PloS One[JOURNAL]
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Supplementation of calcium, magnesium, phosphate, and potassium in critically ill patients: A multicenter cohort study.
Yarnell CJ, Bodley T, Law AC … +3 more , Tomlinson G, Vail EA, Bosch NA
PLoS One · 2026 · PMID 42391217 · Full text
OBJECTIVE: To investigate hospital-level variation in the supplementation of calcium, magnesium, phosphate, and potassium in critically ill patients. DESIGN: Retrospective cohort study. SETTING: Premier Healthcare Databa...
OBJECTIVE: To investigate hospital-level variation in the supplementation of calcium, magnesium, phosphate, and potassium in critically ill patients. DESIGN: Retrospective cohort study. SETTING: Premier Healthcare Database of inpatients from the USA. PATIENTS: Adults (age ≥ 18 years) admitted to an intensive care unit (ICU) on hospital day 1 between October 1, 2022 and July 31, 2024, who had at least one calcium (total or ionized), magnesium, phosphate, or potassium level measured in an ICU between day 2 and 28. We excluded patients with renal failure, a pregnancy-related diagnosis, and intracranial bleeding on admission. INTERVENTIONS: Calcium, magnesium, phosphate, or potassium supplementation. MEASUREMENTS AND MAIN RESULTS: We included 47,988 patients from 67 ICUs across 52 hospitals, totaling 167,621 patient-days with a measurement of one of the studied electrolytes. Median age was 64 years (interquartile range [IQR] 52-74) and 46% (22,057) were female. There were 38,621 patients (80.5%) with a minimum value below a lower limit of normal, and 33,626 (70.1%) patients who received supplementation. Across hospitals, the median (IQR) percentages receiving supplementation per day were: calcium 9.4% (6.7-12.2); magnesium 28.6% (22.6-35.0); phosphate 19.1% (15.9-23.2); potassium 28.9% (25.8-34.6). From a multilevel model, the median relative odds of supplementation, comparing any two hospitals, ranged from 1.51 (95% confidence interval [CI] 1.48-1.55) for potassium to 2.09 (95% CI 1.99-2.19) for magnesium. At most hospitals, there were no calcium or phosphate levels at which the percentage receiving supplementation exceeded 50%. At 75% of hospitals there was a magnesium level at which the percentage receiving magnesium supplementation was 50% or more (range: 1.5-2.1 mg/dL), and at 96% of hospitals there was an analogous potassium level (range: 3.3-3.9 mmol/L). CONCLUSION: Supplementation of calcium, magnesium, phosphate, or potassium is common in critically ill patients and varies across hospitals, suggesting a need for randomized trials to clarify optimal supplementation practices.
Seasonal patterns of vegetation drought resilience and vegetation loss in Central Asia.
Jiang L, Wu G, Gui X … +1 more , Liu X
PLoS One · 2026 · PMID 42391216 · Full text
Drought events have become increasingly common in Central Asia, increasing the risk of vegetation degradation. In this study, the resilience of vegetation to drought and its drivers was investigated across different seas...
Drought events have become increasingly common in Central Asia, increasing the risk of vegetation degradation. In this study, the resilience of vegetation to drought and its drivers was investigated across different seasons. The findings revealed that western Central Asia faced a notably high incidence of spring droughts, characterized by longer durations and greater severity than droughts in other seasons. In contrast, the Aral Sea Basin experienced fewer droughts in summer and autumn, although these droughts were more severe and intense and had longer durations. Croplands, particularly those in northern Kazakhstan, generally demonstrated relatively low resistance but relatively strong resilience. In contrast, sparsely vegetated areas in regions such as southern Xinjiang and areas downstream of the Aral Sea Basin presented high drought resistance but relatively low resilience. Precipitation and vapour pressure deficit (VPD) had the most significant impact on drought resilience in Central Asia, with a combined contribution of 55.18%, particularly in the northern and eastern regions of the area. The vegetation in spring was characterized by the highest resistance and resilience levels (40.67% and 40.65%, respectively) in Central Asia, followed by those in summer. In terms of vegetation loss, vegetation in spring accounted for the greatest proportion (44.03%), followed by that in summer, at 31.07%. The main characteristics of drought (duration and intensity) were the major factors influencing the loss of vegetation, especially in grasslands and sparsely vegetated areas. During prolonged summer droughts (>40 months), grasslands and sparse vegetation suffered substantial declines in gross primary productivity (GPP). In contrast, forests exhibited more severe GPP reduction at a drought peak of around 2 and intensity above 1.5. Quantifying the resilience and loss of vegetation to drought across different seasons can aid in the formulation of effective strategies to prevent and manage vegetation degradation in Central Asia.
