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학술

arXiv 등 학술 논문. CC-BY 라이선스로 자유 재사용 가능 — 출처표시 시 상업 사용 OK.

총 453건

Epidemiology and seasonal patterns of hospitalized dengue cases in Muscat Governorate, Oman (2022–2023): A retrospective study

by Ibtisam Khalifa Al-Maskari, Sanjay Jaju, Zainab M. Al-Zadjali, Amal Malehi, Asiya Al Hasni, Khaleefathullah A. Sheriff, Hilal Al Sidairi, Adil Said Al Wahaibi This study describes the epidemiological, clinical, and seasonal characteristics of hospitalized dengue fever (DF) cases in Muscat Governorate, Oman (2022–2023) and identifies factors associated with wet-season dengue occurrence. A retrospective analytical study was conducted using national dengue surveillance data of 345 laboratory-confirmed DF patients admitted to Sultan Qaboos University Hospital (SQUH) and the Royal Hospital (RH). Sociodemographic, clinical, and laboratory data were analyzed using descriptive statistics and logistic regression to identify factors independently associated with wet-season dengue cases. The results showed that of 345 patients, 54.8% were male, and 94.5% were Omani nationals. Most admissions occurred at RH (56.8%) and during the dry season (58.3%). Adults aged 41–60 years comprised the largest age group (44.6%). A distinct seasonal pattern was observed, with peaks in April-May of both years. Seeb Wilayat accounted for 69.3% of cases, followed by Bawshar (26.1%) (p = 0.027). Clinically, 84.6% had dengue with warning signs, while 15.4% developed severe dengue. Locally acquired infections represented 98.6% of cases. Hypertension (31.9%) and diabetes mellitus (25.2%) were the most common comorbidities. PCR positivity and hospital admission were more frequent during the wet season; however, these patterns are likely to reflect differences in testing and referral practices rather than increased dengue transmission. Overall, 96.2% of patients recovered, and 3.8% (n = 13) died. Multivariable analysis indicated that wet-season admissions were more likely to occur at SQUH (aOR = 1.72; 95% CI = 1.06–2.82; p = 0.030) and among PCR-confirmed cases (aOR = 1.38; 95% CI = 1.02–1.87; p = 0.040); these associations likely reflect hospital referral and diagnostic practices rather than increased transmission risk. In conclusion, hospitalized dengue cases in Muscat Governorate exhibited clear seasonal and geographic clustering, while associations with PCR positivity and hospital of admission reflect health-system and diagnostic patterns rather than increased dengue incidence. The predominance of locally acquired infections indicates ongoing endemic transmission. Strengthening vector surveillance, particularly in Seeb and Bawshar, and enhancing hospital preparedness prior to seasonal peaks remain important public health strategies, supported by existing literature rather than this study alone.

PLOS ONE

Minimal mutational requirements for conversion of a telomere resolvase into a Cre-like site-specific recombinase

by Shu Hui Huang, Kerri Kobryn Hairpin telomere resolvases comprise a family of enzymes that produce the hairpin (hp) telomeres of bacteria and their phages that possess linear chromosomes and plasmids terminated by covalently closed hp telomeres. The hp telomeres overcome the dual issues of end replication and protection faced by all organisms with linear genomes. The hp telomeres are produced from replicated intermediates in which the hp telomeres have been converted into replicated telomere (rTel) junctions possessing inverted repeat symmetry. The telomere resolvases process the rTel junctions in a reaction with mechanistic similarities to that promoted by type IB topoisomerases and tyrosine recombinases. The telomere resolvase of both Borrelia burgdorferi (ResT) and Agrobacterium tumefaciens (TelA) have been shown to be able to promote, under certain conditions, a Cre-like recombination between rTel junctions to produce the Holliday junction (HJ) intermediate typical of recombination reactions promoted by tyrosine recombinases. For TelA mutation of the enzyme was required to unmask this normally cryptic activity. A complex combination of autoinhibition domain deletion and point mutation of TelA had even been shown to completely switch the activity of TelA from a telomere resolvase to a recombinase. We report here that mutation of a pair of aspartic acid residues in TelA is sufficient to accomplish this switch in activity.

