Most-cited articles · 2021

The 100 most-cited articles in PLoS ONE, 2021

Ranked by OpenAlex citation count on 29 October 2026, out of 15,971 eligible articles PLoS ONE published in 2021. Ranks are frozen; this page will not change. Number one, with 888 citations: Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States.

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2026-10-29

The highest ranked articles from this set are dominated by COVID-19 research, particularly studies of mental health among university students and healthcare workers, vaccine hesitancy and attitudes, and the broader psychological and clinical effects of the pandemic. The top paper, by Browning, Larson, Sharaievska and colleagues, examines psychological impacts and risk factors among university students across seven United States states and holds 888 citations. Other prominent themes include systematic reviews of risk factors and co-infections, alongside methodological work such as data augmentation for time series classification and nanopore DNA sequencing.

Readers can use this list to see which 2021 PLoS ONE articles attracted the most citations, as counted by OpenAlex out of 15,971 eligible papers. The ranking reflects citation frequency rather than quality or importance, and the titles and abstracts indicate the topics and study designs involved.

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  1. 1
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    Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States

    Matthew H. E. M. Browning, Lincoln R. Larson, Iryna Sharaievska, Alessandro Rigolon, Olivia McAnirlin and 10 more

    888 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245327OpenAlex

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    BACKGROUND: University students are increasingly recognized as a vulnerable population, suffering from higher levels of anxiety, depression, substance abuse, and disordered eating compared to the general population. Therefore, when the nature of their educational experience radically changes-such as sheltering in place during the COVID-19 pandemic-the burden on the mental health of this vulnerable population is amplified. The objectives of this study are to 1) identify the array of psychological impacts COVID-19 has on students, 2) develop profiles to characterize students' anticipated levels of psychological impact during the pandemic, and 3) evaluate potential sociodemographic, lifestyle-related, and awareness of people infected with COVID-19 risk factors that could make students more likely to experience these impacts. METHODS: Cross-sectional data were collected through web-based questionnaires from seven U.S. universities. Representative and convenience sampling was used to invite students to complete the questionnaires in mid-March to early-May 2020, when most…

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    Partisanship, health behavior, and policy attitudes in the early stages of the COVID-19 pandemic

    Shana Kushner Gadarian, Sara Wallace Goodman, Thomas B. Pepinsky

    743 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249596OpenAlex

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    OBJECTIVE: To study the U.S. public's health behaviors, attitudes, and policy opinions about COVID-19 in the earliest weeks of the national health crisis (March 20-23, 2020). METHOD: We designed and fielded an original representative survey of 3,000 American adults between March 20-23, 2020 to collect data on a battery of 38 health-related behaviors, government policy preferences on COVID-19 response and worries about the pandemic. We test for partisan differences COVID-19 related policy attitudes and behaviors, measured in three different ways: party affiliation, intended 2020 Presidential vote, and self-placed ideological positioning. Our multivariate approach adjusts for a wide range of individual demographic and geographic characteristics that might confound the relationship between partisanship and health behaviors, attitudes, and preferences. RESULTS: We find that partisanship-measured as party identification, support for President Trump, or left-right ideological positioning-explains differences in Americans across a wide range of health behaviors and policy preferences. We…

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    An empirical survey of data augmentation for time series classification with neural networks

    Brian Kenji Iwana, Seiichi Uchida

    723 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0254841OpenAlex

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    In recent times, deep artificial neural networks have achieved many successes in pattern recognition. Part of this success can be attributed to the reliance on big data to increase generalization. However, in the field of time series recognition, many datasets are often very small. One method of addressing this problem is through the use of data augmentation. In this paper, we survey data augmentation techniques for time series and their application to time series classification with neural networks. We propose a taxonomy and outline the four families in time series data augmentation, including transformation-based methods, pattern mixing, generative models, and decomposition methods. Furthermore, we empirically evaluate 12 time series data augmentation methods on 128 time series classification datasets with six different types of neural networks. Through the results, we are able to analyze the characteristics, advantages and disadvantages, and recommendations of each data augmentation method. This survey aims to help in the selection of time series data augmentation for neural…

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    Gender differences in perceived stress and coping among college students

    Barbara Sue Graves, Michael E. Hall, Carolyn Dias-Karch, Michael H. Haischer, Christine Apter

    686 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0255634OpenAlex

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    BACKGROUND: Many college students register each semester for courses, leading to productive careers and fulfilled lives. During this time, the students have to manage many stressors stemming from academic, personal, and, sometimes, work lives. Students, who lack appropriate stress management skills, may find it difficult to balance these responsibilities. OBJECTIVES: This study examined stress, coping mechanisms, and gender differences in undergraduate students towards the end of the semester. DESIGN AND METHOD: University students (n = 448) enrolled in three different undergraduate exercise science courses were assessed. Two instruments, the Perceived Stress Scale and Brief Cope, were administered during the twelfth week of the semester, four weeks prior to final exams. T-tests were used to detect gender differences for the stress levels and coping strategies. RESULTS: Overall, females indicated higher levels of stress than their male counterparts. Gender differences were evident in both coping dimensions and individual coping strategies used. Females were found to utilize the…

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    COVID-19 and vaccine hesitancy: A longitudinal study

    Ariel Fridman, Rachel Gershon, Ayelet Gneezy

    676 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250123OpenAlex

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    How do attitudes toward vaccination change over the course of a public health crisis? We report results from a longitudinal survey of United States residents during six months (March 16 -August 16, 2020) of the COVID-19 pandemic. Contrary to past research suggesting that the increased salience of a disease threat should improve attitudes toward vaccines, we observed a decrease in intentions of getting a COVID-19 vaccine when one becomes available. We further found a decline in general vaccine attitudes and intentions of getting the influenza vaccine. Analyses of heterogeneity indicated that this decline is driven by participants who identify as Republicans, who showed a negative trend in vaccine attitudes and intentions, whereas Democrats remained largely stable. Consistent with research on risk perception and behavior, those with less favorable attitudes toward a COVID-19 vaccination also perceived the virus to be less threatening. We provide suggestive evidence that differential exposure to media channels and social networks could explain the observed asymmetric polarization…

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    Post-COVID-19 syndrome among symptomatic COVID-19 patients: A prospective cohort study in a tertiary care center of Bangladesh

    Reaz Mahmud, Md Mujibur Rahman, Mohammad Aftab Rassel, Farhana Binte Monayem, S.K. Jakaria Been Sayeed and 2 more

    572 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249644OpenAlex

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    BACKGROUND: Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. METHODS: We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. FINDINGS: Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom…

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    Acceptance and attitudes toward COVID-19 vaccines: A cross-sectional study from Jordan

    Tamam El‐Elimat, Mahmoud M. AbuAlSamen, Basima Abdalla Almomani, Nour A. Al‐Sawalha, Feras Qasem Alali

    552 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250555OpenAlex

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    Vaccines are effective interventions that can reduce the high burden of diseases globally. However, public vaccine hesitancy is a pressing problem for public health authorities. With the availability of COVID-19 vaccines, little information is available on the public acceptability and attitudes towards the COVID-19 vaccines in Jordan. This study aimed to investigate the acceptability of COVID-19 vaccines and its predictors in addition to the attitudes towards these vaccines among public in Jordan. An online, cross-sectional, and self-administered questionnaire was instrumentalized to survey adult participants from Jordan on the acceptability of COVID-19 vaccines. Logistic regression analysis was used to find the predictors of COVID-19 vaccines' acceptability. A total of 3,100 participants completed the survey. The public acceptability of COVID-19 vaccines was fairly low (37.4%) in Jordan. Males (OR = 2.488, 95CI% = 1.834-3.375, p < .001) and those who took the seasonal influenza vaccine (OR = 2.036, 95CI% = 1.306-3.174, p = .002) were more likely to accept COVID-19 vaccines.…

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    Population risk factors for severe disease and mortality in COVID-19: A global systematic review and meta-analysis

    Adam Booth, Angus Bruno Reed, Sonia Ponzo, Arrash Yassaee, Mert Aral and 3 more

    551 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247461OpenAlex

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    AIM: COVID-19 clinical presentation is heterogeneous, ranging from asymptomatic to severe cases. While there are a number of early publications relating to risk factors for COVID-19 infection, low sample size and heterogeneity in study design impacted consolidation of early findings. There is a pressing need to identify the factors which predispose patients to severe cases of COVID-19. For rapid and widespread risk stratification, these factors should be easily obtainable, inexpensive, and avoid invasive clinical procedures. The aim of our study is to fill this knowledge gap by systematically mapping all the available evidence on the association of various clinical, demographic, and lifestyle variables with the risk of specific adverse outcomes in patients with COVID-19. METHODS: The systematic review was conducted using standardized methodology, searching two electronic databases (PubMed and SCOPUS) for relevant literature published between 1st January 2020 and 9th July 2020. Included studies reported characteristics of patients with COVID-19 while reporting outcomes relating to…

