PLOS ONE Alerts: New Articles

Prevalence, diagnostic methods, and clinical outcomes of wasting/cachexia among pediatric cancer patients in Africa: A protocol for a systematic review and meta-analysis

2026-05-08T14:00:00Z

by Ivaan Pitua, Daisy Wannyana, Derrick Bary Abila, Felix Bongomin

Introduction

Pediatric cancer is an emerging public health priority in Africa, where survival rates remain critically low compared to high-income regions. Malnutrition; specifically wasting and cachexia; is the most prevalent, yet modifiable comorbidity that compromises treatment tolerance and increases mortality. Recent primary studies from 2025 indicate a significant discrepancy between wasting diagnosed via clinical assessment versus anthropometrically defined wasting, suggesting a “hidden burden” of malnutrition in African oncology wards. However, no comprehensive synthesis of data exists regarding the prevalence of wasting across the continent using modern assessment standards, nor its specific impact on clinical outcomes in the current treatment era.

Methods and analysis

We will conduct a systematic review and meta-analysis of observational studies (cross-sectional, cohort, and case-control) published from January 1, 2000, to the present. Data sources will include PubMed/MEDLINE, EMBASE, Web of Science and CINAHL. We will include studies involving children and adolescents (0–19 years) diagnosed with malignancies in African healthcare settings. Two independent reviewers will screen studies, extract data, and assess risk of bias using Covidence systematic review software. The risk of bias will be assessed using the Joanna Briggs Institute (JBI) critical appraisal tools. The primary outcome will be the pooled prevalence of wasting/cachexia. Secondary outcomes will include diagnostic accuracy of assessment methods (such as Mid-Upper Arm Circumference [MUAC] vs. Weight-for-Height vs. clinical assessment) and associations with adverse clinical events (neutropenia, sepsis, treatment abandonment, and mortality). A random-effects meta-analysis will be performed using R software. Heterogeneity will be assessed using the I² statistic and explored via subgroup analyses (region, tumor type, and assessment tool).

Ethics and dissemination

Ethical approval is not required as this study relies on secondary data. Findings will be disseminated through a peer-reviewed publication and conference presentations to inform nutritional guidelines for pediatric oncology in resource-limited settings.

PROSPERO Registration Number

Registration Number: CRD420251237859

Machine learning-based model for predicting recanalization in isolated distal deep vein thrombosis and analysis of predictors

2026-05-08T14:00:00Z

by Yingjie Kuang, Jun Zhang, Zhen An, Chunxu Yang, Wenxu Guo, Xiaomin Liu, Yue Zhang

Background

Isolated distal deep vein thrombosis (IDDVT) is common, yet tools for predicting poor recanalization remain limited. We aimed to develop and compare machine learning models for predicting poor recanalization in patients with IDDVT and to identify the most informative predictors.

Methods

A total of 1600 patients with IDDVT were retrospectively enrolled. The dataset was randomly divided into a development set (n = 1280) and an independent test set (n = 320) using stratified sampling. Six predictive models were developed and compared: logistic regression (LR), support vector machine (SVM), random forest (RF), multilayer perceptron (MLP), extreme gradient boosting (XGBoost), and a Voting Ensemble. Model training and hyperparameter tuning were performed in the development set using five-fold stratified cross-validation, and optimal classification thresholds were determined using the Youden index. Model performance was evaluated by discrimination, calibration, and classification metrics, with 95% confidence intervals estimated by bootstrap resampling (10,000 iterations). SHAP analysis was applied to interpret the final model.

Results

In the independent test set, all models showed acceptable to strong discrimination, with AUC values ranging from 0.808 to 0.908. XGBoost achieved the best overall performance, with an optimal threshold of 0.183, an AUC of 0.908 (95% CI, 0.855–0.952), a Brier score of 0.077 (95% CI, 0.058–0.096), an accuracy of 0.900 (95% CI, 0.866–0.931), a precision of 0.650 (95% CI, 0.529–0.767), a recall of 0.803 (95% CI, 0.686–0.906), an F1-score of 0.717 (95% CI, 0.615–0.806), and a specificity of 0.918 (95% CI, 0.884–0.950). The calibration intercept and slope of the XGBoost model were 0.149 (95% CI, −0.192 to 0.454) and 1.410 (95% CI, 1.098–1.809), respectively, indicating acceptable overall calibration. SHAP analysis identified D-dimer rate, provoking-factor-related variables, anticoagulant use, and age group as the most influential predictors.

Conclusion

Among six candidate models, XGBoost showed the best overall performance for predicting poor recanalization in patients with IDDVT. This study establishes an interpretable machine learning-based prediction framework focused specifically on poor recanalization in IDDVT and highlights the contribution of dynamic laboratory information, particularly D-dimer rate. The model may support early risk stratification and individualized follow-up planning, but external validation is required before routine clinical implementation.

Copper causes reduced nitrogen fixation but does not accumulate in the nodules of the legume Lotus japonicus

2026-05-08T14:00:00Z

by Kathryn Lamoureux, Sheila M. Macfie

Copper can be a soil contaminant at concentrations that are toxic to plants, particularly because of copper-induced oxidative stress. The legume-rhizobia partnership that allows for biological nitrogen fixation is sensitive to oxidative stress, and this study investigates if copper acts directly on the machinery of nitrogen fixation, or indirectly via toxicity to the entire plant. When Lotus japonicus inoculated with its rhizobial partner Mesorhizobium loti was exposed to 300 or 450 µM of copper, biomass was reduced by 30–40% in the shoots, 40–55% in the roots, and 40–60% in the nodules relative to control. While concentrations of copper in shoots and roots increased in proportion to the amount of copper in the growth medium, concentrations of copper in nodules did not vary in response to copper treatment. Malondialdehyde, a marker of oxidative damage, in the nodule similarly did not vary with copper treatment. However, nitrogen fixation and ascorbate peroxidase activity decreased by 40–45% and 40–60%, respectively, which can be indicators of early nodule senescence. This would suggest that copper-induced reduction in nodule activity is not directly due to oxidative stress in the nodules; it is due to stress on the host plant that limits its ability to support its symbionts.

Consumer anxiety: A scoping review and research agenda

2026-05-08T14:00:00Z

by Mingfei Li, Shanshan Huang

Background

In the current vibrant and transforming era, consumers increasingly experience anxiety. Given its profound implications for consumers’ psychological well-being, decision-making, and consumption behaviors, understanding consumer anxiety (CA) has become a critical issue for both scholars and practitioners. Although existing studies have investigated CA across contexts, the findings remain both limited and fragmented.

Objective

To provide a comprehensive and clearer picture of CA, this scoping review synthesizes the current state of the art in CA research, develops an integrative research framework, and outlines promising avenues for future inquiry.

Method

Following the Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study searched Google Scholar, ScienceDirect, EBSCO, and the Social Science Citation Index for articles. After study selection and quality assessment, 60 articles focusing on CA were identified and included in the review.

Results

Current research elucidates the antecedents and consequences of CA, as well as its mediating and moderating roles in consumer studies.

