PLoS ONE最新文献

{"title":"Risk factors for syphilis among newly admitted prisoners: A case-control study.","authors":"Thanaset Hiranbandit, Wutthichai Jariya","doi":"10.1371/journal.pone.0360956","DOIUrl":"10.1371/journal.pone.0360956","url":null,"abstract":"<p><strong>Background: </strong>Syphilis remains a major global public health concern in various groups, including people in prisons, where the burden is substantial. This study aimed to identify factors associated with syphilis infection among newly admitted prisoners in a province of Thailand.</p><p><strong>Methods: </strong>A case-control study was conducted among newly admitted prisoners in three correctional facilities. Cases and controls were randomly selected from newly admitted prisoners who had undergone syphilis screening at prison entry between 01/04/2025 and 30/09/2025. Data were collected using validated data collection instruments, including case record forms and structured questionnaires. Multivariable logistic regression analysis was used to identify factors associated with syphilis infection among newly admitted prisoners, with statistical significance set at p-value < 0.05.</p><p><strong>Results: </strong>A total of 51 cases and 204 controls were included in the study. In multivariable logistic regression analysis, homosexual or bisexual orientation (adjusted odds ratio [AOR] = 9.59; 95% confidence interval [CI]: 1.81-50.92), a history of sexually transmitted infections (AOR = 38.03; 95% CI: 10.46-138.31), anal intercourse (AOR = 4.47; 95% CI: 1.05-19.12), sexual intercourse without condom use (AOR = 13.82; 95% CI: 3.38-56.43), and injection drug use (AOR = 45.60; 95% CI: 2.88-722.12) were significantly associated with syphilis infection among newly admitted prisoners.</p><p><strong>Conclusions: </strong>Prison entry represents a critical opportunity for syphilis screening. Risk-based screening strategies targeting individuals with high-risk sexual behaviors and substance use should be prioritized to reduce syphilis transmission in correctional facilities.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360956"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Metaphor, multimodality and generative AI: Synthetic images prompted by figurative expressions in anti-immigration discourse.","authors":"Christopher Hart","doi":"10.1371/journal.pone.0359980","DOIUrl":"10.1371/journal.pone.0359980","url":null,"abstract":"<p><p>Complex social processes like migration are frequently understood via metaphors. In right-wing media and far-right political discourses, two metaphors that abound draw on flood and invasion frames to problematise immigration and legitimise hostile attitudes and actions towards it. In so far as metaphor involves the construction of mental imagery, it is intimately bound with visual experience, including semiotically mediated visual experience. In a semiotic landscape increasingly populated by synthetic images, I argue that the meaning of metaphors may be modulated by AI-generated visual content and that this is especially important in contexts of political communication. The study investigates images generated by prompts instantiating an immigration is flood versus an immigration is invasion metaphor to inquire if and how they differ by source-frame and what are the ideological implications of the images returned. Following an initial pilot study, several specific semiotic features are analysed, including colour, properties of the figure (size, shape, orientation) and ground elements (environment, securitising features and frame-consistent features like fire and water). Results show significant differences between metaphorical frames and highlight the potential that AI-generated images have to reflect and reinforce ideological positions.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0359980"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674830/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Histopathologic spectrum of focal liver lesions diagnosed by ultrasound-guided percutaneous liver biopsy and predictors of hepatocellular carcinoma: A single-center experience from Sub-Saharan Africa.","authors":"Tamrat Petros Elias, Abate Bane Shewaye, Kaleb Assefa Berhane, Abdu Mohammed, Zebeaman Tibebu, Amanuel Getu Gebreselassie, Abraham Sisay Abie","doi":"10.1371/journal.pone.0357210","DOIUrl":"10.1371/journal.pone.0357210","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Focal liver lesions (FLLs) encompass a wide spectrum of benign and malignant pathologies, and accurate diagnosis is essential for appropriate management. Although advances in imaging have improved lesion characterization, histopathologic assessment remains the diagnostic gold standard for indeterminate lesions. Data on the histopathologic spectrum and diagnostic utility of ultrasound-guided percutaneous liver biopsy (US-PLB) in sub-Saharan Africa (SSA) are limited. This study aimed to characterize the histopathologic findings of US-PLB performed for FLLs at a tertiary referral center in SSA and to identify factors associated with hepatocellular carcinoma (HCC).