Evaluating the impact of the EU Medical Device Regulation (MDR) on mortality and device availability in Germany.
Gandjour A
PLoS One · 2026 · PMID 42391215 · Full text
INTRODUCTION: The EU Medical Device Regulation (MDR), effective since May 25, 2017, aims to enhance the safety and quality of medical devices within the EU. This study models the potential net mortality implications of t...
INTRODUCTION: The EU Medical Device Regulation (MDR), effective since May 25, 2017, aims to enhance the safety and quality of medical devices within the EU. This study models the potential net mortality implications of the MDR in Germany under explicit assumptions about safety improvements, market withdrawals, and certification delays. METHODS: A combined top-down and bottom-up approach was employed to evaluate the impact of the EU MDR on mortality in Germany. The top-down approach estimated avoided deaths using the Keyfitz-Vaupel life-table elasticity, while the bottom-up approach quantified mortality reductions attributable to individual MDR-regulated medical devices. Based on the results of both approaches, the analysis also estimated the number of deaths potentially resulting from market withdrawals and certification delays. RESULTS: Official German reports attribute an average of 17 device-related deaths annually, whereas international estimates suggest the true figure may reach up to 2,500 per year. Market withdrawals and certification delays associated with MDR implementation were modelled as potentially contributing an estimated 163-1,884 additional annual deaths and a one-time mortality burden of 700-4,200 deaths. CONCLUSION: Under central assumptions, the MDR is consistent with long-term reductions in device-related mortality, but transition-period certification bottlenecks and withdrawals-especially for niche/pediatric devices-can offset gains in the short to medium term. Targeted mitigation is warranted to secure benefits and limit unintended harms.
Correction: Potential mechanisms and effects of AFB1-induced asthma: A comprehensive analysis based on network toxicology and molecular docking.
Yu Z, Gao M, Wu X … +6 more , Li J, Liu B, Wang R, Tan J, Yu X, Geng L
PLoS One · 2026 · PMID 42391214 · Full text
[This corrects the article DOI: 10.1371/journal.pone.0341172.].
[This corrects the article DOI: 10.1371/journal.pone.0341172.].
Association of urinary post-translationally modified fetuin-A fragments with diabetic kidney disease risk stratification in Japanese patients with type 2 diabetes.
Mori T, Ito H, Kozasa T … +4 more , Yukawa C, Matsumoto S, Inoue H, Antoku S
PLoS One · 2026 · PMID 42391213 · Full text
AIMS: Conventional biomarkers such as estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) primarily reflect glomerular damage and often fail to detect early tubular injury. Conseque...
AIMS: Conventional biomarkers such as estimated glomerular filtration rate (eGFR) and urinary albumin-to-creatinine ratio (uACR) primarily reflect glomerular damage and often fail to detect early tubular injury. Consequently, patients with "non-albuminuric diabetic kidney disease (DKD)" may be overlooked. This study evaluated the independent association between urinary post-translationally modified fetuin-A fragments (uPTM-FetA) and DKD risk stratification in Japanese patients with type 2 diabetes. METHODS: We conducted a cross-sectional study of 219 outpatients with type 2 diabetes between November 2023 and February 2024 at Edogawa Hospital. First-morning urine samples were analyzed for uPTM-FetA and urinary liver-type fatty acid-binding protein (uL-FABP) using enzyme-linked immunosorbent assays. DKD risk was classified into four categories based on the KDIGO guidelines. The association between uPTM-FetA and higher DKD-risk (categories 2 + 3 + 4) was assessed using multiple logistic regression and restricted cubic spline (RCS) analyses, validated by bootstrapping. RESULTS: The optimal cutoff value for uPTM-FetA was determined to be 11.76 ng/mgCr. Multivariable analysis adjusted for potential confounders revealed that high uPTM-FetA levels were significantly and independently associated with DKD-risk categories 2 + 3 + 4 (adjusted odds ratio: 3.88; 95% CI: 2.02-7.45; P < 0.01). RCS analysis indicated a significant non-linear association (P = 0.04). Notably, high uPTM-FetA was detected in 38.8% of patients with normoalbuminuria and 42.0% of those with preserved eGFR. A striking discrepancy was observed compared to uL-FABP: while high uL-FABP was completely absent (0.0%) in patients within the low-to-moderate risk categories (categories 1 and 2), high uPTM-FetA was observed in 34.0% and 60.8% of these patients, respectively. CONCLUSIONS: uPTM-FetA is independently associated with DKD severity and is elevated in a substantial proportion of patients with early-stage disease where conventional markers remain normal. Unlike uL-FABP, which increases predominantly in advanced stages, uPTM-FetA appears to identify tubular stress earlier. Thus, uPTM-FetA serves as a valuable complementary biomarker to uACR for refining DKD risk stratification.