Conclusion

On the basis of the reviewed findings, this study discusses the research gaps and thereby proposes promising avenues for future CA research. Moreover, several valuable insights for CA management are provided for practitioners in the marketplace.

Differences in the long-term course of post-COVID-19 symptoms in adults and children across epidemic periods: A retrospective cohort study in Japan, 2020–2024

2026-05-08T14:00:00Z

by Aya Sugiyama, Toshiro Takafuta, Kanon Abe, Yayoi Yoshinaga, Ko Ko, Tomoki Sato, Tomoyuki Akita, Masao Kuwabara, Shingo Fukuma, Junko Tanaka

Background

The prevalence of post-COVID-19 symptoms has been reported to decline since the Omicron variant became predominant. However, differences in their long-term course across epidemic periods and between adults and children, including recent Omicron sublineages, remain insufficiently understood.

Methods

We extended a previously reported retrospective cohort by conducting follow-up and an additional survey in Hiroshima, Japan. The study included 2,689 individuals diagnosed with COVID-19 between March 2020 and June 2024 (1,524 adults and 1,165 children). A self-administered questionnaire captured the presence and duration of 13 symptoms. Interval-censored survival analysis estimated prevalence over time, and proportional hazards models evaluated factors associated with symptom resolution.

Results

At six months, the estimated prevalence in adults was highest during the Delta period (47%) and lower during Omicron-2022 (23%) and Omicron-2024 (21%). In children, prevalence remained about one-quarter to one-third that of adults, with no notable differences between Omicron sublineages. At two years, persistent symptoms were reported by about 20% of adults infected before Omicron and 10% during Omicron periods, compared with 4.1% and 1.9% of children infected during the Delta and Omicron-2022 periods. Symptoms persisting beyond two years showed little further resolution, though in children they did not interfere with daily activities. In the Cox model, resolution was slower during the Delta period (HR 0.79) and faster during Omicron-2022 (HR 1.24) and Omicron-2024 (HR 1.30). Younger age, particularly ≤12 years, was strongly associated with faster recovery.

Conclusion

The long-term course of post-COVID-19 symptoms differed across epidemic periods and age groups. The risk was highest during Delta and lower among children and those infected during Omicron waves, yet some individuals experienced symptoms for over two years. Long-term follow-up and social support remain crucial to mitigate the burden of post-COVID-19 condition.

Significance of RGS13 expression in lupus B cells

2026-05-08T14:00:00Z

by Tomoya Nakajima, Koji Kitagori, Sohei Funakoshi, Mirei Shirakashi, Ryosuke Hiwa, Hideaki Tsuji, Shuji Akizuki, Ran Nakashima, Akio Morinobu, Hajime Yoshifuji

Objectives

B cells play important roles in systemic lupus erythematosus (SLE) pathogenesis. In this study, we explored the proteins preferentially expressed in SLE B cells, especially double-negative 2 B (DN2B) and age-associated B cells (ABCs), and analysed their functions.

Methods

We used our previously reported dataset to identify the mRNAs preferentially expressed in SLE B cells and confirmed their expression in each B cell subset via flow cytometry. Additionally, we also used knockout mice of the identified gene to investigate its roles.

Results

Of the 525 mRNAs exclusively upregulated in SLE B cells, regulator of G protein signalling (RGS)-13 was identified as a top-ten gene of interest. Its expression levels were determined via quantitative polymerase chain reaction and correlated with the anti-dsDNA antibody levels. Flow cytometry revealed that RGS13 levels were particularly high in DN2B cells. Among the DN2B cell differentiation-inducing factors, B cell receptor stimulation induced RGS13 expression. Total B cell, follicular B cell, and ABC numbers were reduced in the spleen, whereas the number of germinal centre B cells, which also highly express Rgs13, was unaffected in Rgs13^−/− mice. Moreover, total B cell number increased in the bone marrow but remained unchanged in the peripheral blood in Rgs13^−/− mice. No difference in responsiveness to ABC-inducing stimuli was observed between the Rgs13^−/− and wild-type mice.

Conclusion

Overall, RGS13 was highly expressed in lupus DN2B cells and mouse ABCs, induced by B cell receptor stimulation, and indirectly associated with the differentiation and maintenance of ABCs relevant to autoimmunity.

Targeted analysis of KRAS and CREBBP mutations uncovers a potential population-specific signature in thai patients with liver fluke-associated cholangiocarcinoma

2026-05-08T14:00:00Z

by Rehab Osman Taha, Wanna Chaijaroenkul, Papichaya Phompradit, Kesara Na-Bangchang

Intrahepatic cholangiocarcinoma (iCCA) is an aggressive malignancy with limited therapeutic options and a poor prognosis. Opisthorchis viverrini (OV) infection is a major risk factor in endemic regions, particularly in Southeast Asia. However, the molecular mechanisms underlying iCCA development and progression remain incompletely understood. This study, as it is, is observational and demonstrates association rather than causation. This study aimed to characterize genetic alterations in key germline variants associated with cancer risk and prognosis, as well as components of the oxidative stress pathway, and to evaluate their associations with clinicopathological features in Thai iCCA patients. A cohort study was conducted involving 112 iCCA patients, 60 OV-infected individuals, and 156 healthy controls. Genetic alterations in TP53, CREBBP, KRAS (codons 12 and 13), CDKN2A, IDH1, and GZMB were analyzed by PCR and sequencing. Gene polymorphic co-occurrence and burden were assessed. Additionally, polymorphisms in the KEAP1–NFE2L2 oxidative stress pathway (KEAP1 rs11085735; NFE2L2 rs6726395, rs6721961, rs4893819) were analyzed in 50 iCCA patients. Associations with clinicopathological parameters, including metastatic status, tumor size, and tumor markers (CEA and CA 19−9), were evaluated using odds ratios (OR) and statistical analyses. CREBBP polymorphisms were significantly more frequent in iCCA patients (50.0%) than in OV-infected individuals (30.0%) and healthy controls (30.8%) (P = 0.003), with homozygous mutations conferring the highest cancer risk (OR = 6.43, 95% CI: 1.70–24.31). KRAS codon 13 polymorphisms were detected exclusively in iCCA patients (21.4%) and were absent in OV-infected individuals. In contrast, TP53 polymorphisms were highly prevalent across all groups, with no significant differences, suggesting these variants may represent background genetic variation rather than tumor-specific drivers. Co-polymorphism analysis revealed that TP53 and CREBBP alterations were the dominant genetic events, with most tumors harboring one or two mutations (mean gene polymorphism burden: 1.46 ± 0.86). Further statistical modeling revealed significant clinicopathological associations. Binary logistic regression identified tumor size (P = 0.029) and TP53 mutation status (P = 0.037) as significant predictors of metastasis. Notably, TP53 wild-type status demonstrated a protective effect against metastasis (OR = 0.083, 95% CI: 0.007–0.950, P = 0.045), and multivariable analysis confirmed TP53 as an independent predictor of metastasis (P = 0.037) after adjusting for sex, age, and sex-by-age interaction. Furthermore, ordinal regression identified metastasis as the primary predictor of advancing tumor stage (P < 0.001), with tumor size showing a trending association (P = 0.068). Evaluation of CDKN2A was limited by quasi-complete separation (adjusted OR = 0.000, P = 1.000) due to sample size constraints. Analysis of the KEAP1–NFE2L2 pathway revealed limited genetic diversity in KEAP1 but substantial polymorphic variation in NFE2L2. These polymorphisms showed minimal associations with clinicopathological features, suggesting a complex role of oxidative stress regulation in iCCA pathogenesis. The study identifies CREBBP and KRAS codon 13 polymorphisms as key genetic alterations enriched in iCCA, supporting their role as candidate germline variants and potential therapeutic targets. Polymorphism co-occurrence patterns indicate a relatively low mutational burden, with epigenetic dysregulation and oncogenic signaling representing central mechanisms in iCCA development. Further large-scale studies integrating tissue and circulating DNA analyses are warranted to validate these findings and identify clinically actionable biomarkers in iCCA.

