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Authors: Heidi M. Soeters, Sébastien Antoni, Shilpa S. Iyer, Goitom Weldegebriel, Joseph Biey, Jason M. Mwenda, Gloria Rey-Benito, Claudia Ortiz, Roberta Pastore, Dovile Videbaek, Simarjit Singh, Emmanuel Njambe, Lucky Sangal, Deepak Dhongde, Varja Grabovac, Josephine Logronio, Kamal Fahmy, Amany Ghoniem, George Armah, Francis E. Dennis, Mapaseka L. Seheri, Nonkululeko Magagula, Kebareng Rakau-Nondela, Tulio M. Fumian, Irene T.A. Maciel, Elena Samoilovich, Galina Semeiko, Tintu Varghese, Sarah Thomas, Julie E. Bines, Dandi Li, Furqan Kabir, Jie Liu, Eric R. Houpt, Rashi Gautam, Sara A. Mirza, Jan Vinjé, Mick N. Mulders, Jacqueline E. Tate, Umesh D. Parashar, James A. Platts-Mills, for the Global Pediatric Diarrhea Surveillance network

Diarrhea remains a leading cause of child morbidity and mortality. Improved and ongoing estimates of the etiology of hospitalized pediatric diarrhea in low- and middle-income countries (LMICs) are needed to help prioritize and evaluate the use of existing and upcoming vaccines and interventions. The Global Pediatric Diarrhea Surveillance (GPDS) network is a World Health Organization (WHO)-coordinated public health surveillance network investigating the etiology of hospitalized diarrhea among children aged <5 years in LMICs. The GPDS network enrolls children hospitalized with diarrhea at 38 sentinel surveillance sites in 31 LMICs. Randomly selected stool specimens were tested by TaqMan Array Card quantitative reverse-transcription polymerase chain reaction (qPCR) for 16 pathogens associated with diarrhea. We estimated pathogen-specific attributable fractions (AFs) and incidence of diarrheal hospitalizations at the global, regional, and country levels during 3 time periods: 2017–2018, 2019–2020, and 2021–2022, with a focus on the most recent results. During 2017–2022, the GPDS network enrolled 70,750 children aged <5 years hospitalized with diarrhea, of which 16,458 (23.3%) were randomly selected for qPCR testing. The most prevalent pathogen detected, regardless of quantity or modeled etiologic attribution, was rotavirus (weighted prevalence 30.4%), followed by adenovirus 40/41 (19.1%), norovirus (17.9%), Shigella (14.1%), and Campylobacter jejuni/coli (8.6%). Overall, in 2017–2022, rotavirus was the leading etiology globally (AF 32.5%; 95% Confidence Interval (CI): 27.4, 37.6), followed by Shigella (9.8%; 8.4, 11.3), adenovirus 40/41 (8.6%; 6.3, 10.8) and norovirus (6.7%; 5.6, 7.7). Over time, rotavirus consistently declined from an AF of 36.7% (95% CI: 28.7, 46.7) in 2017–2018 to 26.7% (20.7, 34.1) in 2021–2022. Norovirus AF increased slightly from 6.2% (4.7, 7.7) in 2017–2018 to 7.3% (5.0, 9.2) in 2021–2022. Global Shigella burden remained stable, and adenovirus 40/41 demonstrated significant volatility, peaking globally in 2019–2020 (11.9%; 5.9, 17.5). In 2021–2022, rotavirus was the leading cause of hospitalized diarrhea in 6 of 9 geographic groupings, norovirus predominated in Central and South America, and Shigella was the leading etiology in South Asia. In the subset of countries that had introduced rotavirus vaccine, the leading etiologies in 2021–2022 were rotavirus (18.4%; 15.8, 21.5) and Shigella (16.4%; 11.8, 21.1). In 2021–2022, rotavirus had the highest attributable incidence of hospitalized diarrhea in children (2.3 per 1,000 child-years; 1.8, 3.0), followed by Shigella (0.9; 0.7, 1.1), norovirus (0.6; 0.4, 0.8) and adenovirus 40/41 (0.6; 0.4, 0.8). Despite the widespread use of rotavirus vaccines, rotavirus remained the leading cause of severe diarrhea among children aged <5 years in LMICs globally. However, the proportion of pediatric diarrhea attributable to rotavirus consistently declined from 2017-2018–2021–2022, and there were notable differences in the distribution of diarrheal etiologies between regions and across time periods. Shigella, norovirus, and enteric adenoviruses were also associated with a substantial burden of disease. Improving the efficacy and coverage of rotavirus vaccination and prioritizing interventions against other enteric pathogens could further reduce diarrhea morbidity and mortality.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006655. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Benjamin Tsofa, Moriasi Nyanchoka, Joshua Munywoki, Fatuma Guleid, Nancy Kagwanja, Lucy Kanya, Francis Wafula, Jacinta Nzinga

