year of life. A retrospective chart review was conducted of 898 neonates born between 34 0/7 and 36 6/7 weeks gestation, as identified from electronic medical records. The study site where the data was obtained was an urban hospital in New Jersey. Head circumference, weight, and length at birth, documented as measurements, percent, and z-scores, at discharge, at two months, at six months, and at twelve months post birth, were collected and evaluated. Data regarding the neonate’s feeding regimen, caloric fortification, and type of nutrition at the point of discharge were assessed. Data were analyzed using independent t-tests and Mann-Whittney U tests to assess the relationship between adherence and growth parameters. Of these participants, 50.1% were male, the mean gestational age was 34.91 (±1.19), and the mean birth weight was 2317 (±489) grams. Infants with lower birth weight (BW) were more likely to receive fortification (BW p < 0.001, BW percentile p < 0.001). Participants who followed fortification guidelines had lower birth weight, discharge weight, and weight percentile (p < 0.001), as well as lower z-scores for BW, length, and head circumference (HC) at birth and at discharge. At six and twelve months, weight, weight percentile, length, length percentile, head circumference, and head circumference percentiles were not statistically significant. The results show that adherence to nutritional guidelines recommending fortified feeding is associated with growth within the first year of life of LPT infants. By two, six, and twelve months, there were no differences in z scores in participants with fortification.

Multi-agent meta-reinforcement learning based on contrastive predictive coding—For rapid adaptive traffic control after emergencies

2026-09-08T14:00:00Z

by Wei Jiang, Xianwei Huang, Genjie Wang, Ruting Li, Shanshan Tang

Emergency signal control has to clear emergency vehicles through intersections without creating excessive delay for ordinary traffic. Many existing controllers still depend on manually designed traffic features, and unfamiliar emergency patterns often require additional training before the control policy can be adjusted reliably. For this setting, a multi-agent meta-reinforcement learning framework is developed using Contrastive Predictive Coding (CPC) for traffic state representation. CPC compresses high-dimensional traffic sequences into compact representations that are subsequently used by intersection agents during few-sample policy adaptation. Agent communication is weighted by both distance and transmission delay, while hierarchical emergency priority control adjusts signal decisions according to event severity. Tests on the iTETRIS simulation platform with the CityFlow Emergency dataset produced an emergency response time of 25.3 s, an average regular vehicle delay of 80.5 s per vehicle, and a 98.2% emergency success rate in high-priority scenarios. In the ablation experiments, removing CPC caused the largest single performance loss, whereas the all-module configuration showed a 44.3% contribution to response-time reduction in the contribution analysis. Overall, the framework maintained emergency vehicle priority while keeping the effect on regular traffic within a comparatively limited range under the evaluated emergency conditions.

Curvularia lunata drives biodeterioration of PVC secondary cable insulation involving surface colonization, moisture retention and chemical deterioration

2026-09-08T14:00:00Z

by Yimeng Liu, Shiying Yan, Jian Zhang, Yiping Chen, Yue Zhou, Changyi Huang, Tianlan Jiang, Yu Gao, Hansheng Zhu, Hao Shi, Chaoyi Han, Fosheng Li, Jie Zhang, Jian Zhao, Mei Cao

Microbial degradation of cable insulation materials is a critical issue affecting the reliability of power systems. In this study, metagenomic analysis was employed to reveal the microbial community structure on contaminated substation cables, identifying Curvularia lunata as a dominant fungal species in high-voltage environments. Subsequently, a specific strain, Curvularia lunata B3, was isolated and identified for further investigation. To assess its specific impact on insulation performance, artificial inoculation experiments were conducted on secondary cable samples. Multi-dimensional characterization techniques, including SEM, WCA measurements, halogen moisture analysis, FTIR, XPS, and LCR digital bridge testing, were utilized to evaluate material degradation. The results demonstrated that C. lunata colonization caused significant surface erosion, characterized by the formation of holes and furrows. This physical damage was accompanied by a marked decrease in hydrophobicity, with the water contact angle dropping from 88.30 ± 0.79° to 78.27 ± 1.27°, and a gradual increase in water content to approximately 1.2% over 60 days. Chemical analysis revealed that microbial activity induced oxidation and dechlorination of the PVC insulation, evidenced by the reduction of C-Cl bonds and the emergence of oxygen-containing functional groups. These physicochemical alterations significantly compromised the electrical insulation of the cables, as evidenced by a marked decrease in series resistance (Rs) and an increase in series capacitance (Cs). This study elucidates the mechanisms of fungal erosion on cable insulation and provides a scientific basis for developing targeted protective strategies in power systems.