Data-driven prediction and thermodynamic performance assessment of industrial cooling towers using advanced machine learning algorithms.
Jamil SR, Shehzad A, Usman M … +7 more , Abbas MM, Qaisrani OZ, Saleem MW, Musharaf HM, Petrů J, Bashir MN, Fouad Y
PLoS One · 2026 · PMID 42391210 · Full text
Cooling towers are an important part of the thermal system in industries, where they are used to remove unwanted heat and help maintain the proper performance of the machines. Four machine learning algorithms, namely ran...
Cooling towers are an important part of the thermal system in industries, where they are used to remove unwanted heat and help maintain the proper performance of the machines. Four machine learning algorithms, namely random forest, support vector machine (SVM), decision tree, and AdaBoost are proposed in this paper for the performance forecasting of cooling towers. for the performance forecasting of cooling towers. These models were built in Python with the help of the following operational parameters: inlet water temperature (32-41°C), ambient air temperature (14-32°C), and relative humidity (35-92%). All the essential performance measures like outlet water temperature, water losses, the effectiveness, and the second law efficiency were predicted and assessed by statistical indicators such as coefficient of determination (R²), root mean square error (RMSE) and mean absolute percentage error (MAPE). The SVM algorithm had the best predictive accuracy and lowest prediction errors of all the tested models with a value of R2 of 0.985 and RMSE of 1.25 kg/s. Parametric analysis had indicated that the increase in relative humidity between 35% and 92% decreased the evaporation losses by about 55-70% and makeup water demand by about 58-68%. Thermodynamic analysis further revealed that the second-law efficiency improved by approximately 65-75% as the ambient temperature increased. The results indicate that predictive modeling with machine learning offers a useful method in the optimization of cooling tower operation and minimizing water use in industrial systems.
NOX2 inhibition attenuates oxidative stress and eNOS uncoupling in pulmonary arteries of rats following simulated air diving.
Gong Q, Xiao L, Wang S
PLoS One · 2026 · PMID 42391209 · Full text
Simulated diving and decompression can impair endothelial function, but the upstream oxidant sources and their relationship with endothelial nitric oxide synthase (eNOS) coupling in the pulmonary circulation remain uncle...
Simulated diving and decompression can impair endothelial function, but the upstream oxidant sources and their relationship with endothelial nitric oxide synthase (eNOS) coupling in the pulmonary circulation remain unclear. We investigated whether NADPH oxidase 2 (NOX2) is associated with oxidative stress, tetrahydrobiopterin (BH4) depletion, altered eNOS coupling, and pulmonary endothelial dysfunction after simulated air diving. Eighteen male Sprague-Dawley rats were assigned to three groups: control, decompression stress, and decompression stress with the NOX2 inhibitor GSK2795039 (100 mg/kg, intraperitoneal) administered before pressurization. Decompression stress was induced by hyperbaric exposure to 600 kPa for 1 h followed by decompression to ambient pressure; pulmonary arteries were collected 1 h after decompression. We evaluated NOX2 expression, oxidative stress indices, BH4 content, eNOS phosphorylation and dimer/monomer ratio, nitric oxide metabolites (nitrate plus nitrite), markers associated with endothelial activation, and vasoreactivity. Compared with controls, decompression stress increased NOX2 expression, reactive oxygen species and lipid peroxidation, decreased superoxide dismutase activity, reduced BH4 and nitric oxide metabolites. It also caused a shift in eNOS towards a lower dimer/monomer ratio, increased endothelin-1 and adhesion molecules, and impaired endothelium-dependent relaxation, though endothelium-independent relaxation remained intact. GSK2795039 pretreatment attenuated oxidative stress, improved BH4 availability, restored nitric oxide metabolites, and decreased markers of endothelial activation, partially improving endothelium-dependent relaxation. These findings suggest that NOX2-associated oxidative stress contributes to reduced BH4 availability and eNOS coupling imbalance, leading to pulmonary endothelial dysfunction after decompression.
Calculation method and predictive analysis of flexural capacity of reinforced concrete beams strengthened with carbon fiber-reinforced polymer sheets applied to the side surfaces.
Liu X
PLoS One · 2026 · PMID 42391208 · Full text
In response to the situation where it is not allowed to stick CFRP cloth at the bottom of a concrete beam and stick it on both sides of the beam, this article analyzes the factors that affect the ultimate flexural bearin...