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    Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: A systematic review and meta-analysis

    Jackson Musuuza, Lauren Watson, Vishala Parmasad, Nathan Putman-Buehler, Leslie Christensen and 1 more

    547 citationsOpen access (PUBLIC-DOMAIN)doi:10.1371/journal.pone.0251170OpenAlex

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    INTRODUCTION: The recovery of other pathogens in patients with SARS-CoV-2 infection has been reported, either at the time of a SARS-CoV-2 infection diagnosis (co-infection) or subsequently (superinfection). However, data on the prevalence, microbiology, and outcomes of co-infection and superinfection are limited. The purpose of this study was to examine the occurrence of co-infections and superinfections and their outcomes among patients with SARS-CoV-2 infection. PATIENTS AND METHODS: We searched literature databases for studies published from October 1, 2019, through February 8, 2021. We included studies that reported clinical features and outcomes of co-infection or superinfection of SARS-CoV-2 and other pathogens in hospitalized and non-hospitalized patients. We followed PRISMA guidelines, and we registered the protocol with PROSPERO as: CRD42020189763. RESULTS: Of 6639 articles screened, 118 were included in the random effects meta-analysis. The pooled prevalence of co-infection was 19% (95% confidence interval [CI]: 14%-25%, I2 = 98%) and that of superinfection was 24% (95%…

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    Sequencing DNA with nanopores: Troubles and biases

    Clara Delahaye, Jacques Nicolas

    541 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0257521OpenAlex

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    Oxford Nanopore Technologies' (ONT) long read sequencers offer access to longer DNA fragments than previous sequencer generations, at the cost of a higher error rate. While many papers have studied read correction methods, few have addressed the detailed characterization of observed errors, a task complicated by frequent changes in chemistry and software in ONT technology. The MinION sequencer is now more stable and this paper proposes an up-to-date view of its error landscape, using the most mature flowcell and basecaller. We studied Nanopore sequencing error biases on both bacterial and human DNA reads. We found that, although Nanopore sequencing is expected not to suffer from GC bias, it is a crucial parameter with respect to errors. In particular, low-GC reads have fewer errors than high-GC reads (about 6% and 8% respectively). The error profile for homopolymeric regions or regions with short repeats, the source of about half of all sequencing errors, also depends on the GC rate and mainly shows deletions, although there are some reads with long insertions. Another interesting…

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    Prevalence of depression, anxiety and post-traumatic stress disorder in health care workers during the COVID-19 pandemic: A systematic review and meta-analysis

    Yufei Li, Nathaniel Scherer, Lambert M. Felix, Hannah Kuper

    536 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246454OpenAlex

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    OBJECTIVE: The COVID-19 pandemic has placed health care workers under psychological stress. Previous reviews show a high prevalence of mental disorders among health care workers, but these need updating and inclusion of studies written in Chinese. The aim of this systematic review and meta-analysis was to provide updated prevalence estimates for depression, anxiety and post-traumatic stress disorder (PTSD) among health care workers during the COVID-19 pandemic, benefitting from the inclusion of studies published in Chinese. METHODS: Systematic search of EMBASE, MEDLINE, PsycINFO, Global Health, Web of Science, CINAHL, Google Scholar and the Chinese databases SinoMed, WanfangMed, CNKI and CQVIP, for studies conducted between December 2019 and August 2020 on the prevalence of depression, anxiety and PTSD in health care workers during the COVID-19 pandemic. Studies published in both English and Chinese were included. RESULTS: Data on the prevalence of moderate depression, anxiety and PTSD was pooled across 65 studies involving 97,333 health care workers across 21 countries. The pooled…

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    COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence

    Md Saiful Islam, Abu-Hena Mostofa Kamal, Alamgir Kabir, Dorothy L. Southern, Sazzad Hossain Khan and 9 more

    533 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251605OpenAlex

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    INTRODUCTION: Rumors and conspiracy theories, can contribute to vaccine hesitancy. Monitoring online data related to COVID-19 vaccine candidates can track vaccine misinformation in real-time and assist in negating its impact. This study aimed to examine COVID-19 vaccine rumors and conspiracy theories circulating on online platforms, understand their context, and then review interventions to manage this misinformation and increase vaccine acceptance. METHOD: In June 2020, a multi-disciplinary team was formed to review and collect online rumors and conspiracy theories between 31 December 2019-30 November 2020. Sources included Google, Google Fact Check, Facebook, YouTube, Twitter, fact-checking agency websites, and television and newspaper websites. Quantitative data were extracted, entered in an Excel spreadsheet, and analyzed descriptively using the statistical package R version 4.0.3. We conducted a content analysis of the qualitative information from news articles, online reports and blogs and compared with findings from quantitative data. Based on the fact-checking agency…

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    The Covid-19 pandemic and mental health of first-year college students: Examining the effect of Covid-19 stressors using longitudinal data

    Jane Cooley Fruehwirth, Siddhartha Biswas, Krista M. Perreira

    526 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247999OpenAlex

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    PURPOSE: The Covid-19 pandemic has brought unprecedented stress to students and educational institutions across the world. We aimed to estimate the effect of the pandemic on the mental health of college students. METHODS: We used data on 419 first-year students (ages 18-20) at a large public university in North Carolina both before (October 2019-February 2020) and after (June/July 2020) the start of the Covid-19 pandemic. After evaluating descriptive data on mental health and stressors by students' demographic characteristics, we estimated the associations between Covid-19 stressors (including work reductions, health, distanced learning difficulties and social isolation) and mental health symptoms and severity controlling for students' pre-pandemic mental health, psychosocial resources, and demographic characteristics. RESULTS: We found that the prevalence of moderate-severe anxiety increased from 18.1% before the pandemic to 25.3% within four months after the pandemic began; and the prevalence of moderate-severe depression increased from 21.5% to 31.7%. White, female and…

  14. 14
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    Why the COVID-19 pandemic is a traumatic stressor

    Victoria M. E. Bridgland, Ella K. Moeck, Deanne M. Green, Taylor L. Swain, Diane M. Nayda and 3 more

    493 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0240146OpenAlex

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    The COVID-19 pandemic does not fit into prevailing Post-traumatic Stress Disorder (PTSD) models, or diagnostic criteria, yet emerging research shows traumatic stress symptoms as a result of this ongoing global stressor. Current pathogenic event models focus on past, and largely direct, trauma exposure to certain kinds of life-threatening events. Yet, traumatic stress reactions to future, indirect trauma exposure, and non-Criterion A events exist, suggesting COVID-19 is also a traumatic stressor which could lead to PTSD symptomology. To examine this idea, we asked a sample of online participants (N = 1,040), in five western countries, to indicate the COVID-19 events they had been directly exposed to, events they anticipated would happen in the future, and other forms of indirect exposure such as through media coverage. We then asked participants to complete the Posttraumatic Stress Disorder Checklist-5, adapted to measure pre/peri/post-traumatic reactions in relation to COVID-19. We also measured general emotional reactions (e.g., angry, anxious, helpless), well-being, psychosocial…

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    Determinants of burnout and other aspects of psychological well-being in healthcare workers during the Covid-19 pandemic: A multinational cross-sectional study

    Alasdair James Scott, Benjamin Yong‐Qiang Tan, Chan Yiong Huak, Ching-Hui Sia, Ying Xian Chua and 25 more

    473 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0238666OpenAlex

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    The Covid-19 pandemic has placed unprecedented pressure on healthcare systems and workers around the world. Such pressures may impact on working conditions, psychological wellbeing and perception of safety. In spite of this, no study has assessed the relationship between safety attitudes and psychological outcomes. Moreover, only limited studies have examined the relationship between personal characteristics and psychological outcomes during Covid-19. From 22nd March 2020 to 18th June 2020, healthcare workers from the United Kingdom, Poland, and Singapore were invited to participate using a self-administered questionnaire comprising the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory (OLBI) and Hospital Anxiety and Depression Scale (HADS) to evaluate safety culture, burnout and anxiety/depression. Multivariate logistic regression was used to determine predictors of burnout, anxiety and depression. Of 3,537 healthcare workers who participated in the study, 2,364 (67%) screened positive for burnout, 701 (20%) for anxiety, and 389 (11%) for depression. Significant…

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    The experiences, challenges, and acceptance of e-learning as a tool for teaching during the COVID-19 pandemic among university medical staff