Retraction: Sentiment analysis of classical Chinese literature: An unsupervised deep learning model with BERT and graph attention networks

2026-09-08T14:00:00Z

by The PLOS One Editors

Existing racial and ethnic representation on top management teams predicts subsequent top management team appointments that preserve the demographic status quo

2026-09-08T14:00:00Z

by Christopher W. Bauman, John Morton, Ben Lourie, Philip Bromiley

Top management teams (TMTs) are considerably less diverse than employees at other levels and the general population. Using over 48,000 firm–year observations of executives across 3,807 firms from 1992 to 2017, we find robust evidence that the existing racioethnic composition of TMTs predicts subsequent TMT appointments that preserve the racioethnic status quo. Specifically, having a racioethnic minority group member on a TMT has a negative association with appointing another member of the same group, and the departure of a racioethnic minority group member from a TMT has a strong positive association with an appointment of a member of that group. However, having a CEO from a racioethnic minority group has a positive association with an appointment from the CEO’s racioethnic group. Moreover, the associations with departures and CEO racioethnicity appear stronger in more recent years (2005–2017) than in the past (1992–2004). Theories of diversity in the upper echelon of firms that focus on the role of stereotypes cannot fully explain these effects. The results are consistent with a status uncertainty account we derive from theories of intergroup dynamics. The results also show that TMT appointment decisions hinge on finer-grained distinctions among racioethnic categories than typically used by researchers and the US Census.

Kinetics of the PASC Index in Long COVID

2026-09-08T14:00:00Z

by Kyungsup Kwon, Choi Young Jang, Woori Kim, JuYeon Son, Euijin Chang, Sung-Han Kim

Background

The post‑acute sequelae of SARS‑CoV‑2 infection (PASC, “Long COVID”) remain difficult to evaluate because standardized diagnostic tools are limited. We applied the recently proposed PASC index (score ≥ 12) to describe the 12‑month trajectory of Long COVID symptoms.

Methods

In this prospective cohort, adults with laboratory‑confirmed COVID‑19 were consecutively enrolled from November 2022 to February 2025. Long COVID was defined by a PASC index of ≥12 across 12 symptom domains persisting for at least 30 days post-infection. Symptom questionnaires were completed at 1, 3, 6 and 12 months after infection.

Results

Among 183 participants, 48 (26.2%) met Long COVID criteria. Symptom assessments indicated that the proportion of participants meeting the Long COVID threshold declined from 27% at 1 month to 18% at 12 months, although this change was not statistically significant (p = 0.16). Participants classified as having Long COVID had consistently higher PASC index values across follow-up, while pairwise within-person comparisons showed no significant temporal changes in either the Long COVID or non-Long COVID group. These findings suggest that the overall symptom burden remained relatively stable over time, despite fluctuations in threshold status.

Conclusion

During 12 months of follow-up, approximately one quarter of participants met the PASC index threshold at least once. Among participants with repeated assessments, PASC index scores showed limited within-person change, although differential non-response limits the interpretation of temporal prevalence estimates.

Management outcomes and factors related to hospital stay for pediatric intussusception in a Tertiary Care Hospital, Northwestern Ethiopia

2026-09-08T14:00:00Z

by Nebiyu Shitaye Aniley, Worku Animaw Temesgen

Background

Intussusception is the most common cause of intestinal obstruction in infants and young children that requires prompt diagnosis and treatment to prevent complications and death. Nowadays, when cases are presented to hospitals on time and have no significant complications, non-invasive ultrasound-guided hydrostatic reduction is the first-line treatment, resulting in favorable outcomes, including higher recovery, lower complications, and shorter hospital stay compared to open surgery. However, evidence on management modalities, clinical outcomes, and factors related to hospital stay in resource-limited settings remains scarce. This study evaluated management outcomes and identified factors associated with the length of hospital stay among children with intussusception at a comprehensive specialized hospital in Northwestern Ethiopia, Bahir Dar.