In response to the situation where it is not allowed to stick CFRP cloth at the bottom of a concrete beam and stick it on both sides of the beam, this article analyzes the factors that affect the ultimate flexural bearing capacity of reinforced concrete beams reinforced with CFRP on the side, and provides a calculation method for the flexural bearing capacity of reinforced concrete beams reinforced with CFRP on the side; At the same time, for the convenience of calculation, this paper explores the comprehensive consideration of the tensile force of carbon fiber cloth pasted on the side and the corresponding correction factor ηf of the force arm, and analyzes it by fitting a quadratic trend function with the ratio of CFRP pasting height to beam height (hf/h). Based on this, the calculation methods for the bending capacity of carbon fiber cloth pasted on the bottom surface according to the "Code" and the bending capacity of carbon fiber cloth pasted on the bottom surface according to the quadratic trend function are proposed. Research has shown that using CFRP to reinforce reinforced concrete beams on the side can effectively improve the flexural bearing capacity. After comparative analysis, the calculation results of three calculation methods are in good agreement with the experimental values; The correction coefficient ηf increases with the increase of the ratio of the bonding height to the beam height (hf/h). When the ratio of the bonding height to the beam height (hf/h) exceeds 0.25, the value of the correction coefficient ηf increases significantly; Especially when the ratio of the pasting height to the beam height (hf/h) exceeds 0.5, it is recommended to calculate the flexural bearing capacity of carbon fiber cloth pasted on the bottom surface according to the proposed quadratic trend function for ηf; At the same time, it is recommended to consider the reduction of the cross-sectional area of carbon fiber cloth as compensation when determining the flexural bearing capacity of reinforced concrete beams with carbon fiber cloth pasted on the side according to the calculation of the beam bottom. In order to reduce errors, the utilization coefficient of ψf is no longer limited. Theoretical analysis shows that there are critical values for the bonding height and thickness of carbon fiber cloth used for reinforcement. When these exceed the critical value, the effect on enhancing load-bearing capacity becomes insignificant or even declines.
Spatio-temporal patterns and prediction of colorectal cancer mortality in Chinese cancer registration areas: A nationwide study based on multiple models.
Zhao Y, He X, Shao J … +4 more , Zhu L, Chu Z, Man Y, He J
PLoS One · 2026 · PMID 42391207 · Full text
OBJECTIVE: To describe the spatiotemporal distribution characteristics of colorectal cancer (CRC) mortality in Chinese cancer registration areas and to predict its future trends, thereby providing an epidemiological basi...
OBJECTIVE: To describe the spatiotemporal distribution characteristics of colorectal cancer (CRC) mortality in Chinese cancer registration areas and to predict its future trends, thereby providing an epidemiological basis for CRC prevention and control in China. METHOD: This study used cancer registry data from 2005 to 2018, collected from the China Cancer Registry Annual Report (2008-2021), to comprehensively describe CRC mortality patterns. Joinpoint regression models were employed to calculate the annual percentage change (APC) and average annual percentage change (AAPC) to analyze temporal trends. The age-period-cohort model was used to disentangle the effects of age, period, and cohort. A Bayesian age-period-cohort (BAPC) model was constructed to predict future trends for 2019-2035. Global and local spatial autocorrelation methods were applied to describe the spatial distribution of CRC mortality and to identify high-risk areas. RESULTS: From 2005 to 2018, in Chinese cancer registration areas, the mortality of CRC was 14.45/100,000, and the age-standardized mortality rate (ASMR) was 11.13/100,000 [95% confidence interval (CI): 11.03, 11.27]. From 2005 to 2007, the mortality rate of CRC showed an upward trend, with an APC of 3.67% (95% CI: -0.77%, 8.33%); from 2007 to 2013, there was a significant downward trend with an APC of -2.45% (95%CI: -3.14%, -1.47%); from 2013 to 2018, there was an upward trend with an APC of 0.13% (95% CI: -0.88%, 1.17%). From 2007 to 2013, the CRC mortality rates of different genders showed a significant downward trend. In urban areas from 2009 to 2018, the CRC mortality rate showed a significant downward trend with an APC of -1.21% (95% CI: -1.71%, -0.71%), but in rural areas, it showed a significant upward trend with an AAPC of 0.59% (95% CI: 0.24%, 1.56%). The age effects indicated that the risk of CRC death increased with age. From 2019 to 2035, the ASMR of CRC in Chinese cancer registration areas will generally show a slow upward trend. Spatial autocorrelation analysis showed that the mortality rate of CRC in Chinese cancer registration areas exhibited spatial clustering characteristics, with hotspots concentrated in the eastern coastal and northeastern provinces. CONCLUSIONS: The mortality rate of CRC in Chinese cancer registration areas showed a trend of first increasing, then decreasing, and then increasing from 2005 to 2018. It was predicted that it will continue to rise from 2019 and still face a series of challenges such as urban-rural, gender, and regional inequality. In the future, more targeted prevention and control strategies should be adopted, combined with dietary and lifestyle interventions, to further reduce the burden of CRC.