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a retrospective observational study of adult patients (≥18 years) who underwent US-PLB for FLL between January 2021 and December 2024 at Adera Medical and Surgical Center. Patients with indeterminate pathology results, incomplete records, biopsies performed for diffuse liver disease, or lesions classified as LI-RADS 1, 2, or 5 were excluded. Demographic, clinical, laboratory, imaging, histopathologic, and outcome data were extracted from medical records. Descriptive statistics were used to summarize patient characteristics and histopathologic diagnoses. Logistic regression analysis was performed to identify factors associated with HCC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 119 were included in the final analysis. The median age was 56 years (IQR 45-65), and 59.7% were male. The median focal liver lesion size was 8.20 cm (IQR: 5.1-11.0 cm), with 38.7% presenting as multifocal lesions. No major biopsy-related complications were reported. HCC was the most common histopathologic diagnosis, accounting for 42.9% of cases, followed by secondary metastatic tumors (15.9%) and regenerative nodules (15.9%). Other diagnoses included chronic hepatitis (8.4%), cholangiocarcinoma (5.9%), and hepatic abscess (3.4%). Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections were present in 14.3% and 12.4% of patients, respectively. On multivariate analysis, HBV infection (AOR 7.85, 95% CI 1.45-42.60; p = 0.017), HCV infection (AOR 9.03, 95% CI 1.41-57.76; p = 0.020), Fibrosis-4 (FIB-4) score (AOR 1.45, 95% CI: 1.05-2.34: p &lt; 0.01), and larger tumor size (AOR 1.27, 95% CI 1.11-1.46; p &lt; 0.01) were significantly associated with HCC.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Ultrasound-guided percutaneous liver biopsy demonstrated a favorable safety profile for the evaluation of FLL. HCC was the predominant histopathologic diagnosis, reflecting the substantial burden of primary liver cancer in this setting. Chronic viral hepatitis and larger tumor size were significantly associated with HCC. These findings support the continued role of US-PLB in the diagnostic evaluation of indeterminate focal liver lesions and underscores the importance of viral hepatitis prevention, surveillance, and early detection strategies in sub-Saharan Afr","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0357210"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual tools for 3D plasma simulation: GPU-based isosurface extraction and particle-based rendering.","authors":"Jong-Hyun Kim, Mintae Na, Junho Kim, Sejin Yun, Jung Lee, Sun-Jeong Kim","doi":"10.1371/journal.pone.0359294","DOIUrl":"10.1371/journal.pone.0359294","url":null,"abstract":"<p><p>This paper presents a GPU-accelerated visualization framework for interactive exploration of fusion-plasma simulation data represented as scalar fields and particle trajectories. The primary technical contribution is a capacity-safe isosurface-extraction pipeline that combines inclusive slab partitioning with a two-pass counting and exact allocation strategy. This design prevents slab-boundary omissions and output-buffer overflow while supporting large scalar grids. The generated positions and normals are written directly to CUDA-OpenGL interoperable buffers, enabling the standalone renderer to display explicit isosurfaces without an intermediate CPU-side copy. The extracted geometry and scalar-volume data are additionally integrated into Unreal Engine through a separate staging interface. This integration provides a unified environment for volume rendering, explicit-isosurface inspection, particle-trajectory visualization, clipping, and VR-based spatial exploration. These engine-side functions are used as interaction and visualization mechanisms rather than being presented as new rendering algorithms. Experiments on electromagnetic-potential fields with resolutions up to 5123 demonstrate stable isosurface extraction across different isovalues. In the most geometrically complex tested case, the method generates approximately 42.81 million vertices in 44.7 ms, uses less than 11 GB of GPU memory, and renders the resulting geometry at 28.6 FPS. The results indicate that the proposed framework provides a practical explicit-surface visualization path for large plasma datasets while complementing direct volume rendering and established scientific-visualization toolkits.