Methods

A retrospective study was conducted among pediatric patients diagnosed with intussusception at a comprehensive referral hospital between September 2020 and August 2024. Data were extracted from patient medical records using a structured data collection tool. Descriptive statistics were used to summarize patient characteristics and treatment outcomes. Non-parametric statistical tests, including Spearman’s correlation, Mann–Whitney U test, and Kruskal–Wallis test were used to examine the relationship between clinical variables and the length of hospital stay. Statistical significance was considered at p < 0.05.

Results

A total of 257 children with intussusception were included in the study. The majority were males (62.6%), and nearly half (47.0) were rural residents. The mean age of participants was 18.8 months, while more than half of the cases (56.4%) were infants. Overall, 255 patients were successfully managed, while two died from complications related to late presentation. The majority (62.3%) were treated using ultrasound-guided hydrostatic reduction, while the rest required open surgical reduction. Most patients (91.8%) presented with ileocolic intussusception. Participants presented after prolonged symptom durations (mean 2.3 days), increasing the risk of complications. The majority had dehydration (67.6%), and over a quarter had fever at admission (28.0%). Longer hospital stay is associated with higher open surgical intervention (r = 0.89; p < 0.001); body temperature (r = 0.55; p < 0.001), elevated white blood cell count (r = 0.39; p < 0.001), longer duration of symptoms before presentation (r = 0.44; p < 0.001), number of hydrostatic reduction attempts (r = 0.54, p < 0.001), dehydration (η² = 0.49; p < 0.001), and rural residency (r = 0.48; p < 0.001).

Conclusion

The high burden of intussusception among children can be effectively managed with a non—operative hydrostatic reduction. However, late presentation, particularly from rural areas, remains a critical driver of complications and mortality. Strengthening early referral systems in peripheral health centers is essential to reducing the surgical burden and improving outcomes for children with intussusception.

Assessing methods to identify Veterans Health Administration populations with Veterans Justice Programs contact to improve health research

2026-09-08T14:00:00Z

by Andrea K. Finlay, Ingrid Binswanger, Alex H.S. Harris, Matthew Stimmel, Mengfei Yu, Kreeti Singh, Jack Tsai

Military veterans with criminal legal involvement have a need for healthcare and housing to attenuate their risks of suicide, overdose, and homelessness. Links between criminal legal involvement and Veterans Health Administration (VHA) care are poorly understood, partly because it is challenging to correctly identify veterans with criminal legal involvement. This study’s primary objective was to assess VHA data sources and codes from the electronic health record that indicate contact with Veterans Justice Programs (VJP) staff – a broad proxy for criminal legal involvement. We examined three data sources used in previous research to identify veterans who had contact with VJP staff: (1) presence of VJP clinic stop codes in the outpatient encounter records, (2) Homeless Outreach Management and Evaluation System (HOMES) VJP form records collected during VJP outreach, and (3) chart note titles that included VJP terms. In Fiscal Year 2024, there were 52,672 unique VHA-eligible veterans with VJP contact as determined by at least one indicator: 80% with clinic stop codes, 22% with HOMES records, and 63% with chart note titles (Fleiss’ κ = 0.22, p < .001). Patient characteristics varied in their association with each data source, suggesting substantial proportions of veterans with specific characteristics who received VJP services would be missing when only one or two data sources were used. Depending on the data source, diagnosis of a clinical condition varied by 9% and there was a 6% difference observed in a performance measure. These results suggest that the use of all three data sources to identify veterans with VJP contact is the most comprehensive strategy among those examined. Results are most applicable to VHA, the largest healthcare system to serve a criminal legal involved population, and provide information that other healthcare systems may need various data sources and indicators to identify patients with criminal legal involvement.