Spatial distribution of uptake of newly introduced vaccines and its associated factors among children aged 12-35 months in Ethiopia: Multi-scale Geographically Weighted Regression Analysis.
Feleke HG, Simegn MB, Worede DT … +1 more , Tilahun WM
PLoS One · 2026 · PMID 42391204 · Full text
BACKGROUND: The pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RVV) have been introduced to Ethiopia's expanded childhood immunization program in 2011 and 2013, respectively. METHODS: A cross-sectional study...
BACKGROUND: The pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RVV) have been introduced to Ethiopia's expanded childhood immunization program in 2011 and 2013, respectively. METHODS: A cross-sectional study among 2,055 children aged 12-35 months was employed. Data were extracted from the Kids Record file of the 2019 Ethiopian Mini Demographic and Health Survey. Spatial regression models were fitted and compared using corrected Akaike Information Criteria, Bayesian Information Criteria and adjusted R2. Spatial predictors were determined to be statistically significant if their p-value was < 0.05. RESULTS: Incomplete uptake of recently introduced immunizations was observed in nearly half (48.83%) of children aged 12-35 months. Its distribution throughout Ethiopia's regions shows significant spatial clustering, with the eastern part of SNNPR and Somali regions having hot spots. A total of 3 significant clusters, located in southern Oromia, east and west Hararge, the entire SNNPR, and the majority of the Somali region, with a high rate of incomplete uptake of newly introduced vaccines, were identified during SaTScan analysis. Not having vaccination cards, household size more than 5 members, home delivery, not having postnatal care, and less than 18 maternal age at first birth are positive significant spatial factors while parents not being head of the household were identified as negative significant spatial factors. CONCLUSION: There is high incomplete uptake and spatial disparities of PCV and RVV. To improve vaccination coverage among children aged 12-35 months, policymakers and health planners should prioritize targeted interventions in hotspot areas, strengthen maternal health service utilization, and enhance vaccination tracking systems. Promoting community awareness and improving access to essential health services will be critical to ensuring equitable immunization uptake across the country.
Study on the influence of compaction energy and moisture content on the permeability and compression characteristics of granite-weathered soil.
Lyu H, Wei D, Gu J … +1 more , Fan L
PLoS One · 2026 · PMID 42391201 · Full text
The feasibility of reusing granular weathered (GW) soil as foundation fill is closely related to the strength and stability. Initial moisture content and compaction energy were identified as the main factors affecting th...
The feasibility of reusing granular weathered (GW) soil as foundation fill is closely related to the strength and stability. Initial moisture content and compaction energy were identified as the main factors affecting the strength and deformation behavior of GW soil. GW soil samples were prepared with different initial moisture contents ranging from 7 ~ 15% and compacted under varying compaction energies ranging from 50 ~ 125%, respectively. The results indicate that the permeability coefficient decreases sharply with increasing compaction energy and then gradually stabilizes at higher compaction energy levels, suggesting that compaction energy is the dominant factor governing soil permeability. Higher initial moisture content leads to larger strains due to the presence of thicker adsorbed water films, whereas higher compaction energy enhances interparticle bonding, reduces the void ratio, and increases soil stiffness. In particular, the void ratio is affected by both initial moisture content and compaction energy, highlighting the necessity of incorporating compaction energy into predictive permeability models. Furthermore, a compaction-energy-based permeability prediction model was developed, with the predicted results showing strong agreement with the experimental data. These findings provide practical guidance for optimizing the compaction of GW soil to enhance foundation stability and reduce the risks associated with rainfall infiltration, and seepage failure.
Association between laryngoplasty and pneumonia incidence in patients with unilateral vocal fold paralysis: A Japanese insurance claims database study.
Hemmi M, Sano D, Tanoshima R … +1 more , Oridate N
PLoS One · 2026 · PMID 42391200 · Full text
OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can lead to both voice impairment and dysphagia. Previous studies have suggested that surgeries aimed at improving voice function in patients with UVFP may also incidenta...