    Marwa Mohamed Zalat, Mona Hamed, Sarah Abdelhalim Bolbol

    461 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248758OpenAlex

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    BACKGROUND: e-learning was underutilized in the past especially in developing countries. However, the current crisis of the COVID-19 pandemic forced the entire world to rely on it for education. OBJECTIVES: To estimate the university medical staff perceptions, evaluate their experiences, recognize their barriers, challenges of e-learning during the COVID-19 pandemic, and investigate factors influencing the acceptance and use of e-learning as a tool teaching within higher education. METHODS: Data was collected using an electronic questionnaire with a validated Technology Acceptance Model (TAM) for exploring factors that affect the acceptance and use of e-learning as a teaching tool among medical staff members, Zagazig University, Egypt. RESULTS: The majority (88%) of the staff members agreed that the technological skills of giving the online courses increase the educational value of the experience of the college staff. The rate of participant agreement on perceived usefulness, perceived ease of use, and acceptance of e-learning was (77.1%, 76.5%, and 80.9% respectively). The highest…

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    The impact of COVID-19 pandemic on physical and mental health of Asians: A study of seven middle-income countries in Asia

    Cuiyan Wang, Michael Lucas Tee, Ashley Edward Roy, Mohammad Ali Fardin, Wandee Srichokchatchawan and 20 more

    460 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246824OpenAlex

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    The coronavirus disease (COVID-19) pandemic has impacted the economy, livelihood, and physical and mental well-being of people worldwide. This study aimed to compare the mental health status during the pandemic in the general population of seven middle income countries (MICs) in Asia (China, Iran, Malaysia, Pakistan, Philippines, Thailand, and Vietnam). All the countries used the Impact of Event Scale-Revised (IES-R) and Depression, Anxiety and Stress Scale (DASS-21) to measure mental health. There were 4479 Asians completed the questionnaire with demographic characteristics, physical symptoms and health service utilization, contact history, knowledge and concern, precautionary measure, and rated their mental health with the IES-R and DASS-21. Descriptive statistics, One-Way analysis of variance (ANOVA), and linear regression were used to identify protective and risk factors associated with mental health parameters. There were significant differences in IES-R and DASS-21 scores between 7 MICs (p<0.05). Thailand had all the highest scores of IES-R, DASS-21 stress, anxiety, and…

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    Anxiety, depression, stress, fear and social support during COVID-19 pandemic among Jordanian healthcare workers

    Eman Khamis Alnazly, Omar Mohammad Ali Khraisat, Ahmad M. Al-Bashaireh, Christine L. Bryant

    449 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247679OpenAlex

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    The emergence of Coronavirus disease 2019 (COVID-19) has affected health-care workers' psychological and mental health. Few studies have been conducted examining the psychological effect of COVID-19 on health-care worker psychological health in Jordan. Therefore, the present study aims to assess the respective levels of fear, anxiety, depression, stress, social support, and the associated factors, experienced by Jordanian health-care workers during the COVID-19 Pandemic. This study adopted a cross-sectional, correlational design to collect data from 365 health-care workers in Amman, Jordan, from August 16th to 23rd, 2020. Along with collecting sociodemographic characteristics, the Fear of COVID-19 Scale, the Depression, Anxiety, Stress Scale, and the Multidimensional Scale of Perceived Social Support electronically administered to participants. The majority of the participants (69.3%) were registered nurses. The mean overall score for the Fear of COVID-19 scale was 23.64 (SD + 6.85) which again exceeded the mid-point for the total score range (21), indicating elevated level fear of…

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    Red seaweed (Asparagopsis taxiformis) supplementation reduces enteric methane by over 80 percent in beef steers

    Breanna Michell Roque, Marielena Venegas, Robert D. Kinley, Rocky de Nys, T. L. Neoh and 4 more

    432 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247820OpenAlex

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    The red macroalgae (seaweed) Asparagopsis spp. has shown to reduce ruminant enteric methane (CH4) production up to 99% in vitro. The objective of this study was to determine the effect of Asparagopsis taxiformis on CH4 production (g/day per animal), yield (g CH4/kg dry matter intake (DMI)), and intensity (g CH4/kg ADG); average daily gain (ADG; kg gain/day), feed conversion efficiency (FCE; kg ADG/kg DMI), and carcass and meat quality in growing beef steers. Twenty-one Angus-Hereford beef steers were randomly allocated to one of three treatment groups: 0% (Control), 0.25% (Low), and 0.5% (High) A. taxiformis inclusion based on organic matter intake. Steers were fed 3 diets: high, medium, and low forage total mixed ration (TMR) representing life-stage diets of growing beef steers. The Low and High treatments over 147 days reduced enteric CH4 yield 45 and 68%, respectively. However, there was an interaction between TMR type and the magnitude of CH4 yield reduction. Supplementing low forage TMR reduced CH4 yield 69.8% (P <0.01) for Low and 80% (P <0.01) for High treatments. Hydrogen…

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    Pneumonia detection in chest X-ray images using an ensemble of deep learning models

    Rohit Kundu, Ritacheta Das, Zong Woo Geem, Gi-Tae Han, Ram Sarkar

    431 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256630OpenAlex

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    Pneumonia is a respiratory infection caused by bacteria or viruses; it affects many individuals, especially in developing and underdeveloped nations, where high levels of pollution, unhygienic living conditions, and overcrowding are relatively common, together with inadequate medical infrastructure. Pneumonia causes pleural effusion, a condition in which fluids fill the lung, causing respiratory difficulty. Early diagnosis of pneumonia is crucial to ensure curative treatment and increase survival rates. Chest X-ray imaging is the most frequently used method for diagnosing pneumonia. However, the examination of chest X-rays is a challenging task and is prone to subjective variability. In this study, we developed a computer-aided diagnosis system for automatic pneumonia detection using chest X-ray images. We employed deep transfer learning to handle the scarcity of available data and designed an ensemble of three convolutional neural network models: GoogLeNet, ResNet-18, and DenseNet-121. A weighted average ensemble technique was adopted, wherein the weights assigned to the base…

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    Association of body mass index with health care expenditures in the United States by age and sex

    Zachary J. Ward, Sara N. Bleich, Michael William Long, Steven L. Gortmaker

    428 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247307OpenAlex

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    BACKGROUND: Estimates of health care costs associated with excess weight are needed to inform the development of cost-effective obesity prevention efforts. However, commonly used cost estimates are not sensitive to changes in weight across the entire body mass index (BMI) distribution as they are often based on discrete BMI categories. METHODS: We estimated continuous BMI-related health care expenditures using data from the Medical Expenditure Panel Survey (MEPS) 2011-2016 for 175,726 respondents. We adjusted BMI for self-report bias using data from the National Health and Nutrition Examination Survey (NHANES) 2011-2016, and controlled for potential confounding between BMI and medical expenditures using a two-part model. Costs are reported in $US 2019. RESULTS: We found a J-shaped curve of medical expenditures by BMI, with higher costs for females and the lowest expenditures occurring at a BMI of 20.5 for adult females and 23.5 for adult males. Over 30 units of BMI, each one-unit BMI increase was associated with an additional cost of $253 (95% CI $167-$347) per person. Among adults,…

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    Study on the effect of digital economy on high-quality economic development in China

    Wei Zhang, Siqi Zhao, Xiaoyu Wan, Yuan Yao

    419 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0257365OpenAlex

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    At present, the digital economy, which takes information technology and data as the key elements, is booming and has become an important force in promoting the economic growth of various countries. In order to explore the current dynamic trend of China's digital economy development and the impact of the digital economy on the high-quality economic development, this paper measures the digital economic development index of 30 cities in China from the three dimensions of digital infrastructure, digital industry, and digital integration, uses panel data of 30 cities in China from 2015 to 2019 to construct an econometric model for empirical analysis, and verifies the mediating effect of technological progress between the digital economy and high-quality economic development. The results show that (1) The development level of China's digital economy is increasing year by year, that the growth of digital infrastructure is obvious, and that the development of the digital industry is relatively slow. (2) Digital infrastructure, digital industry and digital integration all have significant…

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    An observational study of engineering online education during the COVID-19 pandemic

    Shadnaz Asgari, Jelena Trajković, Mehran Rahmani, Wenlu Zhang, Roger C. Lo and 1 more

    351 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250041OpenAlex

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    The COVID-19 pandemic compelled the global and abrupt conversion of conventional face-to-face instruction to the online format in many educational institutions. Urgent and careful planning is needed to mitigate negative effects of pandemic on engineering education that has been traditionally content-centered, hands-on and design-oriented. To enhance engineering online education during the pandemic, we conducted an observational study at California State University, Long Beach (one of the largest and most diverse four-year university in the U.S.). A total of 110 faculty members and 627 students from six engineering departments participated in surveys and answered quantitative and qualitative questions to highlight the challenges they experienced during the online instruction in Spring 2020. Our results identified various issues that negatively influenced the online engineering education including logistical/technical problems, learning/teaching challenges, privacy and security concerns and lack of sufficient hands-on training. For example, more than half of the students indicated…