Integrating decision trees with ANOVA for enhanced interaction visualisations

2026-09-08T14:00:00Z

by Perseverence Savieri, Lara Stas, Kurt Barbé

Interaction effects in ANOVA provide crucial insights into how the effect of one independent variable depends on the level of another. However, interpreting these interactions, especially three-way interactions, remains a challenge. Firstly, visualisation techniques typically rely on multiple separate two-dimensional plots conditioned on the levels of a third factor; as the number of levels of the third factor increases, so does the number of plots, complicating interpretation. Secondly, routinely applying uncorrected post-hoc pairwise comparisons oversimplifies interaction effects and, by ignoring the multiplicity of tests, inflates Type I error rates, potentially leading to misleading conclusions. Advanced methods, such as partial dependence plots and interaction decomposition models, have partially addressed these limitations; however, they typically require substantial statistical or computational expertise, which limits their accessibility. To address these challenges, this manuscript introduces EXCITE (Enhanced eXploration of Complex Interactions in ANOVA using Trees), an interactive web application developed using the Shiny package within the R statistical environment. EXCITE integrates traditional two- and three-way ANOVA models with decision tree-based visualisations. Decision trees detect interaction patterns via recursive data partitioning and present conditional subgroup relationships through an interpretable tree structure. The advantages of EXCITE include presenting two- and three-way interactions intuitively, enhancing accessibility, and facilitating accurate interpretation of complex statistical interactions. This integration provides researchers and educators across various scientific disciplines with a user-friendly tool for interpreting and visualising ANOVA interactions. We illustrate the capabilities of EXCITE using both simulated examples and a real dataset to demonstrate its practical applicability. The web application is freely available online, requiring no installation or coding expertise, at https://zq9mvv-vub0square.shinyapps.io/EXCITE-research-tool/.

Editorial Note: Low-carbon governance, fiscal decentralization, and enterprise green development: Evidence from China

2026-09-08T14:00:00Z

by The PLOS One Editors

Retraction: Investigation of the effect of UV-B light on Arabidopsis MYB4 (AtMYB4) transcription factor stability and detection of a putative MYB4-binding motif in the promoter proximal region of AtMYB4

2026-09-08T14:00:00Z

by The PLOS One Editors

Stigma reduction as quality health care: A qualitative study of structural level mechanisms to address stigma

2026-09-08T14:00:00Z

by Carla Treloar, Emily Lenton, Amy Kirwan, Caitlin Douglass, Gemma Nourse, Adrian Farrugia, Kate Seear, Caroline Watts, Mark Stoove, Elena Cama

The impacts of stigma on health are well-known. Most interventions to reduce stigma focus on education or skills building of health workers and less on organisational or structural approaches. Responding to ongoing efforts to increase the quality of health care, we explore data from semi-structured interviews with 20 key stakeholders to identify and examine stigma reduction opportunities that align with existing practices, policies and structures for strengthening quality in the Australian healthcare system. Analysis focused on the “outer setting” constructs of the Consolidated Framework for Implementation Research to identify and categorise mechanisms that linked to or were determined by governing processes of the (“outer setting”). The necessity to be accredited against national standards was positioned as an over-arching driver of what health systems do and what gets the attention of leaders and executives, and can subsequently impact allocation of resources, including for stigma reduction. Participants’ accounts also raise the possibility of using other more general industrial relations laws to bring greater attention to stigma reduction. Innovative approaches to stigma reduction using macro, structural tools provide a promising opportunity to trial.

Application of musculoskeletal ultrasound in postoperative rehabilitation assessment and monitoring after rotator cuff repair: A systematic review

2026-09-08T14:00:00Z

by Ying Shi, Yi Bao, Chuanxiong Li

Background

The development of rehabilitation protocols after rotator cuff repair has long lacked objective benchmarks. Traditional time‑based regimens are limited by considerable inter‑individual variability and an increased risk of re‑tear. Musculoskeletal ultrasound allows dynamic assessment of tendon healing and muscle morphology, yet evidence for directly linking its use to rehabilitation decisions remains scarce.

Objective

To systematically synthesize the evidence on the use of musculoskeletal ultrasound monitoring to inform rehabilitation decision‑making after rotator cuff repair.

Methods

Following the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) guidelines, we searched PubMed, China National Knowledge Infrastructure (CNKI), and Wanfang Data from January 2020 to April 2026. Original studies were included if they involved patients who had undergone rotator cuff repair, used musculoskeletal ultrasound (including gray‑scale ultrasound, elastography, etc.) to evaluate the rotator cuff tendons or shoulder muscles, and reported at least one parameter related to rehabilitation decision-making or functional outcomes.