PLOS ONE

In vitro dissolution and release kinetics of multisource ciprofloxacin 500 mg tablets in West Gondar, Ethiopia: Implications for interchangeability and regulatory oversight

by Tewodros Denekew Haile, Ayenew Ashenef, Chilot Abiyu Demeke, Yeniewa Kerie Anagaw, Abibo Wondie Mekonen, Minichil Chanie Worku, Asnakew Mulaw Beirhun, Yesuneh Tefera Mekasha, Melaku Getahun Feleke Background In vitro dissolution is a critical quality control test in pharmaceutical development, used to measure the rate and extent at which an active pharmaceutical ingredient (API) is released from solid dosage forms, such as tablets, into solution under standardized conditions. It serves as a predictive tool for in vivo drug behavior, providing insights into drug release mechanisms and ensuring the development of robust, effective, and consistent products. Despite its importance, data on dissolution performance remain limited for certain drugs. As a rapid, reliable, and cost-effective method to estimate drug absorption, this study focused on evaluating the dissolution profiles of different brands of ciprofloxacin 500 mg tablets and applying kinetic modeling to support regulatory decision-making. Methods Twenty samples of ciprofloxacin 500 mg tablets were collected from retail outlets in six selected sites of the West Gondar Zone including Humera, Mai Kadra, Metema, Gendawuha, Kokit, and Midregenet towns between January and July 2022. The samples were obtained from purposively selected outlets using prescription papers issued by the University of Gondar Comprehensive Hospital, following a mystery shopper approach in line with WHO (2015) strategies. All collected samples were transported to the Ethiopian Food and Drug Authority (EFDA) laboratory and conducted as per USP specification. The amount of ciprofloxacin released was quantified using UV-Vis spectrophotometry at 276 nm. While the onset of pharmacological action was not directly measured, the Mean Dissolution Time (MDT) values suggested differences in release rates, which may influence the onset of action in vivo were considered. Dissolution profiles were evaluated using both model-independent parameters (difference factor f₁, similarity factor f₂, dissolution efficiency, and mean dissolution time) and model-dependent kinetics. Results were presented in tables, figures, and narrative form. Results All of the included tablet brands complied with single-point dissolution study test, as their Active Pharmaceutical Ingredient release were greater than 80% within the specified 30 minutes time frame according to USP standards. Only 4 brands (21.05%) met the f1/f2 similarity criteria. However, fifteen brands (78.95%) were not interchangeable with the comparator, as the difference factors (f1) were greater than 15% and the similarity factor (f2) were less than 50%. The mean dissolution time values ranged between 1.02 and 7.16 minutes, and the results showed that four of the twenty brands (4/20) exhibited the fastest dissolution rate and onset of action. The evaluated brands followed the Korsmeyer-Peppas and Weibull curve approach (the highest coefficient of determination) for the release of drug substances from the dosage forms. Conclusion The study reveals that while all tested ciprofloxacin 500 mg tablet brands complied with USP single-point dissolution criteria, only 21.05% met the similarity factor (f₂) and difference factor (f₁) standards for interchangeability with the comparator product. Significant variability in dissolution profiles among brands raises concerns regarding bioequivalence and potential implications for therapeutic efficacy and antimicrobial resistance. These findings underline the necessity for enhanced regulatory oversight, including routine dissolution profiling and, where appropriate, in vivo bioequivalence studies to ensure the quality and interchangeability of multisource ciprofloxacin products in Ethiopia and similar settings.