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0359294"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relation-aware dynamic knowledge subgraph enhanced large language models for medical multiple-choice question answering.","authors":"Yu Ma, Tianning Di, Jiangpeng Xu, Yue Wu","doi":"10.1371/journal.pone.0349628","DOIUrl":"10.1371/journal.pone.0349628","url":null,"abstract":"<p><p>Medical multiple-choice question answering requires models to simultaneously understand question semantics, candidate-answer differences, and structured relations among medical entities in complex clinical contexts. To address the limitations that existing knowledge-enhanced methods often adopt question-level unified modeling and thus struggle to characterize local relational differences among different candidate options, while conventional low-rank adaptation lacks relation-pattern adaptivity, this paper proposes a knowledge-enhanced large language model framework that combines option-level knowledge subgraph representation fusion with relation-aware dynamic LoRA adaptation. The proposed method first constructs a local medical knowledge subgraph for the question stem and each candidate answer separately, and then injects structured knowledge into candidate representations through a graph encoder and gated fusion mechanism. Subsequently, multiple learned LoRA expert branches are dynamically combined through candidate-conditioned routing based on the relational information encoded in the enhanced candidate representations, enabling the model to obtain more suitable parameter update paths. The experimental results are reported as the mean and standard deviation over three random-seed runs. On the MedQA dataset, the proposed method achieves Accuracy scores of 62.90%±0.82% and 62.84%±1.04%, together with F1-Score values of 62.97%±1.07% and 62.79%±0.78%, using Llama3 8B and Qwen 7B, respectively. On the MedMCQA dataset, the corresponding Accuracy scores are 61.04%±0.30% and 58.59%±0.65%, while the F1-Score values reach 61.21%±0.54% and 57.77%±0.57%, respectively. Experimental results show that the proposed method can effectively improve knowledge understanding, candidate discrimination, and reasoning stability in medical multiple-choice question answering.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0349628"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medical rehabilitation use and regional bypass among children and adolescents with disabilities: Lessons from South Korea.","authors":"Sungbae Jo","doi":"10.1371/journal.pone.0360753","DOIUrl":"10.1371/journal.pone.0360753","url":null,"abstract":"<p><p>This cross-sectional secondary analysis examined medical rehabilitation use and regional bypass among Korean children and adolescents with registered disabilities, using a two-stage access framework that distinguished entry into medical-institution rehabilitation from out-of-region use after entry. We analyzed public-use data from the 2023 National Survey on Persons with Disabilities, restricting the sample to respondents younger than 19 years (n = 399; weighted national estimate, 88,611). Weighted descriptive statistics and modified Poisson regression with robust standard errors were used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Overall, 50.0% had no medical-institution rehabilitation use, 31.5% used in-region rehabilitation, and 18.6% used out-of-region rehabilitation; among rehabilitation users, 37.1% reported out-of-region care. In stage 1, non-developmental disability type was associated with higher medical rehabilitation use (PR, 1.61; 95% CI, 1.28-2.03), whereas eup/myeon residence was associated with lower use (PR, 0.66; 95% CI, 0.46-0.94). In stage 2, province residence (PR, 2.13; 95% CI, 1.38-3.27) and non-developmental disability type (PR, 1.74; 95% CI, 1.13-2.69) were associated with out-of-region use, while male sex was associated with lower out-of-region use (PR, 0.62; 95% CI, 0.42-0.92). The most common reason for non-use was use of non-medical facilities (27.4%); better treatment and absence of nearby medical institutions were leading reasons for out-of-region care. Pediatric medical rehabilitation access involves challenges to both non-use and out-of-region use, with implications for local entry support, regional capacity-building, and cross-sector service integration.