Recurrent health worker strikes in Kenya since the 2013 devolution reforms reflect more than episodic labour unrest; they signal broader governance challenges that may be particularly pronounced in decentralised and resource-constrained health systems. Despite constitutional protections for labour rights and decentralised service delivery, Kenya’s health sector has experienced persistent industrial disputes, exposing gaps in legal frameworks, institutional coordination, and dispute resolution systems. We conducted a qualitative policy analysis of health worker strikes in Kenya between 2010 and 2025. Data were drawn from legal statutes, policy documents, government reports, peer-reviewed literature, and grey sources. Guided by Walt and Gilson’s policy triangle, complemented by complex adaptive systems and health governance frameworks, we analysed how institutional arrangements, stakeholder dynamics, and policy processes shape labour relations in a devolved health system. Several interrelated drivers of recurrent strikes were identified, including tensions between the constitutional rights to strike and to health, fragmented governance and weak intergovernmental coordination under devolution, persistent workforce challenges and failures to implement Collective Bargaining Agreements (CBAs) and Return-to-Work Formulae (RTWFs), ineffective dispute-resolution mechanisms, and the absence of enforceable minimum service arrangements during industrial action. Through their interaction, these factors generate recurring cycles of non-compliance, labour unrest, and institutional mistrust. Recurrent disputes over CBA and RTWF implementation suggest that the central issue lies not in the absence of legal protections or negotiated settlements, but in translating commitments into sustained action. Addressing recurrent strikes requires systemic reform beyond short-term dispute settlement to address underlying governance, accountability, and implementation challenges. Priorities include strengthening independent dispute resolution mechanisms, clarifying responsibilities across levels of government, improving accountability for negotiated commitments, harmonising human resource management systems, and institutionalising minimum service protections. Kenya’s experience offers important lessons for decentralised health systems on aligning authority, accountability, and implementation capacity to strengthen resilience and advance universal health coverage.

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0006412. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Afruna Rahman, Kyu Han Lee, Shams El Arifeen, Mohammad Zahid Hossain, Atique Iqbal Chowdhury, Muntasir Alam, Afsana Afrin, Ikechukwu Udo Ogbuanu, Solomon Samura, Erick Kaluma, Julius Ojulong, Samba Sow, Adama Mamby Keita, Milagritos D. Tapia, Kiranpreet Kaur Chawla, Karen Kotloff, Shabir A. Madhi, Sana Mahtab, Yasmin Adam, Amy Wise, Ziyaad Dangor, Christopher Mugah, Elizabeth Oele, Richard Omore, Aggrey K. Igunza, Dickens Onyango, Inacio Mandomando, Quique Bassat, Sara Ajanovic, Rosauro Varo, Elisio Xerinda, Nega Assefa, J. Anthony G. Scott, Lola Madrid, Melisachew M. Yeshi, Fikremelekot Temesgen, Lucy Liu, Portia Mutevedzi, Dianna M. Blau, Victor Akelo, Robert F. Breiman, Cynthia G. Whitney, Emily S. Gurley, for the CHAMPS Consortium