PLOS ONE

Editorial Note: Comparing public support for nuclear and wind energy in Washington State

by The PLOS One Editors

PLOS ONE

Editorial Note: Does green credit promote green sustainable development in regional economies?—Empirical evidence from 280 cities in China

by The PLOS One Editors

PLOS ONE

Expression of Concern: Economic policy uncertainty, intra-industry trade, and China’s mechanical and electrical product exports

by The PLOS One Editors

PLOS ONE

Editorial Note: Do smart services promote sustainable green transformation? Evidence from Chinese listed manufacturing enterprises

by The PLOS One Editors

PLOS ONE

Lung ultrasonography to assess efficacy of intranasal and parenteral vaccinations for bovine respiratory disease (BRD) in dairy calves

by Enrico Fiore, Giorgia Taio, Nicola Morandi, Elisa Mazzotta, Matteo Gianesella, Ortensio Bonato, Arnaldo Azzolin, Anastasia Lisuzzo Vaccination is used to control bovine respiratory disease (BRD). The aim of this study was to evaluate BRD vaccine efficacy through the lung lesions area in dairy calves, also discriminating the lung health status at vaccine administration. One hundred forty-nine dairy calves were enrolled and divided according to vaccine protocol and initial lung condition: healthy (H-CTR; n = 17) and diseased (D-CTR; n = 24) control group; healthy (H-INT; n = 28) and diseased (D-INT; n = 18) intranasal group, healthy (H-VAC; n = 31) and diseased (D-VAC; n = 31) intranasal and parenteral group. Intranasal vaccination was against bovine parainfluenza-3 and respiratory syncytial viruses, while parenteral vaccination was also against Mannheimia haemolytica. Animals were assessed by clinical and ultrasonographical examinations at 10, 17, 38, 52 days; ultrasonography and lung lesion scores (US and LLS), and total consolidation area (TC_A) were greater in CTR with increasing levels over time in both H-CTR (US: 1.45 at 10d vs. 3.8–4.4 thereafter; LLS: 3.5 at 10d vs. 12.4–13.3 thereafter; TC_A: 3.9 cm2 at 10d vs. 9.8–15.4 cm2 thereafter) and D-CTR groups (LLS: 12.1 at 10d vs. 13.0–15.7 thereafter; TC_A: 23.4 cm2 at 10d vs. 34.9–49.4 cm2 thereafter). However, TC_A was maintained in H-INT and reduced in D-INT (22.3 cm2 at 10d vs. 14.3 cm2at 52d). The VAC had the lowest values in US, LLS and TC_A. The H-VAC preserved the initial condition for these parameters, while D-VAC showed a reduction in US (3.8 at 10d vs. 3.0 at 52d) and TC_A (18.4 cm2 at 10d vs. 10.9 cm2 at 52d). In conclusion, the combination of intranasal and parenteral vaccination reduced the progression of lung TC_A severity in both initially healthy and diseased female dairy calves.

PLOS ONE

Mortality salience effects and status consumption–A reasoned action approach

by Jolien Arendsen, Guido M. van Koningsbruggen, Marieke L. Fransen Prior research suggests that mortality salience (MS) can promote status consumption, yet it remains unclear how these effects are formed. To address this gap, we applied the Reasoned Action Approach, which provides a systematic framework to examine how MS may influence intentions to engage in status consumption. Study 1, a belief elicitation study, identified the set of salient beliefs related to status consumption. Study 2 revealed that MS influenced two out of 29 beliefs underlying status consumption identified in Study 1. Additionally, experiential attitude was a weaker predictor of the intention to engage in status consumption after MS. However, no effects of MS were observed on the intention to purchase status products or its determinants. Taken together, these findings suggest that, although MS may influence some underlying beliefs about status consumption, these changes are too weak to translate into meaningful differences in consumers’ behavioral intentions. By using the Reasoned Action Approach, the present research advances our understanding of how MS may or may not influence consumer intentions. It also suggests that MS’s influence on status consumption may be more limited than previously assumed.