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360753"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674712/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joint associations of 2D-3D urban form with land surface temperature along an urban-rural gradient: Implications for sustainable urban planning.","authors":"Liang Zhang, Xue Liu, Xianfan Shu","doi":"10.1371/journal.pone.0358985","DOIUrl":"10.1371/journal.pone.0358985","url":null,"abstract":"<p><p>As fundamental urban units, buildings are closely associated with urban thermal environments, and their morphological attributes are related to spatial variations in thermal conditions. Although significant progress has been made in characterizing building morphology, the relative importance and joint associations between 2D horizontal characteristics and 3D vertical structures in shaping neighborhood-scale thermal environments along urban-rural gradients remain underexplored. This study integrated multi-source remote-sensing data and Geodetector analysis to examine the joint, grid-level associations of 2D and 3D urban-form indicators with land surface temperature (LST) in Hangzhou, China. Multi-temporal LST data from 2000, 2010, 2015, and 2020 were used to characterize the thermal context, whereas the building-morphology data in 2020 supported a cross-sectional spatial association analysis. The results revealed clear spatial variation in the relative explanatory power of morphological indicators. Specifically, 3D building configurations exhibited the greatest explanatory power in the Core Built-up Area, whereas 2D characteristics showed stronger associations with LST in the Suburban Built-up Area. Interactions between 2D and 3D features generally provided greater explanatory power than individual factors, with several factor pairs showing nonlinear enhancement. These findings highlight the value of jointly considering horizontal land-cover patterns and vertical building form when assessing urban thermal environments. By elucidating gradient-specific thermal regulation processes and multidimensional interactions among built-environment features, this study provides a scientific foundation for spatially targeted, climate-responsive heat mitigation strategies and sustainable urban development.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0358985"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Laboratory-based surveillance of antimicrobial non-susceptibility in Enterobacter species over 12 years at a tertiary-care hospital in Saudi Arabia.","authors":"Yahya Shabi, Fatimah Mohmmed Ali Asiri, Khalifa Binkhamis, Ali M Somily, Mona M Alshahrani, Tarik Alazraqi, Safia Abdullah Mohammed, Sara Habbash, Ali Al Bshabshe, Soliuman Mohamed, Abdullah Algarni, Ahmadiyah Siddiq, Abdulah O S Bawazeer, Abdulah J Alqahtani, Abdullah A Al-Shahrani","doi":"10.1371/journal.pone.0358963","DOIUrl":"10.1371/journal.pone.0358963","url":null,"abstract":"<p><strong>Background: </strong>Enterobacter species are increasingly associated with antimicrobial non-susceptibility, but long-term surveillance of temporal trends across antibiotic classes is limited in southern Saudi Arabia.</p><p><strong>Methods: </strong>We retrospectively studied non-duplicate Enterobacter isolates from adults at a tertiary-care hospital in southern Saudi Arabia (August 2012-August 2024), interpreted by contemporaneous CLSI criteria. Temporal trends were modelled by logistic regression as the annual percent change (APC) in the odds of non-susceptibility, adjusted for care setting, specimen source, age, and sex. Carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat resistance (DTR; Kadri criteria) were analysed over time; sensitivity analyses excluded partial years and used breakpoint-comparable periods.</p><p><strong>Results: </strong>Of 1,319 Enterobacter isolates, 91.8% belonged to the Enterobacter cloacae complex. Adjusted trends declined for amikacin (APC -6.1%), gentamicin (-9.4%) and cefepime (-9.1%) and rose for carbapenems (+13.1% to +15.8%), levofloxacin (+6.3%) and piperacillin-tazobactam (+7.0%), with ciprofloxacin stable. The levofloxacin and piperacillin-tazobactam increases did not persist in breakpoint-comparable analyses and are not unequivocal biological increases. Inpatient isolates were more non-susceptible than outpatient isolates by approximately 16-39 percentage points (gentamicin 31.7% vs 14.8%; piperacillin-tazobactam 38.7% vs 23.1%; cefotaxime 63.9% vs 41.5%; cefepime 45.7% vs 28.8%; ceftazidime 61.4% vs 35.3%; ceftriaxone 57.4% vs 18.8%; all p ≤ 0.003). CRE rose early and remained common (APC + 22.8%; 28.7% overall), whereas DTR rose later and stayed infrequent (7.5% of eligible isolates; APC + 16.4%; highest annual value 20.2% in 2023); this difference in timing and overall frequency, not the partially sampled year 2024, indicates dissociation between carbapenem non-susceptibility and loss of all first-line agents.</p><p><strong>Conclusion: </strong>Non-susceptibility among Enterobacter species was heterogeneous and antibiotic-specific. The dissociation between CRE and DTR in timing and overall frequency supports using clinically meaningful phenotypes alongside antibiotic-specific trend analysis for stewardship and reporting; the levofloxacin and piperacillin-tazobactam increases warrant caution, as they did not persist in breakpoint-comparable analyses.