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    First and second waves of coronavirus disease-19: A comparative study in hospitalized patients in Reus, Spain

    Simona Mihaela Iftimie, Ana Felisa López-Azcona, Immaculada Vallverdú, Salvador Hernández-Flix, Gabriel de Febrer and 25 more

    351 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248029OpenAlex

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    Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic, with a first wave during spring followed by the current second wave in late summer and autumn. Empirical data show that the characteristics of the effects of the virus do vary between the two periods. Differences in age range and severity of the disease have been reported, although the comparative characteristics of the two waves still remain largely unknown. Those characteristics are compared in this study using data from two equal periods of 3 and a half months. The first period, between 15th March and 30th June, corresponding to the entire first wave, and the second, between 1st July and 15th October, corresponding to part of the second wave, still present at the time of writing this article. Two hundred and four patients were hospitalized during the first period, and 264 during the second period. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were lower than those in the first wave. In the second wave, there were…

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    Risk factors and protective factors of depression in older people 65+. A systematic review

    Alexander Maier, Steffi Gerlinde Riedel-Heller, Alexander Pabst, Melanie Luppa

    350 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251326OpenAlex

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    OBJECTIVES: Identifying risk factors of depression can provide a better understanding of the disorder in older people. However, to minimize bias due to the influence of confounders and to detect reverse influence, a focus on longitudinal studies using multivariate analysis is required. DESIGN: A systematic literature search was conducted by searching the databases MEDLINE, Cochrane, PsycINFO and Web of Science for all relevant articles published from January 2000 to the end of March 2020. The following inclusion criteria were used: prospective design, nationally or regionally representative sample, published in English or German, analyzed risk factors for depression of individuals 65+ identified by multivariate analysis, and provided validity of diagnostic instrument. All results of multivariate analysis were reported and summarized. RESULTS: Thirty articles were identified. Heterogeneous results were found for education, female gender, self-rated health, cognitive impairment and older age, although significant in several studies. Findings hinted at a protective quality of physical…

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    T cell response to SARS-CoV-2 infection in humans: A systematic review

    Madhumita Shrotri, May CI van Schalkwyk, Nathan Post, Danielle Eddy, Catherine Huntley and 10 more

    350 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245532OpenAlex

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    BACKGROUND: Understanding the T cell response to SARS-CoV-2 is critical to vaccine development, epidemiological surveillance and disease control strategies. This systematic review critically evaluates and synthesises the relevant peer-reviewed and pre-print literature published from 01/01/2020-26/06/2020. METHODS: For this systematic review, keyword-structured literature searches were carried out in MEDLINE, Embase and COVID-19 Primer. Papers were independently screened by two researchers, with arbitration of disagreements by a third researcher. Data were independently extracted into a pre-designed Excel template and studies critically appraised using a modified version of the MetaQAT tool, with resolution of disagreements by consensus. Findings were narratively synthesised. RESULTS: 61 articles were included. 55 (90%) studies used observational designs, 50 (82%) involved hospitalised patients with higher acuity illness, and the majority had important limitations. Symptomatic adult COVID-19 cases consistently show peripheral T cell lymphopenia, which positively correlates with…

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    Burden of post-COVID-19 syndrome and implications for healthcare service planning: A population-based cohort study

    Dominik Menges, Tala Ballouz, Alexia Anagnostopoulos, Hélène Eloise Aschmann, Anja Domenghino and 2 more

    343 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0254523OpenAlex

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    BACKGROUND: Longer-term consequences after SARS-CoV-2 infection are becoming an important burden to societies and healthcare systems. Data on post-COVID-19 syndrome in the general population are required for the timely planning of healthcare services and resources. The objective of this study was to assess the prevalence of impaired health status and physical and mental health symptoms among individuals at least six months after SARS-CoV-2 infection, and to characterize their healthcare utilization. METHODS: This population-based prospective cohort study (Zurich SARS-CoV-2 Cohort) enrolled 431 adults from the general population with polymerase chain reaction-confirmed SARS-CoV-2 infection reported to health authorities between 27 February 2020 and 05 August 2020 in the Canton of Zurich, Switzerland. We evaluated the proportion of individuals reporting not to have fully recovered since SARS-CoV-2 infection, and the proportion reporting fatigue (Fatigue Assessment Scale), dyspnea (mMRC dyspnea scale) or depression (DASS-21) at six to eight months after diagnosis. Furthermore, the…

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    COVID-19 vaccine hesitancy and resistance: Correlates in a nationally representative longitudinal survey of the Australian population

    Ben Edwards, Nicholas Biddle, Matthew Gray, Kate Sollis

    340 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248892OpenAlex

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    BACKGROUND: High levels of vaccination coverage in populations will be required even with vaccines that have high levels of effectiveness to prevent and stop outbreaks of coronavirus. The World Health Organisation has suggested that governments take a proactive response to vaccine hesitancy 'hotspots' based on social and behavioural insights. METHODS: Representative longitudinal online survey of over 3000 adults from Australia that examines the demographic, attitudinal, political and social attitudes and COVID-19 health behavior correlates of vaccine hesitance and resistance to a COVID-19 vaccine. RESULTS: Overall, 59% would definitely get the vaccine, 29% had low levels of hesitancy, 7% had high levels of hesitancy and 6% were resistant. Females, those living in disadvantaged areas, those who reported that risks of COVID-19 was overstated, those who had more populist views and higher levels of religiosity were more likely to be hesitant or resistant while those who had higher levels of household income, those who had higher levels of social distancing, who downloaded the COVID-Safe…

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    Job loss and mental health during the COVID-19 lockdown: Evidence from South Africa

    Dorrit Ruth Posel, Adeola Oyenubi, Umakrishnan Kollamparambil

    338 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249352OpenAlex

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    OBJECTIVES: Existing literature on how employment loss affects depression has struggled to address potential endogeneity bias caused by reverse causality. The COVID-19 pandemic offers a unique natural experiment because the source of unemployment is very likely to be exogenous to the individual. This study assessed the effect of job loss and job furlough on the mental health of individuals in South Africa during the COVID-19 pandemic. DATA AND METHODS: The data for the study came from the first and second waves of the national survey, the National Income Dynamics-Coronavirus Rapid Mobile Survey (NIDS-CRAM), conducted during May-June and July-August 2020, respectively. The sample for NIDS-CRAM was drawn from an earlier national survey, conducted in 2017, which had collected data on mental health. Questions on depressive symptoms during the lockdown were asked in Wave 2 of NIDS-CRAM, using a 2-question version of the Patient Health Questionnaire (PHQ-2). The PHQ-2 responses (0-6 on the discrete scale) were regrouped into four categories making the ordered logit regression model the…

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    Subjective caregiver burden and anxiety in informal caregivers: A systematic review and meta-analysis

    Rafael del Pino Casado, Emilia Priego-Cubero, Catalina López‐Martínez, Vasiliki Orgeta

    329 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247143OpenAlex

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    There is increasing evidence that subjective caregiver burden is an important determinant of clinically significant anxiety in family carers. This meta-analysis aims to synthesise this evidence and investigate the relationship between subjective caregiver burden and anxiety symptoms in informal caregivers. We searched PubMed, CINAHL and PsycINFO up to January 2020. Combined estimates were obtained using a random-effects model. After screening of 4,312 articles, 74 studies (with 75 independent samples) were included. There was a large, positive association between subjective caregiver burden and anxiety symptoms (r = 0.51; 95% CI = 0.47, 0.54; I2 = 0.0%). No differences were found in subgroup analyses by type of study design (cross-sectional vs. longitudinal), sampling, control of confounders or care-recipient characteristics. Subjective caregiver burden is an important risk factor for anxiety in informal caregivers. Targeting subjective caregiver burden could be beneficial in preventing clinically significant anxiety for the increasing number of family carers worldwide.

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    The prevalence of mental health problems in sub-Saharan adolescents: A systematic review

    Astrid Jörns‐Presentati, Ann-Kathrin Napp, Anja Dessauvagie, Dan Joseph Stein, Deborah Jonker and 9 more

    323 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251689OpenAlex

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    BACKGROUND AND PURPOSE: Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. METHODS: A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer's manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10-19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. RESULTS: The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents…

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    Tracking R of COVID-19: A new real-time estimation using the Kalman filter

    Francisco Arroyo Marioli, Francisco Bullano, Simas Kučinskas, Carlos Rondón-Moreno

    320 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0244474OpenAlex

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    Abstract The COVID-19 pandemic has become the center of attention for both researchers and authorities. In this paper, we propose and test a methodology to estimate the daily effective reproduction number (ℛ t ) through the lens of the Kalman Filter and Bayesian estimation. Moreover, we apply our method to data from the current COVID-19 pandemic in China, Italy, Japan, and South Korea. We correlate our findings with the implementation of control measures in each of these countries. Our results show that China, Italy, and South Korea have been able to reduce ℛ t over time. We find significant heterogeneity in the way ℛ t decreases across countries. For instance, China reduced ℛ t from its peak to below one in 19 days, while South Korea achieved the same reduction in 12 days. In contrast, it has taken Italy almost a month to reach similar levels. We hypothesize this is related to how strict, enforceable, and comprehensive are the implemented policies.