PLOS ONE

Association of intraoperative pulse pressure drop and minimum mean arterial pressure with postoperative length of stay: A stratified reanalysis of published data by age and sex

by Victor Beaucoté, Jérôme Cartailler, Jérémie Mattern, Bernard Trillat, Etienne Gayat, Morgan Le Guen, Marc Fischler Objective Intraoperative hypotension (IOH) is associated with postoperative organ dysfunction, but no universal definition exists. Guidelines recommend a mean arterial pressure (MAP) threshold of 60–70 mmHg. Prolonged postoperative length of stay (pPOLOS) serves as a proxy for organ injury. This study explores the association between IOH and pPOLOS risk, accounting for patient characteristics (sex and age). Design Retrospective, single-center cohort study of adult patients undergoing general anesthesia for scheduled non-cardiac surgery between July 2017 and December 2019. Methods pPOLOS was defined as a LOS higher than the median value (main outcome). Relationships between pPOLOS risk and three previously identified IOH variables—drop in pulse pressure (DropPP: difference between maximum and minimum values), minimal MAP (MinMAP), and cumulative time with pulse pressure > 61 mmHg per hour of surgery (CumTimePP > 61 mmHg)—were modeled using piecewise linear splines. Results Our study examined 9,516 patients. For the whole population, the relationship between DropPP and pPOLOS risk was pseudolinear with no activation threshold (slope 0.29–0.52%/mmHg). For MinMAP, an activation threshold of 73 mmHg was identified, below which the association became linear (slope: −0.64%/mmHg). For CumTimePP > 61 mmHg, pPOLOS risk increased sharply (initial slope: 8.40%/min) and reached a saturation threshold at two minutes. Women demonstrated a lower pPOLOS risk and a lower IOH threshold than men. In contrast, older patients (≥65 years) exhibited a higher baseline pPOLOS risk and showed no identifiable IOH threshold. Conclusions The identified IOH threshold (MAP < 73 mmHg) is in line with values reported in the existing literature. Pulse pressure variability, age, and sex emerged as key determinants of pPOLOS risk.

PLOS ONE

Semigroup-theoretic analysis of supply-chain disruptions and resilience

by Job Agba Opue, Marshal I. Sampson, Otobong J. Tom, Uchechukwu E. Okorie This paper develops a rigorous framework using finite transformation semigroups to model supply-chain state evolution under cascading disruptions and resilience interventions. Disruptions and interventions are represented as non-invertible transformations on finite configuration spaces, generating a semigroup whose structure encodes collapse conditions, equilibria, minimal collapse-inducing sets, and redundancy. We establish explicit semigroup-theoretic criteria for synchronizing collapse, idempotent stabilisation, and redundancy identification via basis-pruning algorithms. The framework is illustrated with examples spanning manufacturing, agricultural, and e-commerce logistics systems. Analytical results, algorithmic procedures, and case studies demonstrate how semigroup properties map to measurable resilience indicators, providing interpretable, computationally tractable tools for assessing shock containment strategies in real-world networks.

PLOS ONE

Individual, community, and societal drivers of adolescent peer violence in Asella, Ethiopia: A school-based cross-sectional study utilizing the socio-ecological model