DeepDRP: Dose-response predictions of drug pairs using deep learning based on data-driven feature representation and dose-response curve characteristics

2026-05-08T14:00:00Z

by Mohammadamin Moragheb, Alireza Dehghan, Parvin Razzaghi, Sajjad Gharaghani

Combination therapies have become a cornerstone of modern medicine, offering improved treatment outcomes and reduced side effects compared to monotherapies. However, the efficacy and safety of drug combinations depend heavily on the specific doses of each component, making the optimization of dosing regimens a crucial yet challenging task. Despite the importance of dose optimization, few computational methods address this challenge. Here, we propose DeepDRP, a novel approach that integrates two complementary models: the global model, which is trained using all available combinations, and the local model, which utilizes only samples with similar information to queries. The DeepDRP architecture comprises three main modules: the first module has three embedding networks to extract features from drugs, doses, and cell lines, and then predicts synergy using the fused knowledge. The second module constructs a graph using the input query and the set of similar retrieved training samples fed into a semi-supervised graph convolutional network to predict the synergy value. Finally, these two models are aggregated to have the final predicted value. To evaluate the proposed approach, it is applied to the NCI-ALMANAC dataset and O’Neil dataset. The obtained results denote that the proposed method achieves superior performance with respect to the other approaches.

Healthcare professionals’ awareness of the levels of disciplinary collaboration in older adults’ care during clinical practice in Nigeria: A multi-method study

2026-05-08T14:00:00Z

by Chukwunonso Geoffrey Okafor, Augustine Chukwuebuka Okoh, Adaobi Odega, Stanley Maduagwu, Michael Kalu

Introduction

Collaborative care has been recognized as a fundamental aspect of geriatric/gerontological care, as it can enhance health and social outcomes among older adults. However, very little is known about Nigerian healthcare professionals’ (HCPs) awareness of disciplinary collaborations in older adults’ care. This study investigated the HCPs’ awareness (level of awareness, definitions, and perceived practice) of the disciplinary collaborations in older adults’ care during clinical practice at a tertiary hospital in the South-Eastern region of Nigeria.

Methods

We conducted a multi-method study involving 245 HCPs who responded to authors’ developed questionnaire. Data was analyzed using descriptive and inferential statistics.

Results

The level of awareness of disciplinary collaboration varies: intradisciplinary (65.7%), multidisciplinary (72.1%), cross-disciplinary (57.1%), interdisciplinary (76.3%), and transdisciplinary (40.8%) collaborations. Having a Bachelor’s degree (OR = 1.055, 95% CI [−0.154, 5.662], p = 0.038) and a transdisciplinary education (OR = 1.023, 95% CI [0.904, 6.646], p = 0.010) predicted better awareness of the inter-/trans]disciplinary collaborations. There was a significant change in the participants’ level of awareness of the type of disciplinary practice in their hospital before and after seeing the description of the collaborative practice constructs [X² (2)=29.747, p < 0.001]. Barriers to higher collaborative practices in geriatric/gerontological care were inequitable remuneration (X²(2) = 4.332, p = 0.037), lack of integrated electronic medical records (X²(2) = 12.562, p = 0.002), and a limited number of specialists (X²(2) = 54.093, p < 0.001).

Conclusion

Achieving consensus on the definition of intra-, cross-, multi-, inter-, and transdisciplinary practice is essential for a clear understanding of the constructs, facilitating its proper implementation in geriatric care and the development of effective solutions to systemic barriers. A transdisciplinary educational curriculum could support the uptake of transdisciplinary collaborative geriatric practice models in Nigeria.

Association between vitamin D status and circulating myokines (irisin, myostatin, and myonectin) in children: A cross-sectional study

2026-05-08T14:00:00Z

by Muammer Buyukinan, Huseyin Kurku, Zafer Bagci, Yavuz Turgut Gederet, Ahmet Fatih Yilmaz

Background

Vitamin D is a pleiotropic hormone with regulatory functions that extend beyond bone and mineral metabolism to include skeletal muscle physiology. Skeletal muscle acts as an endocrine organ through the secretion of myokines, including irisin, myostatin, and myonectin, which participate in metabolic and musculoskeletal regulation. However, data regarding the association between vitamin D status and circulating myokines in children remain limited.

Methods

In this single-center, cross-sectional study, 43 children with vitamin D deficiency and 39 age- and sex-matched healthy controls were enrolled. Serum concentrations of 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), mineral metabolism parameters, and circulating levels of irisin, myostatin, and myonectin were measured. Participants were additionally categorized according to PTH status. Between-group comparisons, correlation analyses with false discovery rate (FDR) correction, and multivariable regression analyses were performed.

Results

Children with vitamin D deficiency exhibited significantly lower median circulating levels of irisin (13.76 vs. 29.52 ng/mL), myostatin (363 vs. 1108 ng/L), and myonectin (2.24 vs. 5.28 ng/mL) compared with controls (all p < 0.05). In correlation analyses adjusted using the false discovery rate method, no significant associations between 25(OH)D and circulating myokines were observed in the vitamin D–deficient group, whereas positive correlations between 25(OH)D and both irisin and myonectin were identified in the control group. In multivariable regression models adjusted for age, sex, and BMI SDS, serum 25(OH)D remained independently associated with circulating irisin, myostatin, and myonectin levels. In analyses stratified by PTH status, myostatin and myonectin levels were lower in children with elevated PTH, whereas irisin did not differ significantly.

Conclusions

Vitamin D deficiency in childhood is associated with reduced circulating concentrations of muscle-derived myokines. These findings suggest a link between the vitamin D–PTH axis and muscle endocrine signaling during growth. Given the cross-sectional design, causal relationships cannot be inferred, and longitudinal studies are warranted.