Background Globally, an estimated 1.9 million stillbirths occur annually, yet significant knowledge gaps exist regarding the causes of stillbirths, particularly in high-burden regions. We investigated fetal and maternal conditions causing stillbirths in seven countries in sub-Saharan Africa and South Asia and described missed opportunities for prevention. Methods Child Health and Mortality Prevention Surveillance (CHAMPS) identified stillbirths at sites in Bangladesh, Ethiopia, Kenya, Mali, Mozambique, Sierra Leone, and South Africa. We asked families for consent to conduct minimally invasive tissue sampling (MITS) from December 2016 to December 2023. An expert panel reviewed test results, clinical information, and verbal autopsy data and assigned fetal and maternal conditions leading to stillbirths and identified missed opportunities for prevention. Findings A cause of death (fetal or maternal condition) was determined for 94% (2342/2492) of stillbirths; the most frequent condition in the fetus was intrauterine hypoxia (75%, 1864/2492) across all sites, resulting from either maternal condition (49%, 922/1864) or placental causes (33%, 610/1864). Congenital infections were determined to be the cause of 9% (228/2492) of stillbirths, accounting for the highest proportion in South Africa (31%, 96/306). Group B Streptococcus, Escherichia coli, and Enterococcus faecalis were the most common causative pathogens. Congenital birth defects caused 9% (227/2492) overall and were most common in Ethiopia (24%, 136/568). Primary maternal conditions were identified in 72%, most often placental complications (18%, 446/2492) and maternal hypertension (17%, 414/2492). Complications of placenta, cord and membranes were more common in Mali (43%, 92/212) while maternal medical and surgical conditions were most frequently observed in South Africa (40%, 121/306) and Bangladesh (39%, 158/405). Most (72%, 1808/2492) causes of stillbirth were considered preventable, with heterogeneity observed across sites on the recommended prevention strategies. Interpretation Complications of pregnancy or delivery accounted for most stillbirths across all sites, with intrauterine hypoxia identified as the predominant fetal condition highlighting widespread and persistent gaps in the timely identification and management of maternal and placental conditions during antenatal and obstetric care across sites in Africa and South Asia. At the same time, substantial geographic variation in causes and prevention opportunities, including for infections and birth defects, underscored the need for locally tailored strategies. Strengthening facility-based care alongside targeted interventions based on site-specific patterns, will be critical to reducing the stillbirth burden in these high-priority regions. Funding The Gates Foundation

Source: PLOS Global Public Health. DOI: 10.1371/journal.pgph.0005235. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Katherine Cann

Transformative climate adaptation efforts, which call for the fundamental reshaping of social systems that inform vulnerability to climate risk, introduce significant ethical and procedural questions for researchers. Engaged research practices, such as co-production and participatory action research, may be useful in addressing these complex questions and pushing adaptation research towards more transformative ends. However, there are also ethical and procedural concerns plaguing participatory knowledge production, and scholars claim engaged research efforts have failed to meet goals for transforming scientific practice. Recent literature in adaptation, climate services, sustainability science, and environmental governance, illustrates the ongoing challenges and unresolved tensions holding engaged research practices back from its transformative aims. This essay suggests three areas of growth for engaged researchers in climate services and adaptation: interrogate the aims of research projects, focus on learning outcomes, and evaluate research governance. The essay addresses a wide audience and serves three primary purposes: 1) as a primer for students and early career researchers beginning to explore the history and use of engaged research in climate services and adaptation, 2) as a summary of common challenges for researchers designing and implementing engaged research projects with communities and other stakeholders, and 3) as a blueprint for institutional supporters, including funders and research convenors aiming to improve engaged research outcomes and advance more transformative adaptation.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001093. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Elyas Hannoufa, Eric Johlin

Building-integrated photovoltaics (BIPV) are a promising strategy for enhancing building energy performance and reducing carbon emissions. However, most design optimization studies rely on historical climate datasets that may fail to capture the operating conditions buildings will experience under climate change. This study develops a computational framework for the multi-objective optimization of BIPV envelope systems using future climate projections from the CanESM5 model under the SSP3-7.0 scenario. We analyze two system configurations, awning shades and thin-film window coatings, across four cities with diverse climates (Berlin, Los Angeles, Chicago, Singapore), comparing results from conventional EPW files, NASA 2023 historical data, and 2046–2050 climate scenarios. Optimization integrates electricity generation, thermal loads, and daylighting quality to capture building-level trade-offs. Results show that traditional EPW datasets systematically under-predict BIPV performance, particularly in Berlin and Los Angeles. Under 2046–2050 projected conditions, all four cities exhibit performance gains: substantial in Berlin, Chicago and Los Angeles, and marginal in Singapore, with the largest absolute gains in Los Angeles. By 2050, unshaded windows transition to consistently detrimental for building energy balance. Thin-film coatings achieve optimal outcomes at high absorptance, in the 80–90% range, contrary to current low-absorption design practice. Within the CanESM5 SSP3-7.0 scenario examined, these findings show that projected climate conditions can substantially reshape the modeled performance landscape of BIPV systems, emphasizing the need for forward-looking climate projections in building design optimization and the growing importance of BIPV for climate-adaptive and resilient urban buildings.