OBJECTIVE: Unilateral vocal fold paralysis (UVFP) can lead to both voice impairment and dysphagia. Previous studies have suggested that surgeries aimed at improving voice function in patients with UVFP may also incidentally enhance swallowing. However, the preventive effect of such surgeries on pneumonia remains unclear. We evaluated the impact of laryngoplasty on the incidence of pneumonia in Japan using a large employment insurance claims database of corporate employees under 75 years of age and their family members. METHODS: The study cohort consisted of patients diagnosed with UVFP between January 2013 and December 2022, identified from an insurance claims database. A propensity score-matched cohort was created using a 1:3 matching ratio between the treatment and non-treatment groups. Follow-up began at the index date, defined as the initial diagnosis of UVFP, and continued until the end of the study period. The primary analysis compared the cumulative incidence of pneumonia between treatment and non-treatment groups. The secondary analysis employed a self-controlled design to compare pneumonia incidence before and after laryngoplasty within treated patients. RESULTS: The full cohort included 7,641 patients with UVFP, of whom 914 comprised the matched cohort (treatment group, n = 230; non-treatment group, n = 684). The cumulative incidence of pneumonia tended to be higher in the treatment group than in the non-treatment group (hazard ratio, 1.39; 95% CI, 0.93-2.08; p = 0.098). In contrast, the self-controlled analysis demonstrated a lower pneumonia incidence after laryngoplasty compared with the pre-treatment period (incidence rate ratio, 0.36; 95% CI, 0.27-0.52; p < 0.001). CONCLUSIONS: Given the discordant findings across analytical approaches, no definitive conclusion regarding a preventive effect can be drawn from the present study. Further studies are needed to evaluate long-term outcomes and to clarify causal relationships.
Insomnia and poor sleep quality in refugee and asylum-seeking populations: A systematic review and meta-analysis.
Carpinelli LP, Gauer LE, Soares VHD … +5 more , Williams SB, Szepeilewicz CB, Pezzini JV, Neto AOG, Ribeiro STG
PLoS One · 2026 · PMID 42391198 · Full text
Refugees and asylum seekers face significant mental health challenges, yet sleep disturbances remain underrecognized despite their critical impact on well-being. This systematic review and meta-analysis assessed sleep qu...
Refugees and asylum seekers face significant mental health challenges, yet sleep disturbances remain underrecognized despite their critical impact on well-being. This systematic review and meta-analysis assessed sleep quality and insomnia severity across 66 studies (n = 42,956). Pooled analyses of the Insomnia Severity Index (ISI) and Pittsburgh Sleep Quality Index (PSQI) based on studies identified in Cochrane, Embase, and PubMed from database inception to December 2024 revealed clinically significant sleep disturbances. The pooled mean ISI score (13.76, 95% CI 10.39-17.13) falls within the upper end of the subthreshold range, bordering on moderate clinical insomnia, while PSQI scores (8.59, 95% CI 2.11-15.07) exceeded clinical thresholds for poor sleep. The pooled prevalence of sleep adversities was 43.2% in adults and 36.4% in children. Secondary findings highlighted prolonged sleep latency and frequent nightmares. Although subgroup analyses suggested trends across populations and assessment methods, statistical significance was limited by sample heterogeneity. Standardized sleep assessments must be integrated into refugee health protocols, with targeted interventions addressing insomnia risk factors.
Hybrid RSM-NSGA-II based multi-objective optimization of electrical discharge machining of AISI D2 steel.
Mondal S, Sardar BS, Mandal P … +3 more , Samal SP, Doloi B, Ghadai RK
PLoS One · 2026 · PMID 42391195 · Full text
In this study, electrical discharge machining (EDM) of AISI D2 die steel was performed by varying three different process parameters: peak current (Ip), pulse-on time (Ton), and duty cycle (c). Enhancing both surface qua...
In this study, electrical discharge machining (EDM) of AISI D2 die steel was performed by varying three different process parameters: peak current (Ip), pulse-on time (Ton), and duty cycle (c). Enhancing both surface quality and machining performance is very important for die steel applications; therefore, a hybrid approach for multi-objective optimization was employed. A Box-Behnken design of response surface methodology (RSM) was utilized to conduct the experiments, while analysis of variance (ANOVA) was used to examine the influence of process parameters on the responses. Mathematical models were developed using RSM, which were finally utilized as fitness functions for the Non-Dominated Sorting Genetic Algorithm II (NSGA-II) to get solutions of multi-objective optimization. The algorithm generated a set of non-dominated solutions forming the Pareto frontier. To identify the most desirable solution, the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used. The optimal results obtained through TOPSIS analysis were a surface roughness of 5.22 µm and a material removal rate (MRR) of 0.250 g/min, corresponding to the process parameters: peak current (Ip) = 10.03 A, pulse-on time (Ton) = 30.70 µs, and duty cycle (c) = 14.94%.
The role of estimated muscle power from a sit-to-stand test in determining frailty in community-dwelling older adults.
Condon C, Fallon E, Behan FP … +2 more , Romero-Ortuno R, McAuliffe S
PLoS One · 2026 · PMID 42391194 · Full text
INTRODUCTION: This study explored the usefulness of estimated lower-limb muscle power, derived from the 5-times sit-to-stand (5xSTS) test, for identifying frailty among community-dwelling older adults in Ireland. METHODS...