Results

Eleven studies were included. Shear wave velocity (SWV), cross‑sectional area (CSA), and echo intensity (EI) were the most frequently reported ultrasound parameters. Available evidence indicated that SWV increased progressively after surgery, with an overall increase of approximately 22% to 25% from one week to 12 months postoperatively. This dynamic trajectory may serve as a reference baseline for judging rehabilitation progress. An abnormally elevated SWV in the early postoperative period was associated with an increased risk of re‑tear, suggesting that a more conservative rehabilitation strategy should be adopted. Tendon stiffness measured at 12 weeks after surgery independently predicted long‑term return to sport. Regarding muscle parameters, changes in CSA and EI were positively correlated with shoulder function scores, and the combination of these two parameters effectively identified patients with rehabilitation bottlenecks.

Conclusion

Musculoskeletal ultrasound parameters are associated with the initiation of active movement, adjustment of exercise load, prediction of return‑to‑sport prognosis, and identification of retear risk. Among these, SWV shows particular promise as an objective monitoring parameter for supporting rehabilitation assessment after rotator cuff repair. Future randomized controlled trials are needed to determine whether ultrasound-informed assessment can improve rehabilitation outcomes compared with traditional time-based regimens, and to establish standardized measurement protocols and clinically applicable reference values. Key findings of this review are summarized in S1 File.

Ecological sensitivity and sustainable spatial planning in a highly urbanized plain: An AHP-GIS and geodetector approach in the Yangtze River Delta Plain

2026-09-08T14:00:00Z

by Tiantian Yao, Qian Liu, Huiqin Zeng, Jiabin Tang

Rapid urbanization in plains exacerbates ecological pressures, while most ecological sensitivity (ES) research focuses on mountains, offering limited guidance for highly urbanized plains. This study assesses ES in the Yangtze River Delta Ecological Green Integrated Development Demonstration Zone (YRD EGI-DDZ) and its planning implications. Ten indicators, covering four criteria, geography, hydrology, natural resource, and human interference were integrated using Analytic Hierarchy Process (AHP) with Geographic Information System (GIS). Geodetector quantified drivers of ES spatial variation, and 2018–2020 land use data revealed recent development and fragmentation. Results show over 70% of the area under medium to extremely highly sensitivity, with high or extreme high zones clustered along Dianshan Lake, Yuandang, East Taihu, and contiguous ecological land. Low sensitivity mainly corresponds to urban land. Key drivers include land use, nighttime lights, population density, and water proximity, while elevation and slope contribute marginally. New construction land expands mainly along urban fringes and transport corridors, inserting low sensitivity strips into medium sensitivity belts and fragmenting high sensitivity cores. These findings inform a sensitivity-based zoning and corridor control framework, refining existing plans and supporting sustainable spatial development in similar plains.

Optimizing nitrogen fertilizer via liquid bio-slurry equivalent ration for hot pepper (Capsicum annum L.) and soil productivity in Amhara Region, Ethiopia

2026-09-08T14:00:00Z

by Zelalem Addis, Zelalem Ayalenh, Zimie Ambaw, Tesfaye Feyisa, Bitewelegn Kerebeh

Hot pepper (Capsicum annuum L.) is a critical component of Ethiopian cuisine, widely consumed in both its green and red stages. Despite its importance, the productivity of hot pepper in the Amhara region remains suboptimal, primarily due to degraded soil fertility and the depletion of soil organic matter. To address these challenges, a two-year field experiment (2021/22–2022/23) was conducted in Jabithenan District to evaluate the impact of liquid bio-slurry (LBS) and nitrogen (N) fertilizer combinations on soil chemical properties and hot pepper yield. The study employed a randomized complete block design with six treatments: (1) control (no N), (2) recommended nitrogen (RN), (3)75% LBS + 25% RN, (4) 50% LBS + 50% RN, (5) 25% LBS + 75% RN, and (6) 100% LBS. Each treatment was replicated three times. Hot pepper seedlings (variety Mareko Fana) were transplanted into plots measuring 4.2 m × 3 m, with spacing of 0.3 m between plants and 0.7 m between rows. Soil samples were collected pre-planting and post-harvest to analyze particle size distribution, pH, total nitrogen, organic carbon, available phosphorus, and cation exchange capacity (CEC). Yield and yield components were also evaluated. Data were analyzed using ANOVA in SAS software. The results revealed that integrating LBS with RN significantly improved soil chemical properties and hot pepper yield. The 50% LBS + 50% RN and 25% LBS + 75% RN treatments exhibited superior performance, enhancing soil nutrient content and achieving higher yields compared to the control. These treatments also delivered the highest economic benefits, with a marginal rate of return exceeding 100%. Among the tested combinations, 50% LBS + 50% RN is recommended for farmers with access to sufficient LBS resources and livestock.