Source: PLOS Climate. DOI: 10.1371/journal.pclm.0001087. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Majed M. Aljabri, Bandar S. Alharbi, Endale Alemayehu Ali

Background Psychological stress is highly prevalent among nursing students. The clinical exposure is a major factor contributing to psychological stress, but there is a lack of consistent evidence, particularly in the context of Middle Eastern countries. The aim of this study was to quantify the association between clinical exposure and perceived stress among nursing students, and to assess whether perceived social support moderates this relationship. Methods We conducted a cross-sectional study among nursing students from King Saud University. The Perceived Stress Scale was used to measure psychological stress, and the Multidimensional Scale of Perceived Social Support was employed to measure perceived social support. The clinical exposure was quantified as the average number of hours spent per week. We employed multivariable linear regression to determine the association. The regression analysis was adjusted for age, gender, living arrangements, and employment status. Results Higher perceived social support was significantly associated with lower perceived stress (β = −0.05, 95% CI −0.09 to −0.01). Clinical exposure was not significantly associated with perceived stress. Students living alone had significantly lower levels of perceived stress (β = −0.37, 95% CI −0.63 to −0.11), as did students working part-time (β = −0.34, 95% CI −0.54 to −0.13). The interaction model revealed that perceived social support was inversely associated with perceived stress levels (β = −0.14, 95% CI −0.23 to −0.04). A statistically significant interaction was observed among students with less than 10 hours of clinical exposure per week. This exploratory finding suggests that the association between perceived social support and stress may differ among students with limited clinical exposure. However, the finding was based on a single statistically significant interaction and should be considered preliminary and hypothesis-generating. Conclusions Higher perceived social support was associated with lower levels of perceived stress among nursing students. Interventions aimed at enhancing the social support system may be beneficial in reducing stress, especially during the early clinical exposure period.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361336. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Ganesh Malayath, Fei Wang, Chao Zhou, Nathaniel Huebsch

Standard cell-culture ware is mass-produced in fixed designs, whereas many tissue-engineering workflows require custom inserts, lids, chambers, or patterned substrates, especially during early-stage research and method development. Conventional fabrication methods for cell culture accessories involve injection molding and machining, which are too costly and time-consuming to implement for producing custom designs in small batches, and/or while testing the usefulness of a new design before mass production. Here, we propose polycarbonate (PC) thermoforming as a solution for creating customized transparent and autoclavable accessories. We demonstrate that optimized preheating of PC overcomes issues with bubbling during thermoforming. The use of high heat deflection temperature (HDT) resins allows these PC devices to be thermoformed off molds created by Digital Light Processing (DLP) 3D prints, enabling rapid prototyping of the PC. Using this approach, we fabricated custom PC well plate inserts, staining chambers and other custom accessories. We next validated the cytocompatibility of these devices by demonstrating culture and cardiomyocyte differentiation of human induced pluripotent stem cells (iPSC). Finally, we demonstrated the utility of thermoformed PC for creating 3D engineered tissues (cardiospheres). These results establish DLP-assisted PC thermoforming as a rapid, low-cost workflow for fabricating transparent, autoclavable, user-defined cell-culture accessories during prototyping and small-batch bioengineering applications.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361065. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Carolina G. Downie, Heather M. Highland, Annie Green Howard, Mona Alotaibi, Tali Elfassy, Christina Cordero, Jennifer E. Below, Mercedes Carnethon, Susan Cheng, Martha Daviglus, Olga Garcia-Bedoya, Robert Kaplan, Tasneem Khambaty, Yilun Li, Adam G. Lilly, Dan-Yu Lin, Tao Long, Frank J. Penedo, Lauren E. Petty, Bharat Thyagarajan, Hsiao-Chuan Tien, Mohit Jain, Barrett M. Welch, Kari E. North, Christy L. Avery