Age-related upregulation of p16 expression in mouse ovarian somatic cells correlated with reproductive function decline p16 expression and ovarian aging in mice

2026-05-08T14:00:00Z

by Yorino Sato, Yuta Kawagoe, Kazuhiro Kawamura

Female reproductive aging is a major clinical challenge associated with declining fertility and increased pregnancy complications. The urgent clinical need for developing reliable biomarkers to evaluate ovarian aging has become increasingly evident. Cellular senescence, marked by p16, contributes to age-related tissue dysfunction. However, the relationship between p16 levels and ovarian aging remains poorly understood. Age-related changes in p16 levels across multiple tissues in ICR mice were examined in ICR mice at 4, 30, 45, and 60 weeks of age using qRT-PCR, ELISA, and immunohistochemistry. Cell-type specific p16 levels were analyzed in isolated ovarian cells. Reproductive function was assessed through superovulation, in vitro fertilization, and embryo transfer experiments. p16 mRNA levels increased progressively with age in ovarian tissue (6.8-fold increase at 60 weeks vs. 4 weeks, P < 0.05), with corresponding increases in p16 protein levels. Among tissues examined, ovaries, kidneys, liver, uterus, spleen, and pancreas showed significant age-related p16 upregulation, while brain, heart, and lung did not. Cell-type analysis revealed that somatic cells exhibited pronounced p16 upregulation with age (cumulus cells: 3.2-fold, granulosa cells: 4.6-fold, theca cells: 2.8-fold increase), whereas oocytes and blastocysts showed no significant changes. Ovulation numbers decreased significantly with age (42.3 ± 3.1 vs. 15.6 ± 1.9 oocytes in young vs. aging mice), but fertilization rates and early embryo development remained unaffected. However, post-implantation outcomes deteriorated substantially, with implantation rates declining from 78.4% to 38.1% and live birth rates from 82.3% to 43.2% in aging mice at 60 weeks of age. Age-related upregulation of p16 in ovarian somatic cells, but not in oocytes, correlated with declining reproductive function, particularly affecting post-implantation development. These findings suggest that somatic cell senescence may contribute to age-related declines in oocyte competence, leading to fertility decline with aging.

Optimal seamline detection for SAR image mosaicking guided by superpixel segmentation and region merging

2026-05-08T14:00:00Z

by Dong Yan, Feixiang Zeng, Bairu Chen, Rui Huang, Yi She

Large-scale studies and applications of SAR images require the mosaicking of multiple scenes. However, geometric misregistration and radiometric inconsistencies among adjacent images often lead to poor continuity and unnatural transitions in the mosaicked images, which severely restrict the effectiveness of SAR images in large-area information analysis and retrieval. Optimal seamline detection seeks to determine the most suitable stitching path within the overlapping regions of adjacent images, ensuring that mosaicked SAR images exhibit maximal consistency in intensity, texture, and geometric features while minimizing stitching artifacts and visual discontinuities. Existing seamline detection methods, however, are often limited by their obstacle-avoidance capability and computational efficiency. To overcome these limitations, this study proposes an optimal seamline detection approach for SAR images guided by superpixel segmentation and region merging. First, the Patch-Based SLIC (PB-SLIC) algorithm is enhanced to achieve consistent superpixel segmentation across multiple overlapping images. Second, a region adjacency graph is constructed by integrating Bhattacharyya distance, texture distribution, and boundary length information, which guides the merging of superpixels and produces candidate seamlines that preserve object integrity and accurately follow object boundaries. Then, an initial seamline network is generated using area Voronoi diagrams with overlap (AVDO), and a cost function based on normalized cross-correlation is established. The seamline network is further refined using a shortest-path algorithm to extract the optimal seamline network from the candidates. Finally, using real SAR datasets, we analyze and verify the effectiveness of superpixel segmentation and region merging in seamline detection. Comparative experiments with two classical methods further demonstrate that the proposed approach achieves superior obstacle-avoidance capability and shorter search time, while ensuring higher mosaicking quality and significantly improving computational efficiency.

Comprehensive feature evaluation of the main facades of Catholic churches in Sichuan-Chongqing region based on semantic difference method, 1840–1949

2026-05-08T14:00:00Z

by Qin Lai, Xinkai Li, Beibei Zhang, Nan Chen, YunZhang Li

The existing Catholic churches constructed in the Sichuan-Chongqing region between 1840 and 1949, as precious carriers of Sino-Western cultural integration, have been listed in the cultural heritage protection catalog. This study employs the semantic difference method to conduct a quantitative evaluation of the main facade characteristics of these churches across five dimensions, operationalized through six specific evaluation criteria: relationship with the environment, facade contour, facade style 1 (Chinese vs. Western), facade style 2 (Folk vs. Official), facade decoration, and religious expression. The correlation between these facade features was also analyzed. The findings reveal: (1) Among the 62 existing Catholic churches in Sichuan and Chongqing, 14 are Chinese-style churches, accounting for 22.6%. (2) Facades demonstrate distinct cultural fusion: Chinese-style churches incorporate Western vertical composition elements, while Western-dominated churches integrate environmental harmony, Chinese architectural style, folk styles, and minimalist decoration. (3) According to the correlation analysis of Spearman’s correlation coefficient, the correlation coefficient between the facade style and decorative characteristics of the church is 0.857, and the correlation coefficient with religious expression is 0.754, showing a significant positive correlation. This study aims to provide a reference for the quantitative evaluation of cultural heritage facade characteristics and preservation of Sino-Western architectural cultural integration.

Differences in perceived travel distance from central versus peripheral optic flow are the same when standing and walking

2026-05-08T14:00:00Z

by Ambika Bansal, Hongyi Guo, Robert S. Allison, Laurence R. Harris

The continuously evolving ways in which people move challenges our ability to process self-motion. Previous research from our lab has shown that when seated, optic flow presented in the far periphery results in people feeling they moved further than when the same motion was presented over the full field or in the central field only. The literature is mixed on the relative weightings of visual and non-visual cues when estimating travel distance, and it is unknown how non-visual cues might affect the use of optic flow in the far periphery. Here, we used a large-field edgeless display to visually “move” participants. Participants were either (i) physically stationary (visual-only condition), (ii) performing a blindfolded walking task on a treadmill (blindfolded walking condition), or (iii) visually “moving” while walking on a treadmill (visual-and-treadmill condition). Optic flow simulating forward self-motion was presented either full field, in the central field (inside 40°), or in the far periphery (outside 180°). Participants estimated travel distances by stopping at the location of a previously seen target (Move-To-Target Task) or adjusting a target to indicate the distance of a previous movement (Adjust-Target Task). In the Move-To-Target task, peripheral optic flow led to higher gains (perceived travel distance/ actual travel distance) compared to the central field and full-field conditions during both the visual-only and visual-and-treadmill conditions. In the same task, the blindfolded walking condition also led to higher gains than the visual-only or visual-and-treadmill conditions. In the Adjust-Target task, there were no significant differences between conditions. There were also no interaction effects in either task between field-of-view, and whether participants were standing or walking. This implies that the high sensitivity to optic flow in the far periphery is a general feature of perceptual odometry even when integrating non-visual cues with visual cues.

Identification of risk areas and associated factors of unfavorable treatment outcomes in drug-resistant tuberculosis: Evidence from Rio de Janeiro, Brazil

2026-05-08T14:00:00Z

by Heitor Levy Ferreira Praça, Juliana Cavalcanti Figueiredo, Natalia Santana Paiva, Jefferson Pereira Caldas dos Santos, Paulo Victor de Sousa Viana, Rejane Sobrino Pinheiro, Antonio Jose Leal Costa, Gerusa Gibson, Alexandre San Pedro

Drug-resistant tuberculosis remains a major challenge to tuberculosis control in Brazil and worldwide.