by Ayalneh Demissie, Tesfa G/Meskel, Kasim Kimo, Muhammedawel Kaso, Yehwalishet Demeke, Tahir Aman, Yonas Mulugeta, Addis Wordofa Background Adolescent peer violence is a critical public health challenge in low- and middle-income countries. However, existing research in sub-Saharan Africa often focuses disproportionately on intimate partner violence or male-centered aggression, leaving a significant data gap regarding broader peer-to-peer dynamics in rapidly urbanizing Ethiopian settings. Furthermore, there is an urgent need for evidence that integrates psychosocial traits with environmental influences. This study addresses these gaps by utilizing the Socio-Ecological Model (SEM)—a framework that examines the interplay between individual, relationship, community, and societal factors—to investigate peer violence in Asella, Ethiopia. We specifically explore the role of General Self-Efficacy (GSE), defined as an individual’s belief in their ability to perform across a variety of situations, as a potential driver of behavior. Our objective was to determine the magnitude of violence victimization and perpetration and to identify multi-level risk factors among school-going adolescents. Methods A school-based cross-sectional study was conducted among 542 adolescents (response rate = 99.5%) using a structured, self-administered questionnaire. Magnitude was assessed through standardized behavioral scales, and psychological resilience was measured using the General Self-Efficacy (GSE) scale. Multivariable binary logistic regression was utilized to identify independent predictors across the Socio-Ecological Model (SEM) levels. Results The prevalence of violence victimization was 41.6% (95% CI: 37.3–45.9%) and perpetration was 33.8% (95% CI: 29.7–38.1%). Based on bullying roles, 15.0% were “Bully-Victims,” who reported the lowest mean self-efficacy score (25.5 ± 3.6). Multivariable analysis revealed that low self-efficacy (≤28) was the strongest predictor for victimization (AOR = 2.88; 95% CI: 1.95–4.26), while witnessing community violence was the primary driver for perpetration (AOR = 2.52; 95% CI: 1.77–3.59). Male gender and belonging to the lowest wealth quartile significantly increased the odds for both outcomes. Conclusions Adolescent violence in Asella is a multi-dimensional public health issue driven by a cycle of low individual agency and environmental normalization of aggression. Strategies to mitigate this burden must move beyond the individual level. We recommend a comprehensive response that integrates school-based self-efficacy enhancement, community-level peace-building initiatives to reduce the impact of witnessed violence, and societal-level poverty alleviation. Such a multi-level approach is essential to disrupt the interplay between psychological vulnerability and environmental risk.

PLOS ONE

Building breastfeeding knowledgeable health systems: Focus groups with physician leaders

by Miena Meek Hall, Julie A. Patterson, Alexandra L. MacMillan Uribe, Liliana Simon, Anne R. Eglash, Katherine R. Standish Despite the growth of breastfeeding and lactation medicine as a specialty, the care of breastfeeding families is compromised because few standards and recommendations exist for its practice and integration into health systems. We conducted a qualitative study involving three focus groups (N = 13) with breastfeeding and lactation medicine physician leaders who currently work within large health systems across the United States. Our study aimed to gather the perspectives of physician leaders regarding breastfeeding care in health systems, to summarize current practices and recommendations for optimal care, and to explore barriers and facilitators to the implementation of these recommendations. A deductive content analysis approach guided by the Exploration, Preparation, Implementation, and Sustainment Framework was used to analyze the transcripts. Resulting themes revealed the important role that health systems play in modeling breastfeeding supportive practices and the strong influences of leadership and staff personal breastfeeding experiences on health system policies. Recommendations included the creation of breastfeeding and lactation medicine divisions, adequate staff education, staffing and coordination of lactation care across the system and community, support for lactating employees, and public awareness of resources and programs. Barriers to implementation included siloing of lactation services by department, lack of breastfeeding-supportive workplaces, deficient clinical billing for lactation services, and low prioritization by training programs. Facilitators included multidisciplinary collaborations, employee supportive lactation policies, appropriate dyadic lactation billing, and electronic health record workflows. Our focus groups revealed many barriers to the delivery of optimal breastfeeding care within health systems, but strategies were identified for systemic changes. Next steps include identification of breastfeeding and lactation medicine divisions and health systems already implementing the best practices described here. Further research should engage additional stakeholders to better understand administrative and financial points of view regarding barriers and facilitators of breastfeeding support.

PLOS ONE

Taxonomic characterizations of the genus <i>Commicarpus</i> Standl. (Nyctaginaceae) in Saudi Arabia