Background Inflammation is a common pathological feature underlying type 2 diabetes (T2D) risk and progression. Determining the roles of fatty acids and bioactive lipid oxylipin inflammatory mediators could inform T2D preventative efforts and therapeutic targets. Methods Leveraging the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), we evaluated cross-sectional and prospective associations of 81 oxylipins and polyunsaturated, monounsaturated, and saturated fatty acids with T2D. We assessed whether fatty acid levels differed at visit 2 by visit 1-prevalent T2D status and prioritized likely causal metabolites using Bayesian model averaging Mendelian randomization (MR-BMA). Results Fifty-four fatty acids and oxylipins were associated with prevalent T2D at visit 1 (15,138 participants; 2,962 T2D cases), four of which (adrenic, dihomo-gamma-linolenic, tricosanoic, and lignoceric acids) were also associated with incident T2D by visit 2 (8,548 participants; 1,376 T2D events), though effects were attenuated for adrenic and dihomo-gamma-linolenic acids upon further adjustment for impaired glucose tolerance. Sixteen out of 28 fatty acids were significantly different at visit 2 between those with and without prevalent T2D at visit 1 (9,115 participants; 2,151 T2D cases), holding visit 1-measured fatty acid levels constant. MR-BMA prioritized one diHETrE oxylipin as a likely causal risk factor for T2D. Conclusions Fatty acids and oxylipins showed complex patterns of association with T2D, including more associations likely reflecting overt disease processes in prevalent T2D, than incident risk-enhancing associations.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0360656. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: David E. Goldsbury, Anne E. Cust, Caroline Watts, Alison Pearce, Philip Haywood, Louisa G. Collins, Preston Ngo, Kirstie McLoughlin, Michael Caruana, Karen Canfell, Julia Steinberg, Marianne F. Weber

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361490. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Chidera M. Ejike, Rebecca Ramos, Christiana Ketema, Mackenzie Waller, Kai Glahn, Auwal Abubakar, Deborah Jean McClelland, Kacey Ernst, Huaqing Wang, Shujuan Li, Maiya Grace Block Ngaybe

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361454. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.

Authors: Behzad Amirzade, Tareq Zobaer, Janis Lapsley, Do-Gyoon Kim, Laura E. Selmic, Ali Nassiri

Bone is a hierarchical and heterogeneous bio-composite material, with cortical and trabecular regions exhibiting distinct mechanical behaviors across scales. Patient-specific Finite Element Analysis (FEA) derived from medical images is increasingly used in both human and veterinary medicine to predict bone mechanical behavior under various loading conditions, assess fracture risk, and evaluate treatment outcomes. However, due to the complexity associated with measuring full elasto-plastic bone properties across multiple scales and bridging microscale properties to macroscale models, simplified material definitions are often adopted in FEA simulations. Such simplifications may produce unrealistic mechanical responses and fail to capture permanent microscopic and macroscopic deformations that occur when stresses exceed the bone yield point, particularly in implant design applications. This study presents an integrated experimental–computational framework for generating continuum material maps as a function of density from tissue-scale characterization of the canine femur. High-depth spherical nanoindentation combined with Genetic Algorithm (GA)-based inverse optimization was conducted to extract mechanically consistent elasto-plastic properties of cortical and trabecular bone from load–displacement responses influenced by post-yield contact uncertainties. Trabecular tissue-scale properties were then assigned to Representative Volume Elements (RVEs) reconstructed from micro-Quantitative Computed Tomography (μQCT) data and homogenized to account for architecture-dependent effective behavior. Finally, optimized cortical and homogenized trabecular properties were correlated with density to establish compartment-specific material mapping relationships for whole-bone FEA simulations. The optimized responses showed good agreement with the experimental indentation measurements, supporting the capability of the proposed framework to generate mechanically informed material definitions for patient-specific bone FEA simulations. Overall, the proposed framework provides a pathway for translating localized experimental measurements into heterogeneous elasto-plastic material inputs for whole-bone FEA without explicitly resolving trabecular microarchitecture.

Source: PLOS ONE. DOI: 10.1371/journal.pone.0361283. Abstract from the publisher’s feed; HTML formatting and repeated author line removed.