Objective

To identify factors associated with unfavorable treatment outcomes and to analyze the occurrence of high-risk spatial clusters at an intra-urban scale in the municipality of Rio de Janeiro, Brazil.

Methods

A retrospective cohort study of drug-resistant tuberculosis cases reported between 2015 and 2022 was conducted. Individual-level and spatial analyses were performed to identify associated factors with unfavorable outcomes and high-risk clusters.

Results

Of the 972 cases analyzed, 31.6% had unfavorable outcomes, including 20.2% lost to follow-up, 4.9% with treatment failure, and 6.3% deaths. Loss to follow-up was higher among males, Black individuals, those with low education levels, individuals with AIDS, and those who used alcohol, tobacco, or illicit drugs, whereas older age and diabetes were associated with lower odds. Treatment failure was more frequent among individuals of Brown race/skin color, those with multidrug-resistant and extensively drug-resistant tuberculosis, and those with multiple previous treatments. Mortality was higher among individuals over 40 years of age, those with multidrug-resistant and extensively drug-resistant tuberculosis, those with alcohol use, and individuals AIDS. Three high-risk spatial clusters were identified in the northern zone of the city, an area of marked social vulnerability.

Conclusion

Unfavorable drug-resistant tuberculosis outcomes are influenced by socioeconomic factors, particularly in socially vulnerable urban areas. In this context, strengthening local surveillance in identified high-risk clusters, improving patient-centered care across primary and secondary levels, and providing robust socioeconomic support are essential strategies for reducing unfavorable outcomes and achieving more equitable tuberculosis control.

Research on the development and differentiation of the physical literacy scale for Chinese college students

2026-05-08T14:00:00Z

by Rongjing Ni, Ying Yu

Objectives

To understand the current status and characteristics of physical literacy among Chinese college students, develop a measurement scale suitable for this population, and provide an appropriate assessment tool for related research.

Methods

The Delphi method and a questionnaire survey were initially employed to screen and evaluate the reliability and validity of 53 preliminary items. Subsequently, the finalized measurement tool, which had been assessed for reliability, was administered to 3,077 Chinese college students via a questionnaire survey to identify population variation characteristics.

Results

Following a systematic screening process, the reliability coefficients for the four dimensions ranged from 0.731 to 0.821, and a reliable measurement tool for assessing physical literacy among Chinese college students was established. The final scale comprises four dimensions—physical activity capacity, physical activity behavior, physical activity cognition, and emotional experience—with a total of 32 items. The survey revealed significant differences in physical literacy among Chinese college students across the following dimensions: gender (t = 24.914, P < 0.001), household registration (t = 11.464, P < 0.001), grade (F = 30.811, P < 0.001), university category (F = 17.305, P < 0.001), and university district (F = 4.957, P < 0.01). Furthermore, significant differences were observed to varying degrees across all four dimensions—physical activity capacity, physical activity behavior, physical activity cognition, and emotional experience.

Conclusion

The developed Physical Literacy Scale for Chinese College Students is suitable for research targeting this population. The survey revealed significant differences in physical literacy levels among Chinese college students based on gender, grade, household registration, university category, and university district.

Neuromedin U mediates left atrial pressure–induced diuresis in the anaesthetised pig

2026-05-08T14:00:00Z

by Vincent Healy, Therese Ruane O’Hora, Eric Lucking, Gerard O’Donoghue, Farouk Markos

Finding a potential biomarker for elevated left atrial pressure would be clinically useful as a diagnostic for pre-heart failure. Therefore, an investigation into whether the protein neuromedin U (NMU), which is significantly elevated in heart failure patients, mediates a classical diuresis that results from a sustained increase in left atrial pressure was conducted in the anaesthetized pig. Left atrial pressure was increased a little above 15 mmHg for 30 minutes in 8 chloralose anaesthetised female pigs. There was a significant increase in circulating NMU and urine flow rate, which surprisingly occurred without an accompanying natriuresis; both the serum NMU increase and the diuresis did not occur when the procedure was repeated post-vagal section. There was also a significant increase in glomerular filtration rate during the diuresis, which indicates a likely direct renal effect. The results show that NMU could be the mediator of the historic diuresis induced by an increased left atrial pressure. Future work to assess NMU levels in humans in pre-heart failure would be required to confirm NMU’s potential usefulness as a diagnostic.

Estimating HIV incidence and assessing associated risk factors among adults: Evidence from the 2018–2022 HIV vaccine preparedness cohort in Masaka, Uganda

2026-05-08T14:00:00Z

by Sylvia Kusemererwa, Sheila Kansiime, Gertrude Mutonyi, Ayoub Kakande, Shamim Nabukenya, Aeron Namirembe, Naphtal Erima, Doreen Joan Asio, Elizabeth Mbabazi Atuhura, Shamim Ssendagire, Martin Onyango, Julie Fox, Sheena McCormack, Pontiano Kaleebu, Eugene Ruzagira, on behalf of the PrEPVacc Study Team

Introduction

Despite global reports of declining HIV incidence, current data are limited. This study presents findings on HIV incidence and risk factors in a HIV trial preparedness cohort.

Methods

Between 18 July 2018 and 13 October 2022, individuals 18–45-year-old were recruited from communities along the trans-African highway and the shores of Lake Victoria in Masaka district, Uganda. Eligible individuals were HIV-negative and met at least one of the following criteria: suspected or confirmed sexually transmitted infection (STI), unprotected sex with ≥2 partners, unprotected sex with a new partner in the past 3 months, or unprotected sex in exchange for money/goods in the past month. Baseline data included demographics, sexual behaviour, and HIV risk factors. Follow-up assessments of HIV risk and sexual behaviour were conducted every six months, while HIV counselling and testing (HCT) were provided every 3 months, with linkage to care for those testing positive. Data were summarised descriptively, and associations with HIV incidence were analysed using uni-variable and multi-variable Poisson regression models.

Results

Of the 1422 individuals enrolled, 1115 (78.4%) attended ≥1 follow-up visit; 69% were female and 55% were aged ≤24 years. Over 900.3 person-years of observation (PYO), 24 individuals acquired HIV, yielding an incidence rate (IR) of 2.7 PYO [95% Confidence Interval (CI): 1.8–4.0]. Baseline factors independently associated with incident HIV included female sex [adjusted incidence rate ratio (aIRR) = 6.84 PYO, 95% CI 1.60–29.30], residence in a fishing community [aIRR = 3.04 PYO, 95% CI 1.05–8.78] and recreational drug use in the past 3 months [aIRR = 3.08 PYO, 95% CI 1.19–7.99]. In a separate analysis, using time-updated variables assessed during follow-up, HIV acquisition was associated with sex after alcohol consumption [aIRR = 2.65 PYO, 95% CI 1.11–6.31], and STI diagnosis/treatment within the past 3 months [aIRR = 2.52 PYO, 95% CI 1.09–5.80].