by Maad S. Ytemi, Hameed Alsamadany, Faraj Abdullah Al-Ghamdi, Abadi M. Mashlawi, A. El-Shabasy The genus Commicarpus Standl. is a member of the family Nyctaginaceae. The genus includes about 30–35 species distributed across tropical and subtropical regions worldwide, including Saudi Arabia. Five species of Commicarpus are found through, the field survey, which are primarily concentrated in the western and southwestern regions of Saudi Arabia. The collected species are C. grandiflorus, C. helenae, C. mistus, C. plumbagineus, and C. sinuatus. The aim of this study is to do morphological, anatomical, and palynological analyses of these species. Morphologically, growth habit, stem texture, leaf characteristics, floral structure, and fruit morphology were evaluated, these characters are significant to distinguish Commicarpus species. Anatomical studies of the stems, leaves, and petioles show some important characteristics that can help to separate Commicarpus species, including variations in collenchyma and chlorenchyma layers, vascular bundle arrangement, and mesophyll structure. Petiole anatomy, particularly the shape and arrangement of ground tissue and vascular bundles, provides additional taxonomic markers. Also, the study of pollen grains of the species using light microscopes (LM) and scanning electron microscopes (SEM) provides significant character that can be used for species differentiation, including differences in pollen size, shape, polar and equatorial axis dimensions, tubuliferous density, pore diameter, and spinule length. Pollen grains are very large in C. grandiflorus, C. plumbagineus, and C. sinuatus and large in C. helenae and C. mistus; their shapes range from oblate-spheroidal in C. grandiflorus to prolate-spheroidal in the other species. Two keys are constructed, one utilizing morphological characteristics and the other employing anatomical features of the petioles to aid in species identification. These results contribute valuable taxonomic information for the genus Commicarpus in Saudi Arabia.

PLOS ONE

The impact of China’s employee basic medical insurance outpatient pooling scheme on outpatient healthcare utilization among middle-aged adults

by Xinjuan Zhou, Xinrui Li, Haiyi Chen, Jing Deng Background This study evaluates the association between China’s Employees’ Basic Medical Insurance (EBMI) outpatient pooling policy and outpatient service utilization among middle-aged insured individuals (aged 45–60). By analyzing outpatient service use, visit frequency, and out-of-pocket (OOP) expenditures, the study documents utilization patterns associated with the policy and explores their implications for healthcare-seeking behavior among middle-aged enrollees, providing evidence that may inform future adjustments to outpatient coverage design. Methods Using cross-sectional data from the 2018 wave of the China Health and Retirement Longitudinal Study (CHARLS), this study employed a logistic regression model to examine the effect of the outpatient pooling policy and different levels of outpatient benefit coverage on the probability of outpatient visits. A zero-inflated negative binomial regression model was used to analyze the impact on the frequency of outpatient visits, and a Tobit model was applied to assess its effect on out-of-pocket outpatient expenditures. Although the analysis relies on 2018 pilot data, the core institutional mechanisms of outpatient pooling were retained in the post-2021 national framework, suggesting that behavioral responses observed in pilot regions may still be informative under the current reform framework. Results Implementation of the outpatient pooling policy was associated with a 5.0 percentage points higher probability of outpatient visits (p p p < 0.05). Regions with higher levels of outpatient benefit coverage exhibited stronger utilization responses. In addition, individuals with multiple chronic conditions demonstrated significantly greater outpatient healthcare utilization. Conclusions The EBMI outpatient pooling policy was associated with higher outpatient service utilization, suggesting improved access to previously unmet outpatient healthcare needs. However, additional adjustments may be required to better address the needs of patients with chronic conditions and to strengthen primary healthcare resources, thereby contributing to improvements in equity and efficiency.

PLOS ONE

Validation and utility of the French version of the Unified Multidimensional Calling Scale (UMCS-22) for stipended volunteer firefighters

by Marina Burakova This study evaluated the psychometric properties of the French version of the Unified Multidimensional Calling Scale (UMCS-22), adapted for use with volunteer firefighters, including reliability, construct and criterion validity. Data were collected electronically via LimeSurvey (N = 1,149) and analysed using Jamovi 2.3.3. The measurement model of the French UMCS-22, examined globally and with respect to measurement invariance across gender and age groups, exhibited strict invariance. Internal consistency coefficients ω-McDonald of the dimensional scores of the French UMCS-22 fell between.75 and.86; while its global score had ω = .96. The evaluation of criterion validity through Bayesian linear regression and Structural equation modelling demonstrated differential functioning of the French UMCS-22 facets. Specifically, transcendent summons and pervasiveness were associated with the negative outcomes and purposefulness did not predict any outcome. The utility of the French UMCS-22 adapted for stipended volunteer firefighters is discussed with regard to the neoclassical and modern approaches as well as with regard to the double-edged sword nature of calling.