Pain alleviation in diabetic neuropathy using hybrid closed loop insulin pumps (PAINLESS) – A randomised crossover trial protocol

2026-09-08T14:00:00Z

by Simon Alexander Berry, Ahmed Iqbal, Jackie Elliott, Rajiv Gandhi, Abdul Paracha, Vaios Koutroukas, Mohummad Shaan Goonoo, Mahnoor Fatima Haq, Andrew Gerges, Gordon Sloan, Solomon Tesfaye, Pratik Choudhary, Dinesh Selvarajah

Introduction

Painful diabetic neuropathy (PDN) is a common complication of diabetes that leads to significant co-morbidity. Emerging evidence suggests glycaemic variability may be linked to fluctuations in pain intensity. Hybrid closed loop (HCL) systems reduce glycaemic variability, raising the possibility that they may modify pain intensity. This study aims to evaluate the effects of HCL use on pain intensity in people with PDN.

Materials and methods

PAINLESS is a two-centre, randomised cross-over study, recruiting 49 adults with type 1 diabetes and PDN. Each participant will complete two 12-week intervention periods in a randomised sequence (1:1): one with standard care including continuous glucose monitoring (CGM) and one with HCL using the Tandem t:slim X2 insulin pump with Control-IQ technology. The primary outcome is the change in 7-day average 24-hour pain intensity [rated on a numerical scale from 0-10 (NRS)] from baseline to the end of each 12-week intervention period as measured by daily pain diaries. Secondary outcomes include measures of pain trajectory/durability [responder rates (30% and 50% pain reduction in 7-day NRS), and the AUC for daily NRS scores], functional and quality of life outcomes [Short Form Health Survey (SF-36), and Short Form of the Brief Pain Inventory (BPI-MSF)], mood [Beck Depression Inventory (BDI)], health status [EQ-5D-5L], and global improvement [participant and clinician reported global impression of change]. Exploratory endpoints will harness neurophysiological assessments including Sudoscan, DPN-Check, Vagus and Vibrosense, and sleep and activity data from Withings devices. Statistical analyses will employ an intention-to-treat approach and mixed effect models.

Timelines

24-month trial: 18 months recruitment/follow up, 6 months close-out, analyses and dissemination.

Registration Details

ISRCTN24233750.

Retraction: Utilizing multi-level convolutional neural networks to achieve refined modeling and visual analysis of college students’ mental health data

2026-09-08T14:00:00Z

by The PLOS One Editors

Preferences and reasons for clothing colors in women patients and survivors of breast cancer in Korea

2026-09-08T14:00:00Z

by Seon-Hye Won, Yun-A. Kim, Sang-Yeon Suh, Ji Hyun Im, Erika Nakanishi, Tae Seon Lee, Yoonjoo Kim, Hee Jung Kim, David Hui, Beom Seok Kwak

Purpose

Clothing color can affect the psychological aspects in female patients and survivors of breast cancer; however, little is known regarding their preferences and reasons for choosing specific clothing color. This study aimed to explore the factors influencing their clothing color choices.

Method

This qualitative study was conducted through face-to-face interviews. Fourteen adult female patients and survivors of breast cancer were recruited at a university hospital in Korea. An art therapist requested participants to indicate their usual choice of clothing colors and reasons. Participants were encouraged to talk about memories related to clothing colors in the past and present. Participants were asked if there were any changes in clothing colors after the diagnosis of breast cancer. Preferences and reasons regarding clothing colors were explored during one-hour interview. The interviews were audiotaped and analyzed using the Korean Computer Assisted Qualitative Data Analysis Software (CAQDAS), Blue Bird 2.0 (www.thebluebird.kr). The researchers crosschecked thematic coding results using the software.