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    Negative attitudes about facemasks during the COVID-19 pandemic: The dual importance of perceived ineffectiveness and psychological reactance

    Steven J. Taylor, Gordon J. G. Asmundson

    319 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246317OpenAlex

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    This study reports a comprehensive empirical investigation of the nature and correlates of anti-mask attitudes during the COVID-19 pandemic. Accumulating evidence underscores the importance of facemasks, as worn by the general public, in limiting the spread of infection. Accordingly, mask wearing has become increasingly mandatory in public places such as stores and on public transit. Although the public has been generally adherent to mask wearing, a small but vocal group of individuals refuse to wear masks. Anti-mask protest rallies have occurred in many places throughout the world, sometimes erupting violently. Few empirical studies have examined the relationship between anti-mask attitudes and mask non-adherence and little is known about how such attitudes relate to one another or other factors (e.g., non-adherence to social distancing, anti-vaccination attitudes). To investigate these issues, the present study surveyed 2,078 adults from the US and Canada. Consistent with other surveys, we found that most (84%) people wore masks because of COVID-19. The 16% who did not wear masks…

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    Reduction in hospitalised COPD exacerbations during COVID-19: A systematic review and meta-analysis

    Jaber Saud Alqahtani, Tope Oyelade, Abdulelah Mastour Aldhahir, Renata Gonçalves Mendes, Saeed M. Alghamdi and 3 more

    316 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0255659OpenAlex

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    BACKGROUND: Reports have suggested a reduction in exacerbations of chronic obstructive pulmonary disease (COPD) during the coronavirus disease 2019 (COVID-19) pandemic, particularly hospital admissions for severe exacerbations. However, the magnitude of this reduction varies between studies. METHOD: Electronic databases were searched from January 2020 to May 2021. Two independent reviewers screened titles and abstracts and, when necessary, full text to determine if studies met inclusion criteria. A modified version of the Newcastle-Ottawa Scale was used to assess study quality. A narrative summary of eligible studies was synthesised, and meta-analysis was conducted using a random effect model to pool the rate ratio and 95% confidence intervals (95% CI) for hospital admissions. Exacerbation reduction was compared against the COVID-19 Containment and Health Index. RESULTS: A total of 13 of 745 studies met the inclusion criteria and were included in this review, with data from nine countries. Nine studies could be included in the meta-analysis. The pooled rate ratio of hospital…

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    Sarcopenia prevalence and associated factors among older Chinese population: Findings from the China Health and Retirement Longitudinal Study

    Xin Wu, Xue Li, Meihong Xu, Zhaofeng Zhang, Lixia He and 1 more

    315 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247617OpenAlex

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    Sarcopenia a recognised geriatric syndrome. This study aims to evaluate the prevalence of possible sarcopenia, sarcopenia and severe sarcopenia among older Chinese adults and to identify any associated factors for possible sarcopenia according to the updated diagnostic criteria of the Asian Working Group for Sarcopenia 2019 (AWGS 2019). We used data from the China Health and Retirement Longitudinal Study (CHARLS). The main outcome of this study was possible sarcopenia. Handgrip strength was measured via a dynamometer. The muscle mass was estimated by anthropometric measures. Physical performance was measured by 5-time chair stand test and gait speed test. A multivariate logistic regression model with stepwise method was employed to identify factors associated with possible sarcopenia. A total of 6172 participants aged 60-94 years were included. The prevalence of possible sarcopenia, sarcopenia and severe sarcopenia was 38.5%, 18.6%, and 8.0%, respectively. Age, rural area, falls, higher C-reactive protein (CRP), and chronic diseases (including hypertension, chronic lung diseases,…

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    A performance comparison of supervised machine learning models for Covid-19 tweets sentiment analysis

    Furqan Rustam, Madiha Khalid, Waqar Aslam, Vaibhav Rupapara, Arif Mehmood and 1 more

    313 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245909OpenAlex

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    The spread of Covid-19 has resulted in worldwide health concerns. Social media is increasingly used to share news and opinions about it. A realistic assessment of the situation is necessary to utilize resources optimally and appropriately. In this research, we perform Covid-19 tweets sentiment analysis using a supervised machine learning approach. Identification of Covid-19 sentiments from tweets would allow informed decisions for better handling the current pandemic situation. The used dataset is extracted from Twitter using IDs as provided by the IEEE data port. Tweets are extracted by an in-house built crawler that uses the Tweepy library. The dataset is cleaned using the preprocessing techniques and sentiments are extracted using the TextBlob library. The contribution of this work is the performance evaluation of various machine learning classifiers using our proposed feature set. This set is formed by concatenating the bag-of-words and the term frequency-inverse document frequency. Tweets are classified as positive, neutral, or negative. Performance of classifiers is evaluated…

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    College students’ stress and health in the COVID-19 pandemic: The role of academic workload, separation from school, and fears of contagion

    Chunjiang Yang, Aobo Chen, Yashuo Chen

    313 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246676OpenAlex

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    The COVID-19 pandemic has unhinged the lives of people across the globe. In particular, more than 30 million Chinese college students are home-schooling, yet there is little understanding of how academic workload, separation from school, and fears of contagion lead to a decrease in their health. This study examined the relationships between Chinese college students' three critical stressors and two types of health in the COVID-19 pandemic context. We used a three-wave lagged design with a one-week interval. All the constructs were assessed by self-report in anonymous surveys during the COVID-19 pandemic. College students were asked to report their demographic information, academic workload, separation from school, fears of contagion, perceived stress, and health. The results of this study showed that academic workload, separation from school, and fears of contagion had negative effects on college students' health via perceived stress. In the COVID-19 crisis, multiple prevention and control measures focusing on college students may lead them to have different degrees of stress and…

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    Psychological factors and consumer behavior during the COVID-19 pandemic

    Adolfo Di Crosta, Irene Ceccato, Daniela Marchetti, Pasquale La Malva, Roberta Maiella and 7 more

    312 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256095OpenAlex

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    The COVID-19 pandemic is far more than a health crisis: it has unpredictably changed our whole way of life. As suggested by the analysis of economic data on sales, this dramatic scenario has also heavily impacted individuals' spending levels. To better understand these changes, the present study focused on consumer behavior and its psychological antecedents. Previous studies found that crises differently affect people's willingness to buy necessities products (i.e., utilitarian shopping) and non-necessities products (i.e., hedonic shopping). Therefore, in examining whether changes in spending levels were associated with changes in consumer behavior, we adopted a fine-grained approach disentangling between necessities and non-necessities. We administered an online survey to 3833 participants (age range 18-64) during the first peak period of the contagion in Italy. Consumer behavior toward necessities was predicted by anxiety and COVID-related fear, whereas consumer behavior toward non-necessities was predicted by depression. Furthermore, consumer behavior toward necessities and…

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    Effect of Covid-19 pandemic on tourist travel risk and management perceptions

    Muhammad Khalilur Rahman, Md. Abu Issa Gazi, Miraj Ahmed Bhuiyan, Md. Atikur Rahaman

    303 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256486OpenAlex

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    This study aims to explore the impact of the Covid-19 pandemic on tourists' travel risk and management perceptions. Driven on the effect of the pandemic, we investigate tourists' travel risk and management perceptions and its effect on society using a sample of 716 respondents. The data was collected through social media platforms using a representative sampling method and analyzed applying the PLS-SEM tool. The findings reveal that Covid-19 pandemic has greatly affected travel risk and management perceptions. Travel risk and management perception had a significant association with risk management, service delivery, transportation patterns, distribution channels, avoidance of overpopulated destinations, and hygiene and safety. The results also identified the mediating effect of travel risk and management perceptions. The finding of this study contributes to tourism crises and provides future research insights in the travel and tourism sector and response to change tourists' travel risk and management perceptions in the post-covid recovery period.