PLOS ONE

Burden and patterns of dyslipidaemia among adult Ghanaians: A systematic review

by Richmond Owusu Ateko, Andrew Decker, Afua Bontu Adjei, Samuel Mawuli Adadey, Eric Nana Yaw Nyarko, Nicholas Ekow Thomford Background Dyslipidaemia is a major modifiable risk factor for cardiovascular disease and has become an increasing public health concern in sub-Saharan Africa. Rapid urbanisation, dietary transitions, and sedentary lifestyles have contributed to the rising incidence of cardiometabolic diseases in Ghana. However, evidence on the overall burden and patterns of dyslipidaemia in adults remains unclear. This systematic review aimed to synthesise the evidence on the prevalence and lipid profile patterns of adult Ghanaians. Methods A comprehensive search of PubMed, Scopus, Web of Science, African Journals Online, Africa-Wide Information and African Index Medicus databases was conducted for studies published between January 1980 and November 2025. Eligible studies reported the prevalence or distribution of dyslipidaemia in Ghanaian adults (≥ 18 years). Two reviewers independently screened, extracted, and assessed the quality of included studies. Findings were synthesised narratively and summarised in descriptive tables and figures, due to heterogeneity in study designs and data reporting. Results Twenty-four studies published between 2003 and 2023, comprising approximately 11,400 participants, met the inclusion criteria. Across the included studies, the reported prevalence of dyslipidaemia ranged from 3.0% to 72.4%, reflecting differences in study populations, diagnostic criteria and study settings. Low high-density lipoprotein cholesterol (HDL-C) was the most frequent abnormality, followed by elevated total and low-density lipoprotein cholesterol (LDL-C), whereas hypertriglyceridaemia was the least common. Studies from southern and middle regions—particularly Ashanti, Brong-Ahafo, and Greater Accra—reported a higher dyslipidaemia prevalence than those from northern Ghana. Considerable variation in diagnostic criteria, study populations and sampling strategies limited comparability and precluded meta-analysis. Conclusion Dyslipidaemia is common among adult Ghanaians, with low HDL-C emerging as the predominant abnormality. Methodological differences and sampling biases limit the precise estimation of the national burden, but the available evidence indicates a growing cardiometabolic risk. Future studies should prioritise community-based sampling and context-appropriate lipid thresholds to support evidence-based cardiovascular risk-reduction strategies.

PLOS ONE

Editorial Note: Towards secure and efficient integration of blockchain and 6G networks

by The PLOS One Editors

PLOS ONE

Cost-effectiveness of various referral pathways to identify advanced fibrosis among type 2 diabetes mellitus patients with metabolic dysfunction-associated steatotic liver disease in primary care setting in Malaysia