Results

All 14 patients and survivors had memorable experiences regarding their favorite clothing colors. Thematic coding identified four key themes: (1) social interactions and social image (39.5% of key sentences stated), (2) enhanced self-image and concealment of body shape (20.9%), (3) positive feelings (18.6%), and (4) changes in color preference after breast cancer diagnosis (14%).

Conclusion

All female patients and survivors of breast cancer had preferences and good memories for clothing color. In most participants, these colors supported social interaction, self-image, and positive feelings. It is needed to investigate if intervention through clothing colors would support quality of life.

Polish adaptation and validation of the sustainable career scale

2026-09-08T14:00:00Z

by Jaroslaw Grobelny, Angela Russo, Mateusz Klakus, Andrea Zammitti

The evolving global labor market highlights the significance of sustainable careers, which balance individual well-being, productivity, and social empowerment. This study aimed to adapt the Sustainable Career Scale for the Polish context, addressing the need for culturally transferable models to support evolving career paths. Understanding these cultural influences is crucial for advancing global career research. The study followed a rigorous, multi-stage process involving mixed methods. Focus group interviews were conducted to assess cultural relevance, item clarity, and face validity. The pilot study tested reliability and internal consistency using exploratory factor analysis. Study 1 utilized confirmatory factor analysis to verify the four-factor structure and evaluate measurement invariance across gender and age groups. Study 2 assessed lagged associations with well-being outcomes and test-retest reliability through longitudinal data collection. The Polish adaptation of the SCS maintained its four-factor structure (happiness, health, productivity, and social empowerment) and demonstrated high internal consistency and temporal stability, along with criterion and discriminant validity evidence and lagged associations with well-being outcomes, with some limitations for the Health dimension. The scale showed measurement invariance across gender and tested age groups. This study provides preliminary evidence supporting the Polish adaptation of the SCS in the present samples, confirming the distinctiveness of its four dimensions. The findings support the applicability of the sustainable careers model in the Polish context and underscore the significance of sustainable career strategies.

Spatiotemporal dynamics and phylogeography of HCoV-NL63 and HCoV-OC43 in Thailand, 2024–2025

2026-09-08T14:00:00Z

by Jiratchaya Puenpa, Ratchadawan Aeemjinda, Preeyaporn Vichaiwattana, Sumeth Korkong, Yong Poovorawan

Endemic human coronaviruses (HCoVs) HCoV-NL63 and HCoV-OC43 are common causes of acute respiratory infections (ARI), yet integrated surveillance and genomic data from Southeast Asia remain limited. We characterized HCoV-NL63 and HCoV-OC43 circulation in Thailand, during 2024–2025 using routine real-time RT-PCR testing, partial spike sequencing, and time-scaled phylogenetic analyses with global references. Among 11,709 ARI specimens, 329/8,122 were HCoV-positive in 2024 (4.05%) and 131/3,587 in 2025 (3.65%). Positivity was strongly seasonal, peaking in winter, and SARS-CoV-2 surges in the same testing stream generally coincided with lower endemic HCoV positivity. Genotype composition differed by virus: HCoV-OC43 was dominated by genotypes K and J at near-equal frequencies (48.3% and 47.2%), whereas HCoV-NL63 was mainly genotype C4 (43.6%), followed by B2 (32.7%) and C3 (20.9%). Time-scaled phylogenies placed Thai sequences across multiple regions of global diversity, consistent with repeated introductions and onward transmission within several co-circulating lineages. Estimated substitution rates were 3.86 × 10^-4 substitutions/site/year for HCoV-NL63 and 9.27 × 10^-4 for HCoV-OC43. Discrete-trait phylogeography supported bidirectional connectivity involving Thailand, with virus-specific differences in the most supported routes. Skygrid reconstructions suggested declines in genetic diversity after 2020, overlapping the COVID-19 era, with a more pronounced decrease for HCoV-OC43. Evidence for selection was limited and inconsistent for HCoV-NL63, whereas several HCoV-OC43 sites overlapped codon-based signals of diversifying selection. Overall, these findings provide a baseline for endemic HCoV seasonality, genotype composition, and connectivity in Thailand, and support continued genomic surveillance in Southeast Asia.