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    COVID-19 and mental health deterioration by ethnicity and gender in the UK

    Eugenio Proto, Climent Quintana‐Domeque

    297 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0244419OpenAlex

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    We use the UK Household Longitudinal Study and compare pre-COVID-19 pandemic (2017-2019) and during-COVID-19 pandemic data (April 2020) for the same group of individuals to assess and quantify changes in mental health as measured by changes in the GHQ-12 (General Health Questionnaire), among ethnic groups in the UK. We confirm the previously documented average deterioration in mental health for the whole sample of individuals interviewed before and during the COVID-19 pandemic. In addition, we find that the average increase in mental distress varies by ethnicity and gender. Both women -regardless of their ethnicity- and Black, Asian, and minority ethnic (BAME) men experienced a higher average increase in mental distress than White British men, so that the gender gap in mental health increases only among White British individuals. These ethnic-gender specific changes in mental health persist after controlling for demographic and socioeconomic characteristics. Finally, we find some evidence that, among men, Bangladeshi, Indian and Pakistani individuals have experienced the highest…

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    Gender differences in unpaid care work and psychological distress in the UK Covid-19 lockdown

    Baowen Xue, Anne McMunn

    287 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247959OpenAlex

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    OBJECTIVE: To describe how men and women divided childcare and housework demands during the height of the first Covid-19 lockdown in the UK, and whether these divisions were associated with worsening mental health during the pandemic. BACKGROUND: School closures and homeworking during the Covid-19 crisis have resulted in an immediate increase in unpaid care work, which draws new attention to gender inequality in divisions of unpaid care work. METHODS: Data come from the wave 9 (2017-19) of Understanding Society and the following April (n = 15,426) and May (n = 14,150) waves of Understanding Society Covid-19 study. Psychological distress was measured using the General Health Questionnaire (GHQ) at both before and during the lockdown, and unpaid care work was measured during the lockdown. Linear regression models were used. RESULTS: Women spent much more time on unpaid care work than men during lockdown, and it was more likely to be the mother than the father who reduced working hours or changed employment schedules due to increased time on childcare. Women who spent long hours on…

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    COVID-19 ICU and mechanical ventilation patient characteristics and outcomes—A systematic review and meta-analysis

    Raymond Y. Chang, Khaled Mosaad Elhusseiny, Yu‐Chang Yeh, Wei‐Zen Sun

    287 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246318OpenAlex

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    BACKGROUND: Insight into COVID-19 intensive care unit (ICU) patient characteristics, rates and risks of invasive mechanical ventilation (IMV) and associated outcomes as well as any regional discrepancies is critical in this pandemic for individual case management and overall resource planning. METHODS AND FINDINGS: Electronic searches were performed for reports through May 1 2020 and reports on COVID-19 ICU admissions and outcomes were included using predefined search terms. Relevant data was subsequently extracted and pooled using fixed or random effects meta-analysis depending on heterogeneity. Study quality was assessed by the NIH tool and heterogeneity was assessed by I2 and Q tests. Baseline patient characteristics, ICU and IMV outcomes were pooled and meta-analyzed. Pooled odds ratios (pOR) were calculated for clinical features against ICU, IMV mortality. Subgroup analysis was carried out based on patient regions. A total of twenty-eight studies comprising 12,437 COVID-19 ICU admissions from seven countries were meta-analyzed. Pooled ICU admission rate was 21% [95% CI…

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    COVID-19 cognitive deficits after respiratory assistance in the subacute phase: A COVID-rehabilitation unit experience

    Federica Alemanno, Elise Houdayer, Anna Parma, Alfio Spina, Alessandra Del Forno and 6 more

    276 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246590OpenAlex

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    INTRODUCTION: COVID-19 complications can include neurological, psychiatric, psychological, and psychosocial impairments. Little is known on the consequences of SARS-COV-2 on cognitive functions of patients in the sub-acute phase of the disease. We aimed to investigate the impact of COVID-19 on cognitive functions of patients admitted to the COVID-19 Rehabilitation Unit of the San Raffaele Hospital (Milan, Italy). MATERIAL AND METHODS: 87 patients admitted to the COVID-19 Rehabilitation Unit from March 27th to June 20th 2020 were included. Patients underwent Mini Mental State Evaluation (MMSE), Montreal Cognitive Assessment (MoCA), Hamilton Rating Scale for Depression, and Functional Independence Measure (FIM). Data were divided in 4 groups according to the respiratory assistance in the acute phase: Group1 (orotracheal intubation), Group2 (non-invasive ventilation using Biphasic Positive Airway Pressure), Group3 (Venturi Masks), Group4 (no oxygen therapy). Follow-ups were performed at one month after home-discharge. RESULTS: Out of the 87 patients (62 Male, mean age 67.23 ± 12.89…

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    Nationwide incidence of sarcomas and connective tissue tumors of intermediate malignancy over four years using an expert pathology review network

    Gonzague Du Bouexic De Pinieux, Marie Karanian, François Le Loarer, Sophie Le Guellec, Sylvie Chabaud and 25 more

    270 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246958OpenAlex

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    BACKGROUND: Since 2010, nationwide networks of reference centers for sarcomas (RREPS/NETSARC/RESOS) collected and prospectively reviewed all cases of sarcomas and connective tumors of intermediate malignancy (TIM) in France. METHODS: The nationwide incidence of sarcoma or TIM (2013-2016) was measured using the 2013 WHO classification and confirmed by a second independent review by expert pathologists. Simple clinical characteristics, yearly variations and correlation of incidence with published clinical trials are presented and analyzed. RESULTS: Over 150 different histological subtypes are reported from the 25172 patients with sarcomas (n = 18712, 74,3%) or TIM (n = 6460, 25.7%), with n = 5838, n = 6153, n = 6654, and n = 6527 yearly cases from 2013 to 2016. Over these 4 years, the yearly incidence of sarcomas and TIM was therefore 70.7 and 24.4 respectively, with a combined incidence of 95.1/106/year, higher than previously reported. GIST, liposarcoma, leiomyosarcomas, undifferentiated sarcomas represented 13%, 13%, 11% and 11% of tumors. Only GIST, as a single entity had a yearly…

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    Excess mortality associated with the COVID-19 pandemic among Californians 18–65 years of age, by occupational sector and occupation: March through November 2020

    Yea‐Hung Chen, M. Maria Glymour, Alicia R. Riley, John Randolph Balmes, Kate A. Duchowny and 3 more

    265 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0252454OpenAlex

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    BACKGROUND: Though SARS-CoV-2 outbreaks have been documented in occupational settings and in-person essential work has been suspected as a risk factor for COVID-19, occupational differences in excess mortality have, to date, not been examined. Such information could point to opportunities for intervention, such as vaccine prioritization or regulations to enforce safer work environments. METHODS AND FINDINGS: Using autoregressive integrated moving average models and California Department of Public Health data representing 356,188 decedents 18-65 years of age who died between January 1, 2016 and November 30, 2020, we estimated pandemic-related excess mortality by occupational sector and occupation, with additional stratification of the sector analysis by race/ethnicity. During these first 9 months of the COVID-19 pandemic, working-age adults experienced 11,628 more deaths than expected, corresponding to 22% relative excess and 46 excess deaths per 100,000 living individuals. Sectors with the highest relative and per-capita excess mortality were food/agriculture (39% relative excess;…

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    Review of machine learning methods in soft robotics

    Daekyum Kim, Sang-Hun Kim, Taekyoung Kim, Brian Byunghyun Kang, Minhyuk Lee and 9 more

    261 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246102OpenAlex

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    Soft robots have been extensively researched due to their flexible, deformable, and adaptive characteristics. However, compared to rigid robots, soft robots have issues in modeling, calibration, and control in that the innate characteristics of the soft materials can cause complex behaviors due to non-linearity and hysteresis. To overcome these limitations, recent studies have applied various approaches based on machine learning. This paper presents existing machine learning techniques in the soft robotic fields and categorizes the implementation of machine learning approaches in different soft robotic applications, which include soft sensors, soft actuators, and applications such as soft wearable robots. An analysis of the trends of different machine learning approaches with respect to different types of soft robot applications is presented; in addition to the current limitations in the research field, followed by a summary of the existing machine learning methods for soft robots.