Conclusion

HIV incidence remains high among women, fishing community residents, and individuals with high risk behaviours, underscoring the need for targeted interventions to reduce the burden in these populations.

Astragaloside IV attenuates high-glucose-Induced peritoneal fibrosis via modulation of the ENKUR/PI3K/Akt signalling pathway

2026-05-08T14:00:00Z

by Tianxin Jiang, Lijie Zhang, Jiahan Liu, Xinxin Xu, Yuanyuan Shi, Zhanzheng Zhao, Jing Xiao

This study aimed to explore the mechanisms by which Astragaloside IV (AS-IV), a major bioactive component of Astragalus membranaceus, mitigates high-glucose-induced peritoneal fibrosis (PF) in peritoneal dialysis (PD). Using both in vivo (uremic rat model) and in vitro (human peritoneal mesothelial cells) approaches, we observed that AS-IV treatment was associated with a significant attenuation of PF. This effect was mediated through the inhibition of epithelial-mesenchymal transition (EMT) and fibrosis. In vivo, AS-IV reduced extracellular matrix deposition and collagen accumulation, downregulated EMT and fibrosis markers (α-SMA, collagen IV), and restored E-cadherin levels. Notably, these changes correlated with the downregulation of ENKUR, pPI3K, and pAkt. The in vitro results corroborated these findings, showing that AS-IV suppressed EMT without cytotoxic effects. Our data indicate that AS-IV may exert antifibrotic effects via modulation of the ENKUR/PI3K/Akt signaling pathway, suggesting a potential target for the prevention of PF.

YOLO-MDEW:Improved YOLOv8 for application of wood board edge banding defect detection

2026-05-08T14:00:00Z

by Enjing Xiao, Rougang Zhou, Zhenchao Ruan, Chou Jay Tsai Chien, Junjie Zhu

With the growing demand for wooden furniture, accurate and efficient detection of edge banding defects in wood panels has become increasingly important. To address the limitations of existing methods—such as low accuracy, high missed detection rates, and frequent false positives—this study proposes an improved YOLOv8-based detection algorithm, termed YOLO-MDEW. Built upon the YOLOv8n framework, the model integrates several key enhancements: the C2f-MCFF(Multi-Channel Feature Fusion) module replaces the original C2f structure to improve multi-scale feature extraction; an enhanced SPPF-D(Spatial Pyramid Pooling with Dilation) module is incorporated to strengthen cross-scale information fusion; and an Efficient Local Attention (ELA) mechanism is applied within SPPF-D to better capture fine-grained defect features. Additionally, the original CIoU loss is replaced with Wise-IoU v3 (WIoU) to accelerate convergence and improve localization accuracy. Experimental results on a custom-built wood panel edge defect dataset demonstrate that YOLO-MDEW achieves a mean average precision (mAP) of 74.0%, representing a 1.9% improvement over the baseline YOLOv8n. These results highlight the proposed method’s enhanced robustness and effectiveness in detecting edge banding defects in wooden panels.

Feasibility, acceptability, and fidelity evaluation of a contextualised physical activity and diet intervention for hypertension control in rural South African adults

2026-05-08T14:00:00Z

by Kganetso Sekome, Francesc Xavier Gómez-Olivé, Hellen Myezwa, Dale W. Esliger, Lauren B. Sherar

Despite the known benefits of physical activity and diet modifications for hypertension control, adults in rural South African settings still have high levels of uncontrolled hypertension. This paper outlines an intervention that targets adjusting routine physical activity and diet practices for hypertension control in adults from rural South Africa (HYPHEN). The intervention involved a structured group education, individualised physical activity education, and individualised dietary education. We aimed to evaluate the feasibility, acceptability, and fidelity of HYPHEN for adults aged 40 years and older living with hypertension in rural South Africa. Feasibility was measured by assessing recruitment and retention rates. Acceptability was assessed through interviews after the intervention using pre-determined themes of perceived expectations, benefits, motivation, and barriers concerning the intervention. Fidelity was evaluated by intervention adherence, dosage, quality, and participant responsiveness. Participants were also asked to rate their overall satisfaction on a Likert scale out of 10. Our study demonstrated high level of feasibility, acceptability, and fidelity. Thirty participants were successfully recruited (100% of target), 28 (93%) participants were retained, and 28 (93%) provided complete data. Qualitative data demonstrated high acceptability, with participants reporting that the intervention met expectations, provided benefits, motivated continued engagement, and involved few barriers. Intervention fidelity was high with all three components carried out as planned, minor dosage adjustment, high delivery quality, and 100% participant engagement. The average rating on the Likert scale was 8.6/10 (SD = 2.55). HYPHEN is a feasible and acceptable intervention for hypertension control. Trial registration: Pan African Clinical Trial Registry (pactr.samrc.ac.za) PACTR202306662753321. Retrospectively registered on 29 June 2023.

A modular deep learning architecture for interpretable disease prediction across tabular clinical and biometric datasets

2026-05-08T14:00:00Z

by Vijay U. Rathod, Siddhesh Sanjay Amrutkar, Kirti A. Patil, Aoudumber D. Londhe, Sandip Y. Bobade, Virendrakumar A. Dhotre, Melkamu Workie Kebede

Accurate disease prediction using clinical datasets is essential for improving early diagnosis and clinical decision-support systems; however, many existing deep learning approaches are disease-specific, computationally intensive, and difficult to generalize across heterogeneous biomedical datasets. This study addresses this challenge by proposing a unified and dataset-aware deep learning framework that enables accurate and interpretable disease prediction across diverse clinical datasets. The framework adopts a modular architecture that selects appropriate models based on dataset characteristics such as feature dimensionality, sample size, and class imbalance. It integrates multiple deep learning architectures, including MLP, one-dimensional CNN, FT-Transformer, autoencoder-based classifiers, and ensemble strategies. Robust preprocessing, fold-safe feature selection, and nested cross-validation are incorporated to ensure reliable performance evaluation. The framework is evaluated on three heterogeneous benchmark datasets: the UCI Heart Disease dataset (303 samples, 13 clinical features), the PIMA Indians Diabetes dataset (768 samples, 8 metabolic features), and the Parkinson’s disease voice dataset (195 recordings, 22 acoustic features). Experimental results demonstrate competitive predictive performance relative to classical baselines across the diverse tasks. The FT-Transformer + autoencoder ensemble achieved an AUC of 0.8980 (±0.0483) for heart disease prediction, while the CNN + Autoencoder ensemble obtained an AUC of 0.8451 (±0.0270) for diabetes classification. For Parkinson’s disease detection, the MLP achieved an AUC of 0.7538 with perfect specificity. Overall, all models achieved AUC values comparable to ML baselines. The study contributes a scalable and interpretable deep learning framework that improves reliability, generalization, and practical applicability for multi-disease prediction in real-world healthcare environments.