INTRODUCTION: This study explored the usefulness of estimated lower-limb muscle power, derived from the 5-times sit-to-stand (5xSTS) test, for identifying frailty among community-dwelling older adults in Ireland. METHODS: Data from Wave 3 of The Irish Longitudinal Study on Ageing (TILDA) were analysed, focusing on adults aged 50 years and older. Muscle power was estimated using a standardised equation from the five-time sit-to-stand (5xSTS) test, incorporating body height, mass, and chair height. Frailty status was classified using an Index, according to established criteria. Logistic regression models assessed the predictive capacity of muscle power relative to 5xSTS. Thresholds for frailty risk were explored through Receiver Operating Curves and Locally Weighted Scatterplot Smoothing. RESULTS: Findings reveal a decline in muscle power with advancing age, more pronounced in females and frail individuals. Muscle power estimates showed moderate agreement with frailty status, with sensitivity and specificity comparable to those of the 5xSTS. Muscle power less than 2.5 Watt·kg -¹ in males and 2.08 Watt·kg -¹ in females was associated with increased frailty risk, consistent with other studies. Overall power estimation showed a predictive performance similar to that of traditional assessments such as Timed Up and Go, supporting its utility in clinical and community settings. CONCLUSION: Estimated muscle power derived from the 5xSTS test is a practical, reliable tool for early identification of frailty among older adults. Its accessibility and predictive validity suggest it could complement existing clinical assessments but not replace them.
A high centrifugal force-enhanced Ziehl-Neelsen method for improved detection of Mycobacterium tuberculosis.
Chaula GT, Namkinga L, Sabiiti W … +3 more , Ntiningya NE, Mtafya B, Mahadhy A
PLoS One · 2026 · PMID 42391193 · Full text
Ziehl-Neelsen (ZN) smear microscopy remains central to tuberculosis (TB) diagnosis and treatment monitoring; however, its sensitivity is limited by incomplete recovery of Mycobacterium tuberculosis during pre-analytical...
Ziehl-Neelsen (ZN) smear microscopy remains central to tuberculosis (TB) diagnosis and treatment monitoring; however, its sensitivity is limited by incomplete recovery of Mycobacterium tuberculosis during pre-analytical processing. This study evaluated whether modifying centrifugation force and duration improves bacillary recovery and ZN smear microscopy performance. Laboratory experiments were conducted using M. tuberculosis H37Rv suspensions and clinical sputum specimens. Following NALC-NaOH treatment, samples were centrifuged at 2,000, 3,000, and 6,000 × g for 40 min. The effect of centrifugation duration was assessed at 3,000 × g by comparing 20 and 40 min using the same M. tuberculosis H37Rv cultures and the same clinical sputum specimens at both time points, ensuring paired measurements within each sample type. Smear positivity and ZN smear grading were evaluated from replicate smears and analyzed using non-parametric statistical tests, with significance set at p < 0.05. In M. tuberculosis H37Rv suspensions, no significant differences in smear positivity or grading were observed across centrifugal forces (p = 0.368 and p = 0.212, respectively). In clinical sputum specimens, smear positivity did not differ significantly across forces (p = 0.716), whereas ZN smear grading increased significantly with higher centrifugal force (p = 0.0051). At 3,000 × g, extending centrifugation time from 20 to 40 min did not significantly affect smear positivity in either sample type (both p = 1.000). In contrast, ZN smear grading increased from 1+ to 2+ in clinical specimens with extended centrifugation time (p = 0.016), while no change was observed in M. tuberculosis H37Rv suspensions. These findings indicate that increasing centrifugal force may enhance bacillary concentration in clinical sputum, resulting in improved smear grading without a corresponding increase in detection rate. Extending centrifugation time has limited impact on smear positivity. Optimization of pre-analytical centrifugation parameters may improve ZN smear microscopy performance in clinical specimens.
Expression of Concern: Targeting tumor-associated genes, immune response, and circulating tumor cells in intrahepatic cholangiocarcinoma: Therapeutic potential of Atractylodes lancea (Thunb:) DC.
PLOS One Editors
PLoS One · 2026 · PMID 42391192 · Full text
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Research on the impact of artificial intelligence on the export technological complexity of chinese manufacturing enterprises: An analysis based on mediating effects.
Lin H, Wang M, Guo M … +4 more , Wang Z, Cheng Z, Li W, Arshad MU
PLoS One · 2026 · PMID 42391188 · Full text
Technological innovation drives high-quality economic development, and artificial intelligence (AI) represents a new impetus for developing productive forces with new qualities. AI is becoming a focal point in economic d...