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0358963"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability and validity of the Japanese version of the Sleep Problem Acceptance Questionnaire.","authors":"Mizuki Bando, Tomohiro Asakura, Hiroshi Sato, Isa Okajima","doi":"10.1371/journal.pone.0358990","DOIUrl":"10.1371/journal.pone.0358990","url":null,"abstract":"<p><p>This study aimed to develop a Japanese version of the Sleep Problem Acceptance Questionnaire (SPAQ-J) and assess its reliability and validity. The SPAQ-J was developed through a forward-backward translation procedure with permission from the original authors. The sample included 861 adults with insomnia who completed questionnaires on experiential avoidance, insomnia symptoms, dysfunctional beliefs about sleep, sleep-related safety behaviors, insomnia catastrophizing, and pre-sleep arousal. Confirmatory factor analysis confirmed that the SPAQ-J retained the two-factor structure of the original version (CFI = 0.972, TLI = 0.958, RMSEA = 0.082, SRMR = 0.059): Activity Engagement and Willingness. Although internal consistency was adequate (Activity Engagement: α = 0.868, ω = 0.870; Willingness: α = 0.895, ω = 0.895), test-retest reliability was below the recommended threshold (Activity Engagement: ICC = 0.586, Willingness: ICC = 0.589). In terms of construct validity, Willingness moderately correlated with all scales, whereas Activity Engagement showed moderate-to-weak correlations. Hierarchical multiple regression analysis revealed that adding the SPAQ-J subscales significantly enhanced the explanatory power. Measurement invariance analysis across sex and age groups showed no significant changes in the fit indices, indicating stability. These findings suggest that the SPAQ-J is a valid and partially reliable measure of psychological flexibility related to sleep problems in the Japanese population.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0358990"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674769/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rising stroke burden in Uganda: A national time-series analysis and forecasts, 2016-2028.","authors":"Suzan Nakasendwa, Joan Nankya Mutyoba, Alex Riolexus Ario, Evans Omondi, Brenda Birungi Bashemera, Francis Kakooza, Letisha Najjemba, Joyce Nakatumba Nabende, David Guwatudde, Agnes Kiragga","doi":"10.1371/journal.pone.0360963","DOIUrl":"10.1371/journal.pone.0360963","url":null,"abstract":"<p><strong>Introduction: </strong>Stroke is a leading cause of mortality and disability globally, with a disproportionate and growing burden in low- and middle-income Countries. However, evidence on national temporal trends and potential impacts in Uganda remains limited. This study examined trends in stroke cases and deaths in Uganda and forecast of future stroke burden through December 2028.</p><p><strong>Methods: </strong>We conducted a retrospective time-series analysis of District Health Information System (DHIS2) from 2016 to 2025. Monthly stroke cases, and deaths were analyzed. Monthly populations of Uganda were estimated using exponential growth interpolation and incorporated as an offset term in Bayesian negative binomial regression models to estimate incidence rate ratios (IRR) at 95% confidence interval (CI). Decomposition analysis using the Kitagawa method was applied to derive contributions from population growth and epidemiological change, based on model estimates. Stationarity and autocorrelation were assessed using the unit root and Ljung-Box tests. Forecasting was performed using the exponential smoothing state-space (ETS) model at 80% prediction intervals (PI).</p><p><strong>Results: </strong>Trend analysis showed sustained monthly increases in stroke incidence and mortality with IRR; 1.005 (95% CI: 1.004-1.006), and 1.006 (95% CI: 1.005-1.007), respectively (all p < 0.001). The epidemiological effect was approximately twice as large as the population effect, indicating that the majority of the increase in stroke cases and deaths is attributable to rising incidence rates rather than population growth alone. ETS model demonstrated that by December 2028, monthly cases and deaths are projected to reach approximately 927 (80% PI: 709-1,156) and 126 (80% PI: 94-160), respectively.</p><p><strong>Conclusion: </strong>Stroke burden in Uganda is projected to continue increase further over the next years in the absence of effective prevention measures. Strengthened primary prevention, expanded acute stroke care capacity, and improved surveillance systems are urgently needed to mitigate the growing health system impact.</p>","PeriodicalId":20189,"journal":{"name":"PLoS ONE","volume":"21 10","pages":"e0360963"},"PeriodicalIF":2.8,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13674727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149207898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"综合性期刊","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}