Day-night variations in sleep and locomotor activity in lambs during the first 72 hours after birth and following the onset of rumination

2026-05-08T14:00:00Z

by Younes Beniaich, Hicham Farsi, Manal Larbaoui, Hiba Ouardirhi, Nouha Sbai, Mohammed Piro, Mohamed Rachid Achaâban, Paul Pévet, Etienne Challet, Amal Satté, Khalid El Allali

The sleep-wake and rest-activity profiles of many species undergoes changes during the development. In ruminants, the onset of rumination-related digestive function is contingent on the attainment of full forestomach maturity. The study aimed to characterise sleep–wake at birth and to assess the rumination onset effects on vigilance-states and rest–activity patterns in lambs. Eight newborn lambs were subjected to two non-invasive polysomnographic (PSG) and behavioural recordings. The first recording was conducted immediately after birth for a duration of 72 h, while the second was performed after rumination onset (1–1.5 months) for an additional 72 h. At birth, lambs exhibited twilight activity, with a peak occurrence during the day-night transitions, resulting in an average of 5.3 ± 0.3 h of daytime activity. Following the onset of rumination, a rise in daytime activity was observed, reaching an average of 7.8 ± 0.3 h. PSG results revealed polyphasic sleep, with lambs spending 58.6% (6.4 h) of the night and 39.6% (4.9 h) of the day asleep. The prevalence of NREM-sleep was observed to exceed that of drowsiness and REM-sleep, both during diurnal and nocturnal periods. Four to six weeks later, rumination occupied 28.6 ± 4.5% of the night and 13.3 ± 2.4% of the day, coinciding with reduced sleep time (from 11.3 h to 6.9 h) due to fewer episodes, without changes in episode duration. All sleep stages were found to be affected, whereas wakefulness remained unchanged. These findings suggest that in neonatal ruminants, rumination may compete with sleep without altering wakefulness, providing new insight into behavioural and vigilance states from suckling to the onset of rumination.

Concurrent circulation of avian influenza viruses H5N1 and H9N2 enhances the genetic evolution of reassortant viruses in Egyptian poultry populations

2026-05-08T14:00:00Z

by Nahed Yehia, Mahmoud Ibrahim, Rawan Muhammad Shady, Ahmed Abd Elhalem Mohamed, Dalia Said, Mohamed E. Taha, Abdelsatar Arafa, Samah Eid, Mohamed A. Shalaby, Uwe Truyen, Rea Maja Kobialka, Ahmed Abd El Wahed, Arianna Ceruti

The co-circulation of the recently emerged H5N1 clade 2.3.4.4b and the endemic H9N2 avian influenza viruses (AIV) in poultry farms has led to significant economic losses and increased the likelihood of viral reassortment. Continuous and extensive surveillance with full genome sequencing is highly recommended. The objective of this study was to monitor AIV circulating in Egyptian poultry populations throughout 2024 using molecular surveillance and to detect genetic reassortment events. A total of 50 chicken flocks that exhibited respiratory symptoms from seven governorates in Egypt were tested for avian influenza H5, H9, Infectious Bronchitis virus (IBV), and Newcastle Disease Virus (NDV) using real-time RT-PCR. Four flocks that tested positive for H5 (AN1, AN6, AN7, and AN8) and three flocks that tested positive for H9N2 (AN2, AN3, and AN4) were selected for isolation and full-genome sequencing. They were subjected to virus isolation in specific-pathogen-free (SPF) embryonated chicken eggs, and identification was done using real-time RT-PCR assay. The full-genome sequencing was performed using rapid barcoding from Oxford Nanopore Technologies. The genome analysis revealed a H5N2 reassortant virus, comprising the HA, PB2, PB1, and PA gene segments from H5N1 clade 2.3.4.4b (EA-2021-AB), while the NA, NP, NS, and M genes were from H9N2 (G5.6). Additionally, two reassorted H9N2 viruses were identified, containing HA, NA, NP, M, and NS genes from H9N2 (G5.6), and PB1, PB2, and PA genes from Highly Pathogenic Avian Influenza H5N1 virus Clade 2.3.4.4b (EA-2021-AB). Interestingly, both reassortant H9N2 viruses have specific adaptive mutations in some of their internal genes that were not present in any other Egyptian H9N2 viruses. Several mutations, potentially associated with increased virulence and mammalian adaptation, were also detected in the internal genes. This study highlights the emergence of novel reassortant AIV viruses and underscores the need for continuous molecular surveillance, as well as further studies on the pathogenicity and vaccine efficacy against these newly emerged viruses.

Gender-specific sociodemographic and lifestyle factors associated with frailty status among Korean older adults

2026-05-08T14:00:00Z

by Subeen Kim, Haerang Lee, Nayeon Park, Eunseo Choi, Minji Kang

This study aimed to identify gender-specific sociodemographic and lifestyle factors associated with frailty among Korean older adults. We conducted a cross-sectional analysis using data from the 2014–2019 Korean National Health and Nutrition Examination Survey, including 6,556 participants aged 65 years and older. Frailty was defined by the Fried phenotype. Multivariable logistic regression models were used to examine gender-specific associations between frailty and sociodemographic factors (age, education, marital status, household income, household type, and body mass index) as well as lifestyle factors (smoking, alcohol consumption, meals with family in the past year, energy intake, number of chronic diseases, and self-rated health status), with mutual adjustment for all listed covariates in a single fully adjusted model. The prevalence of frailty was 20.6% in women and 11.5% in men. Among women, current smoking [odds ratio (95% confidence interval), 2.22 (1.16–4.26)] and sharing meals with family in the morning [1.42 (1.05–1.93)] were associated with an increased risk of frailty. For men, high household income [0.51 (0.27–0.99)] and higher energy intake [>2,120 kcal; 0.49 (0.34–0.71)] were associated with a reduced risk of frailty. In both men and women, multiple chronic diseases and poor self-rated health were significantly associated with an increased risk of frailty. Frailty was associated with various sociodemographic and lifestyle characteristics in both men and women. The associations with several factors, such as smoking, meal patterns, and household income, differed by gender. This study highlights distinct gender-specific predictors of frailty among older Korean adults, emphasizing the need for tailored and integrated public health prevention strategies.

Real-world patient characteristics and clinical outcomes in patients with myelofibrosis in Japan

2026-05-08T14:00:00Z

by Yusuke Yasutomi, Masashi Takano, Yi-Chen Chen, Chi-Chang Chen, Seok-Won Kim, Catherine McGuiness, Alex Slowley, Keita Kirito

Anemia is associated with increased morbidity, mortality, healthcare resource utilization, and costs in myelofibrosis. This longitudinal, retrospective, and descriptive cohort study used a Japanese health administrative database (Medical Data Vision) to examine treatment patterns, transfusion burden, healthcare resource utilization, and costs in patients with myelofibrosis and a subset treated with a Janus kinase inhibitor. Ruxolitinib (a Janus kinase inhibitor) was the first targeted therapy for myelofibrosis in Japan (2014). Patients were identified from April 1, 2015 to June 30, 2022. In the overall myelofibrosis cohort, myelofibrosis diagnosis was the index date; in the Janus kinase inhibitor-treated subgroup, the first date of Janus kinase inhibitor use was the index date. Of the 836 patients with myelofibrosis, median age: 73 years at or before index; female: 38.0%; median follow-up: 576 days; anemia: 59.9%; thrombocytopenia: 18.7%. At index, 37.9%, 6.6%, and 55.5% of patients were transfusion-dependent, -requiring, and -independent, respectively. Median overall survival from myelofibrosis diagnosis was 83.3 months from the index date. Of 281 patients who received a Janus kinase inhibitor, median age: 74 years at or before index; female: 39.5%; median follow-up: 592 days; anemia: 66.9%; thrombocytopenia: 22.8%. All patients who received a JAK inhibitor were treated with ruxolitinib; mean dose was 15.6 mg/day and median duration of treatment was 14 months. The proportion of patients who were transfusion-dependent, -requiring, and -independent in this subgroup was 47.0%, 9.3%, and 43.8%, respectively. Median overall survival from myelofibrosis diagnosis was 53.9 months from first Janus kinase inhibitor administration. This real-world study showed the clinical characteristics and outcomes of Japanese patients with myelofibrosis.