Technological innovation drives high-quality economic development, and artificial intelligence (AI) represents a new impetus for developing productive forces with new qualities. AI is becoming a focal point in economic development plans and national strategies worldwide due to its contribution to economic growth and the transformation of traditional production methods. This paper examines the impact and mechanism of AI on the export technological complexity of Chinese manufacturing enterprises from a corporate perspective. It utilizes data from listed manufacturing companies on the Shanghai and Shenzhen A-shares from 2008 to 2021 and employs a fixed-effects model. The results indicate that: (1) AI positively promotes the export technological complexity of Chinese manufacturing enterprises, with more pronounced effects in regions with higher export technological complexity. (2) Heterogeneity analysis indicates that AI significantly enhances the export technological complexity across various categories of enterprises. Particularly notable impacts are observed among state-owned enterprises, light textile enterprises, and enterprises located in the eastern and central regions. (3) Mechanism analysis reveals that AI indirectly promotes the export technological complexity of manufacturing enterprises by improving labor structure and enhancing corporate innovation capabilities. This study proposes relevant policy recommendations from four aspects: strengthening AI technology research and application, optimizing labor structure, enhancing corporate innovation development, and promoting balanced AI development.
Retraction: The Succinate Receptor GPR91 Is Involved in Pressure Overload-Induced Ventricular Hypertrophy.
PLOS One Editors
PLoS One · 2026 · PMID 42391186 · Full text
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Diabetes among Indigenous Orang Asli adults in Peninsular Malaysia: Prevalence and associated factors from Orang Asli Health Survey 2022.
Ismail H, Saminathan TA, Abd Hamid HA … +3 more , Kim Sui W, Robert Lourdes TG, Ahmad NA
PLoS One · 2026 · PMID 42391179 · Full text
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing public health problem globally, and in Malaysia. Orang Asli, the Indigenous population in Peninsular Malaysia, often experience a disproportionate burden of diabet...
BACKGROUND: Type 2 diabetes mellitus (T2DM) is a growing public health problem globally, and in Malaysia. Orang Asli, the Indigenous population in Peninsular Malaysia, often experience a disproportionate burden of diabetes, driven by social disadvantage, lifestyle transitions, and limited access to healthcare. Given that no nationwide diabetes assessment has been conducted among this under-represented group, this study therefore aimed to determine the prevalence of diabetes and its associated factors among Orang Asli adults in Peninsular Malaysia. METHODS: The Orang Asli Health Survey (OAHS) 2022 was a nationwide cross-sectional survey with a complex sampling design conducted among Orang Asli adults living in non-institutional households across nine states of Peninsular Malaysia. A two-stage stratified sampling strategy was used, with locality (urban, fringe, remote) as the primary stratum and tribe (Senoi, Proto-Malay, Negrito) as the secondary stratum. Data were collected using structured interviewer-administered questionnaires and standardised clinical measurements. Diabetes was defined as self-reported physician-diagnosed diabetes or fasting blood glucose ≥7.0 mmol/L. Descriptive statistics, chi-square tests, and multiple logistic regression were performed using SPSS Version 20, accounting for the complex survey design. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were reported. RESULTS: A total of 9,206 Orang Asli adults participated in the diabetes module. The overall prevalence of diabetes was 16.1% (95% CI: 14.3-17.9). Diabetes prevalence was higher among the females (16.8%), those aged ≥60 years (28.1%), urban residents (21.1%), Proto-Malay (18.8%) and Senoi (14.0%) tribes, participants with no formal or incomplete primary education (19.1%), those with monthly household income ≥RM2000 (21.2%), obese individuals (21.1%), respondents with hypertension (24.2%) and those with high total cholesterol (21.7%). In multivariable analysis, diabetes was significantly associated with age 40-59 years (AOR 1.64; 95% CI: 1.35-1.99) and ≥60 years (AOR 2.14; 95% CI: 1.40-3.28), urban (AOR 1.73; 95% CI: 1.07-2.79) and fringe (AOR 1.63; 95% CI: 1.13-2.35) localities, Senoi (AOR 1.70; 95% CI: 1.08-2.68) and Proto-Malay (AOR 2.41; 95% CI: 1.50-3.86) tribes, incomplete primary education (AOR 1.28; 95% CI: 1.02-1.60), household income ≥RM2000 (AOR 1.47; 95% CI: 1.12-1.93), hypertension (AOR 1.42; 95% CI: 1.03-1.95) and hypercholesterolemia (AOR 2.17; 95% CI: 1.70-2.76). CONCLUSIONS: Diabetes is common among Orang Asli adults in Peninsular Malaysia. Older age, urban and fringe residence, specific tribal groups, lower education, higher income, hypertension, and hypercholesterolaemia were associated with diabetes. These findings highlight the need for culturally appropriate diabetes prevention, screening, and management strategies tailored to Orang Asli communities, particularly for the elder subgroup and those living in urbanised settings.
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