by Wei Yoon Poh, Amirah Azzeri, Shamsul Mohd Zain, Rosmawati Mohamed, Kim Sui Wan, Xe Hui Lee, Maznah Dahlui, Fatiha Hana Shabaruddin Background and aim Most international guidelines recommend a two-step approach using the Fibrosis-4 index (FIB-4) and vibration-controlled transient elastography (VCTE) to identify advanced fibrosis, a key predictor of all-cause and liver-related mortality in patients with metabolic dysfunction-associated steatotic liver disease (MASLD). However, VCTE is not available in most primary care settings in Malaysia, and there is scarce data on the cost-effectiveness of different approaches. This study evaluated the cost-effectiveness of three referral pathways for identifying advanced fibrosis among type 2 diabetes mellitus(T2DM) patients with MASLD. Methods We developed a decision-analytical model from the healthcare provider’s perspective, using 1,000 simulated patients to compare: (i) Current Practice (direct referral based on elevated alanine transaminase), (ii) Clinical Practice Guidelines (CPG) Pathway using FIB-4 single-cutoff 1.3, and (iii) FIB-4 dual-cutoffs (1.3,3.25) followed by a gamma-glutamyl transferase (GGT) test for indeterminate cases (Sequential FIB-4/GGT Pathway). Current practice served as the reference comparator. The primary outcomes were the average cost-effectiveness ratio (ACER) and the incremental cost-effectiveness ratio (ICER). Model parameters were mainly derived from local studies. Direct medical costs were reported in 2024 Malaysian Ringgit (MYR). Results Sequential FIB-4/GGT pathway had the lowest ACER at MYR930 per advanced fibrosis case identified, compared to MYR1,299 for current practice and MYR1,581 for the CPG pathway. Sequential FIB-4/GGT pathway was potentially more effective and less costly, demonstrating dominance over current practice with a cost savings of MYR2,911/additional advanced fibrosis case identified. CPG pathway was more effective and more costly than current practice, with an ICER of MYR3,785. Conclusions Sequential FIB-4/GGT pathway was cost-effective for identifying advanced fibrosis in T2DM patients with MASLD. This pragmatic approach could reduce tertiary care referrals, lower healthcare resource use and costs compared to current practice. CPG pathway was more effective than current practice, but incurred higher costs and required increased availability of VCTE within clinical practice.

PLOS ONE

Effect of digitizing Community Health Information System on the delivery and use of maternal and child health services: Propensity score matching analysis

by Gizachew Tadele Tiruneh, Girma Tadesse, Alemnesh Mirkuzie Hailemariam, Yared Kifle, Tsegaye Shewangzaw, Bezawit Mesfin Hunegnaw, Getnet Alem, Nebreed Fesseha, Biruk Bogale, Gete Mekuria, Alemayehu Hunduma, Dessalew Emaway Introduction In 2018, Ethiopia’s government digitized its Community Health Information System (eCHIS) to enhance Health Extension Program service delivery. However, the impact of eCHIS on health outcomes remains unclear. This study, therefore, examined the effects of eCHIS on the uptake of maternal and child health services. Methods A post-test-only, non-equivalent group household survey design was used, collecting data from July to August 2024 in rural communities with and without eCHIS. A stratified multistage sampling technique was employed to recruit respondents. A sample of 1,728 women of reproductive age (271 in eCHIS and 1,457 in non-eCHIS woredas), 1,118 women with children ages 0–11 months (188 in eCHIS and 930 in non-eCHIS), and 569 women with children ages 12–23 months (301 in eCHIS and 268 in non-eCHIS) were included in this study.Propensity scores were used to match intervention and comparison communities based on women’s age, religion, parity, education, household wealth, distance to health facilities, and autonomy. A modified Poisson regression analysis, adjusting for covariates, was conducted to estimate the adjusted prevalence ratios (PR) for maternal and child health outcomes. Results Modern contraceptive use was 66% in intervention areas versus 56% in comparison areas. Institutional delivery rates were 95% in intervention and 79% in comparison areas. In intervention areas, 94% of children received the first dose of the Pentavalent vaccine compared to 83% in comparison areas, while 85% and 68%, respectively, received the third dose. Adjusted analyses showed that eCHIS intervention areas had statistically significant increases in contraceptive use (13.0 percentage points; PR: 1.25; p-value < 0.01) and institutional deliveries (8.9 percentage points; PR: 1.18; p-value < 0.01) compared to comparison areas. Similarly, the average treatment effect of eCHIS on Pentavalent 1, Pentavalent 3, and full vaccination coverage showed significant increases of 10.3 (PR: 1.13; p-value < 0.01), 13.6 (PR: 1.26; p-value < 0.01), and 14.6 (PR: 1.36; p-value < 0.01) percentage points, respectively. Conclusion This study underscores the transformative potential of eCHIS in improving maternal and child health outcomes in Ethiopia. Sustained investment in digital health systems can help scale effective health care services to rural and underserved communities.

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PLOS ONE

In vitro dissolution and release kinetics of multisource ciprofloxacin 500 mg tablets in West Gondar, Ethiopia: Implications for interchangeability and regulatory oversight