Life lost due to the COVID-19 pandemic: A model-based cohort analysis of mortality displacement in the registered population of England

2026-05-08T14:00:00Z

by Andrew Hughes, Sharmani Barnard, Clarissa Bauer-Staeb, Richard Holleyman, Samantha Dunn, Paul Fryers, John N. Newton, Justine Fitzpatrick, Paul Burton, Peter Goldblatt

Background

Uncertainty about the prior health status of those dying during the pandemic has fuelled debate about its impact. To date, attempts to quantify life years lost during the pandemic have relied on using life tables without taking into account varying levels of vulnerability among those that died.

Methods

Using retrospective, linked data from March 2020 to September 2022 for the cohort of all individuals in England alive at outset, we quantified the risk of death, associated with a wide variety of comorbidities, using primary care and hospital data, as well as evidence of vaccination and COVID-19 infection. We then simulated the survival of every individual in the population with a positive COVID-19 test, with and without the assumption that COVID-19 affected their survival, taking account of their personal vulnerability. We used the difference between these simulated survival times to estimate mortality displacement (how long those who died would have lived, had they not tested positive). We used the displacement estimates for those aged 65 and older to revise estimates of excess deaths.

Results

We estimated median mortality displacement of 4.8 (IQR = 1.5 to 16) years for females and 4.4 (IQR = 1.4 to 12.6) years for males at ages 65 and over. We estimate 28% of those dying with COVID-19 aged 65 and over would have survived five years or more without the infection (66% for females aged 65–74).

Conclusions

Life expectancy of those who died with COVID-19 was substantial and, based on our analysis of vulnerability, most of those who died at ages 65 and over are unlikely to have been close to death. In future pandemics, real-time modelling of displacement would be helpful in assessing the mortality impact of the pandemic.

An exploratory dosimetric and treatment-time analysis of tangent-arc and continuous semi-arc VMAT in deep inspiration breath-hold radiotherapy for stage I left-sided breast cancer

2026-05-08T14:00:00Z

by Yucheng Li, Yinan Chen, Chaoqing Xu, Wenming Zhan, Kainan Shao, Yongshi Jia, Haibo Zhang, Lingyun Qiu, Jieni Ding, Weijun Chen

Background

The use of the deep inspiration breath-hold (DIBH) technique reduces cardiac and lung radiation exposure during left breast cancer radiotherapy. However, the optimal beam delivery technique and the effects of patient adaptation during DIBH remain incompletely understood.

Objective

In this study, the dosimetric differences between continuous semi-arc and tangent-arc plans in stage I left-sided breast cancer patients using DIBH were compared, and the treatment session duration was descriptively analyzed to characterize treatment-time trends during routine DIBH delivery.

Methods

Twenty patients treated at our hospital from 01/05/2022–31/05/2023 were retrospectively selected from the institutional database for exploratory dosimetric analysis. Two radiotherapy plans were created on the basis of each patient’s computed tomography (CT) images. Dosimetric parameters for the planning target volume (PTV) and organs at risk (OARs), and beam-on and total treatment times, were compared.

Results

The conformity index (CI) for the PTV was significantly better with the continuous semi-arc plan (P < 0.05), whereas the other PTV parameters did not significantly differ between the plans (P > 0.05). The doses and beam-on time for all OARs (except the left ventricle) were significantly lower for the tangent-arc plan (P < 0.05). Treatment time tended to stabilize across fractions, with a significant difference between the 15th and 16th sessions (P < 0.05).

Conclusion

With the tangent-arc plan, the beam-on time and radiation exposure to OARs were observed to be lower, while adequate PTV coverage was maintained in patients with stage I left-sided breast cancer using DIBH. Treatment times tended to stabilize with increasing treatment fractions. This observation suggests gradual patient adaptation during routine DIBH rather than a predefined training effect. Given the exploratory nature of these findings and the limited sample size from a single institution, these findings should be interpreted with caution and warrant further investigation in larger, multicenter studies.

Analysis of the importance of using intermediate intervals in the calculation of geometrical characteristics of the ship’s hull

2026-05-08T14:00:00Z

by Paweł Chorab, Dorota Łozowicka

This article examines the impact of incorporating intermediate sections in geometric hull calculations and highlights their role in improving the accuracy of underwater volume estimation and the determination of the center of buoyancy. The study demonstrates that neglecting intermediate sections can lead to substantial numerical errors, which may affect the reliability of hydrostatic parameters used in stability assessment. In the context of hydrodynamic analyses, accurate geometric representation remains essential for obtaining consistent and reproducible results. The presented results quantitatively assess the reduction of numerical integration error achieved by introducing intermediate sections and by comparing selected classical numerical integration schemes. Based on these findings, a genetic algorithm–based optimization framework is proposed as future work to support the automated selection of the number and spatial distribution of intermediate sections, as well as the integration strategy, while balancing accuracy and computational cost. The proposed framework is intended to provide a systematic approach for adapting hull discretization to local geometric characteristics and to support reproducible hydrostatic calculations in engineering applications.

Outage performance of UAV-NOMA networks over rician faded channel with hardware impairments, channel estimation error, and SIC imperfection

2026-05-08T14:00:00Z

by Sk Thaherbasha, S.D. Nageena Parveen, Sivasubramanyam Medasani, Suman Turpati, Tathababu Addepalli, Manish Sharma, Sameena Pathan

The escalating demand for enhanced coverage and high data rates in wireless networks is driving the adoption of advanced technologies like unmanned aerial vehicles (UAVs). Integrating UAVs with non-orthogonal multiple access (NOMA) has emerged as a promising solution to boost spectral efficiency and user connectivity. However, the practical performance of these UAV-assisted NOMA systems is critically constrained by real-world imperfections, including hardware impairments, inaccurate channel state information (CSI), and non-ideal successive interference cancellation (SIC). To address this, a reliable system design necessitates a precise outage probability analysis, which quantifies the impact of these impairments on both reliability and user experience. This work derives closed-form expressions for the outage probability of a multi-user UAV-assisted NOMA system operating over Rician fading channels, explicitly incorporating the effects of the aforementioned impairments. Analytical results are obtained for a two-user UAV-assisted NOMA system by considering the detrimental effect of hardware impairments along with imperfect CSI and SIC on system performance. These analytical results are further validated by simulated results.