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    The worldwide burden of HIV in transgender individuals: An updated systematic review and meta-analysis

    Sarah E. Stutterheim, Mart van Dijk, Haoyi Wang, Kai J. Jonas

    258 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0260063OpenAlex

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    INTRODUCTION: Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. METHODS: We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic…

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    Impact of Covid-19 on health-related quality of life of patients: A structured review

    Ak Narayan Poudel, Shihua Zhu, Nicola J. Cooper, Paul J. Roderick, Nisreen A Alwan and 3 more

    255 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0259164OpenAlex

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    INTRODUCTION: Coronavirus disease (Covid-19) has led to a global pandemic since its emergence in December 2019. The majority of research into Covid-19 has focused on transmission, and mortality and morbidity associated with the virus. However, less attention has been given to its impact on health-related quality of life (HRQoL) of patients with Covid-19. METHODS: We searched for original studies published between December 2019 and Jan 2021 in PubMed, Scopus and Medline databases using a specific search strategy. We also explored literature on websites of distinguished public health organisations and hand-searched reference lists of eligible studies. The studies were screened by two reviewers according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) flowchart using pre-determined eligibility criteria. Data were synthesised, analysed descriptively and reported in line with PRISMA guidelines. RESULTS: In total, 1276 studies were identified through the search strategy. Of these, 77 studies were selected for full-text reading after screening the…

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    A cross-national study of factors associated with women’s perinatal mental health and wellbeing during the COVID-19 pandemic

    Archana Basu, Hannah Hayoung Kim, Karmel W. Choi, Lily Charron, Nora Kelsall and 4 more

    254 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249780OpenAlex

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    Pregnant and postpartum women face unique challenges during the COVID-19 pandemic that may put them at elevated risk of mental health problems. However, few large-scale and no cross-national studies have been conducted to date that investigate modifiable pandemic-related behavioral or cognitive factors that may influence mental health in this vulnerable group. This international study sought to identify and measure the associations between pandemic-related information seeking, worries, and prevention behaviors on perinatal mental health during the COVID-19 pandemic. An anonymous, online, cross-sectional survey of pregnant and postpartum women was conducted in 64 countries between May 26, 2020 and June 13, 2020. The survey, available in twelve languages, was hosted on the Pregistry platform for COVID-19 studies (https://corona.pregistry.com) and advertised in social media channels and online parenting forums. Participants completed measures on demographics, COVID-19 exposure and worries, information seeking, COVID-19 prevention behaviors, and mental health symptoms including…

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    On the analysis of mortality risk factors for hospitalized COVID-19 patients: A data-driven study using the major Brazilian database

    Fernanda Sumika Hojo de Souza, Natália Satchiko Hojo-Souza, Ben Dêivide de Oliveira Batista, Cristiano M. Silva, Daniel L. Guidoni

    252 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248580OpenAlex

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    BACKGROUND: Brazil became the epicenter of the COVID-19 epidemic in a brief period of a few months after the first officially registered case. The knowledge of the epidemiological/clinical profile and the risk factors of Brazilian COVID-19 patients can assist in the decision making of physicians in the implementation of early and most appropriate measures for poor prognosis patients. However, these reports are missing. Here we present a comprehensive study that addresses this demand. METHODS: This data-driven study was based on the Brazilian Ministry of Health Database (SIVEP-Gripe) regarding notified cases of hospitalized COVID-19 patients during the period from February 26th to August 10th, 2020. Demographic data, clinical symptoms, comorbidities and other additional information of patients were analyzed. RESULTS: The hospitalization rate was higher for male gender (56.56%) and for older age patients of both sexes. Overall, the lethality rate was quite high (41.28%) among hospitalized patients, especially those over 60 years of age. Most prevalent symptoms were cough, dyspnoea,…

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    Mask usage, social distancing, racial, and gender correlates of COVID-19 vaccine intentions among adults in the US

    Carl Asher Latkin, Lauren Dayton, Grace Tian Yi, Brian Colon, Xiangrong Kong

    252 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246970OpenAlex

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    Vaccine hesitancy could become a significant impediment to addressing the COVID-19 pandemic. The current study examined the prevalence of COVID-19 vaccine hesitancy and factors associated with vaccine intentions. A national panel survey by the National Opinion Research Center (NORC) was designed to be representative of the US household population. Sampled respondents were invited to complete the survey between May 14 and 18, 2020 in English or Spanish. 1,056 respondents completed the survey-942 via the web and 114 via telephone. The dependent variable was assessed by the item "If a vaccine against the coronavirus becomes available, do you plan to get vaccinated, or not?" Approximately half (53.6%) reported intending to be vaccinated, 16.7% did not intend, and 29.7% were unsure. In the adjusted stepwise multinominal logistic regression, Black and Hispanic respondents were significantly less likely to report intending to be vaccinated as were respondents who were females, younger, and those who were more politically conservative. Compared to those who reported positive vaccine…

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    Face masks reduce emotion-recognition accuracy and perceived closeness

    Felix Grundmann, Kai Epstude, Susanne Scheibe

    251 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249792OpenAlex

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    Face masks became the symbol of the global fight against the coronavirus. While face masks' medical benefits are clear, little is known about their psychological consequences. Drawing on theories of the social functions of emotions and rapid trait impressions, we tested hypotheses on face masks' effects on emotion-recognition accuracy and social judgments (perceived trustworthiness, likability, and closeness). Our preregistered study with 191 German adults revealed that face masks diminish people's ability to accurately categorize an emotion expression and make target persons appear less close. Exploratory analyses further revealed that face masks buffered the negative effect of negative (vs. non-negative) emotion expressions on perceptions of trustworthiness, likability, and closeness. Associating face masks with the coronavirus' dangers predicted higher perceptions of closeness for masked but not for unmasked faces. By highlighting face masks' effects on social functioning, our findings inform policymaking and point at contexts where alternatives to face masks are needed.

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    Comparison of seroprevalence of SARS-CoV-2 infections with cumulative and imputed COVID-19 cases: Systematic review

    Oyungerel Byambasuren, Claudia Caroline Dobler, Katy Bell, Diana Patricia Rojas, Justin Michael Clark and 2 more

    251 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248946OpenAlex

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    Abstract Background Accurate seroprevalence estimates of SARS-CoV-2 in different populations could clarify the extent to which current testing strategies are identifying all active infection, and hence the true magnitude and spread of the infection. Our primary objective was to identify valid seroprevalence studies of SARS-CoV-2 infection and compare their estimates with the reported, and imputed, COVID-19 case rates within the same population at the same time point. Methods We searched PubMed, Embase, the Cochrane COVID-19 trials, and Europe-PMC for published studies and pre-prints that reported anti-SARS-CoV-2 IgG, IgM and/or IgA antibodies for serosurveys of the general community from 1 Jan to 12 Aug 2020. Results Of the 2199 studies identified, 170 were assessed for full text and 17 studies representing 15 regions and 118,297 subjects were includable. The seroprevalence proportions in 8 studies ranged between 1%-10%, with 5 studies under 1%, and 4 over 10% - from the notably hard-hit regions of Gangelt, Germany; Northwest Iran; Buenos Aires, Argentina; and Stockholm, Sweden. For…

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    Interventions to reduce social isolation and loneliness during COVID-19 physical distancing measures: A rapid systematic review

    Christopher Y. K. Williams, Adam T. Townson, Milan Kapur, Alice F. Ferreira, Rebecca Nunn and 4 more

    250 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247139OpenAlex

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    BACKGROUND: A significant proportion of the worldwide population is at risk of social isolation and loneliness as a result of the COVID-19 pandemic. We aimed to identify effective interventions to reduce social isolation and loneliness that are compatible with COVID-19 shielding and social distancing measures. METHODS AND FINDINGS: In this rapid systematic review, we searched six electronic databases (Medline, Embase, Web of Science, PsycINFO, Cochrane Database of Systematic Reviews and SCOPUS) from inception to April 2020 for systematic reviews appraising interventions for loneliness and/or social isolation. Primary studies from those reviews were eligible if they included: 1) participants in a non-hospital setting; 2) interventions to reduce social isolation and/or loneliness that would be feasible during COVID-19 shielding measures; 3) a relevant control group; and 4) quantitative measures of social isolation, social support or loneliness. At least two authors independently screened studies, extracted data, and assessed risk of bias using the Downs and Black checklist. Study…

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    Student’s experiences with online teaching following COVID-19 lockdown: A mixed methods explorative study

    Kari Almendingen, Marianne Sandsmark Morseth, Eli Gjølstad, Asgeir Brevik, Christine Tørris

    247 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250378OpenAlex

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    BACKGROUND: The COVID-19 pandemic lead to a sudden shift to online teaching and restricted campus access. AIM: To assess how university students experienced the sudden shift to online teaching after closure of campus due to the COVID-19 pandemic. MATERIAL AND METHODS: Students in Public Health Nutrition answered questionnaires two and 12 weeks (N = 79: response rate 20.3% and 26.6%, respectively) after the lockdown in Norway on 12 March 2020 and participated in digital focus group interviews in May 2020 (mixed methods study). FINDINGS AND DISCUSSION: Two weeks into the lockdown, 75% of students reported that their life had become more difficult and 50% felt that learning outcomes would be harder to achieve due to the sudden shift to online education. Twelve weeks into the lockdown, the corresponding numbers were 57% and 71%, respectively. The most pressing concerns among students were a lack of social interaction, housing situations that were unfit for home office purposes, including insufficient data bandwidth, and an overall sense of reduced motivation and effort. The students…

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    Minority stress, distress, and suicide attempts in three cohorts of sexual minority adults: A U.S. probability sample

    Ilan H. Meyer, Stephen T. Russell, Phillip L. Hammack, David M. Frost, Bianca D. M. Wilson

    247 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246827OpenAlex

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    During the past 50 years, there have been marked improvement in the social and legal environment of sexual minorities in the United States. Minority stress theory predicts that health of sexual minorities is predicated on the social environment. As the social environment improves, exposure to stress would decline and health outcomes would improve. We assessed how stress, identity, connectedness with the LGBT community, and psychological distress and suicide behavior varied across three distinct cohorts of sexual minority people in the United States. Using a national probability sample recruited in 2016 and 2017, we assessed three a priori defined cohorts of sexual minorities we labeled the pride (born 1956-1963), visibility (born 1974-1981), and equality (born 1990-1997) cohorts. We found significant and impressive cohort differences in coming out milestones, with members of the younger cohort coming out much earlier than members of the two older cohorts. But we found no signs that the improved social environment attenuated their exposure to minority stressors-both distal stressors,…

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    Global seroprevalence of SARS-CoV-2 antibodies: A systematic review and meta-analysis

    Niklas Bobrovitz, Rahul K. Arora, Christian Cao, Emily Louise Boucher, Michael Liu and 22 more

    246 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0252617OpenAlex

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    BACKGROUND: Many studies report the seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies. We aimed to synthesize seroprevalence data to better estimate the level and distribution of SARS-CoV-2 infection, identify high-risk groups, and inform public health decision making. METHODS: In this systematic review and meta-analysis, we searched publication databases, preprint servers, and grey literature sources for seroepidemiological study reports, from January 1, 2020 to December 31, 2020. We included studies that reported a sample size, study date, location, and seroprevalence estimate. We corrected estimates for imperfect test accuracy with Bayesian measurement error models, conducted meta-analysis to identify demographic differences in the prevalence of SARS-CoV-2 antibodies, and meta-regression to identify study-level factors associated with seroprevalence. We compared region-specific seroprevalence data to confirmed cumulative incidence. PROSPERO: CRD42020183634. RESULTS: We identified 968 seroprevalence studies including 9.3 million participants…

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    Impact of COVID-19 pandemic on mobility in ten countries and associated perceived risk for all transport modes

    Diego Maria Barbieri, Baowen Lou, Marco Passavanti, Cang Hui, Inge Hoff and 25 more

    246 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245886OpenAlex

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    The restrictive measures implemented in response to the COVID-19 pandemic have triggered sudden massive changes to travel behaviors of people all around the world. This study examines the individual mobility patterns for all transport modes (walk, bicycle, motorcycle, car driven alone, car driven in company, bus, subway, tram, train, airplane) before and during the restrictions adopted in ten countries on six continents: Australia, Brazil, China, Ghana, India, Iran, Italy, Norway, South Africa and the United States. This cross-country study also aims at understanding the predictors of protective behaviors related to the transport sector and COVID-19. Findings hinge upon an online survey conducted in May 2020 (N = 9,394). The empirical results quantify tremendous disruptions for both commuting and non-commuting travels, highlighting substantial reductions in the frequency of all types of trips and use of all modes. In terms of potential virus spread, airplanes and buses are perceived to be the riskiest transport modes, while avoidance of public transport is consistently found across…

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    Population density and basic reproductive number of COVID-19 across United States counties

    Karla Therese L. Sy, Laura Forsberg White, Brooke E Nichols

    243 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249271OpenAlex

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    The basic reproductive number (R0) is a function of contact rates among individuals, transmission probability, and duration of infectiousness. We sought to determine the association between population density and R0 of SARS-CoV-2 across U.S. counties. We conducted a cross-sectional analysis using linear mixed models with random intercept and fixed slopes to assess the association of population density and R0, and controlled for state-level effects using random intercepts. We also assessed whether the association was differential across county-level main mode of transportation percentage as a proxy for transportation accessibility, and adjusted for median household income. The median R0 among the United States counties was 1.66 (IQR: 1.35-2.11). A population density threshold of 22 people/km2 was needed to sustain an outbreak. Counties with greater population density have greater rates of transmission of SARS-CoV-2, likely due to increased contact rates in areas with greater density. An increase in one unit of log population density increased R0 by 0.16 (95% CI: 0.13 to 0.19). This…

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    eDNA metabarcoding as a biomonitoring tool for marine protected areas

    Zachary J. Gold, Joshua L. Sprague, David J. Kushner, Erick Zerecero Marin, Paul Henry Barber

    243 citationsOpen access (PUBLIC-DOMAIN)doi:10.1371/journal.pone.0238557OpenAlex

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    Monitoring of marine protected areas (MPAs) is critical for marine ecosystem management, yet current protocols rely on SCUBA-based visual surveys that are costly and time consuming, limiting their scope and effectiveness. Environmental DNA (eDNA) metabarcoding is a promising alternative for marine ecosystem monitoring, but more direct comparisons to visual surveys are needed to understand the strengths and limitations of each approach. This study compares fish communities inside and outside the Scorpion State Marine Reserve off Santa Cruz Island, CA using eDNA metabarcoding and underwater visual census surveys. Results from eDNA captured 76% (19/25) of fish species and 95% (19/20) of fish genera observed during pairwise underwater visual census. Species missed by eDNA were due to the inability of MiFish 12S barcodes to differentiate species of rockfishes (Sebastes, n = 4) or low site occupancy rates of crevice-dwelling Lythrypnus gobies. However, eDNA detected an additional 23 fish species not recorded in paired visual surveys, but previously reported from prior visual surveys,…

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    Trust predicts COVID-19 prescribed and discretionary behavioral intentions in 23 countries

    Stefano Pagliaro, Simona Sacchi, Maria Giuseppina Pacilli, Marco Brambilla, Francesca Lionetti and 25 more

    240 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248334OpenAlex

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    The worldwide spread of a new coronavirus (SARS-CoV-2) since December 2019 has posed a severe threat to individuals' well-being. While the world at large is waiting that the released vaccines immunize most citizens, public health experts suggest that, in the meantime, it is only through behavior change that the spread of COVID-19 can be controlled. Importantly, the required behaviors are aimed not only at safeguarding one's own health. Instead, individuals are asked to adapt their behaviors to protect the community at large. This raises the question of which social concerns and moral principles make people willing to do so. We considered in 23 countries (N = 6948) individuals' willingness to engage in prescribed and discretionary behaviors, as well as country-level and individual-level factors that might drive such behavioral intentions. Results from multilevel multiple regressions, with country as the nesting variable, showed that publicized number of infections were not significantly related to individual intentions to comply with the prescribed measures and intentions to engage…

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    The role of health literacy in cancer care: A mixed studies systematic review

    Chloe E. Holden, Sally Wheelwright, Amelie Sylvia Mary Harle, Richard Wagland

    237 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0259815OpenAlex

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    BACKGROUND: Patients diagnosed with cancer face many challenges and need a good understanding of their diagnosis and proposed treatments to make informed decisions about their care. Health literacy plays an important role in this and low health literacy has been associated with poorer outcomes. The aims of this review are to identify which outcomes relate to health literacy in patients with cancer, and to combine this through a mixed studies approach with the patient experience as described through qualitative studies. METHODS: Four electronic databases were searched in January 2021 to identify records relating to health literacy and patients with cancer. Records were independently screened then assessed for inclusion by two reviewers according to the following criteria: patients aged ≥18 years with cancer, English language publication AND health literacy measured with validated tool and measured outcome associated with health literacy OR qualitative study exploring the role of health literacy as patients make decisions about health. Quality was independently assessed by two…

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    Depression, anxiety and stress symptoms in Brazilian university students during the COVID-19 pandemic: Predictors and association with life satisfaction, psychological well-being and coping strategies

    Adriana Rezende Lopes, Oscar Kenji Nihei

    236 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0258493OpenAlex

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    BACKGROUND: The COVID-19 pandemic raises concerns about the mental health of the world population. Protection measures to prevention the disease impacted education and undergraduate students were exposed to additional stressors. OBJECTIVES: Analyze depression, anxiety and stress symptoms in undergraduates, their respective predictors and the association with satisfaction with life, psychological well-being and coping strategies. METHODS: An online cross-sectional study was conducted from September 14 to October 19, 2020, involving undergraduate students enrolled in 33 courses from 5 public university campuses in the state of Parana, Brazil, using: questionnaire with sociodemographic, academic, health and pandemic effects variables; Depression, Anxiety and Stress Scale-21 (DASS-21); Satisfaction with Life Scale (SWLS); Psychological Well-Being (PWB); BriefCOPE. The convenience sample was composed of 1,224 participants, with 18 years old or older, that completed all research instruments. Spearman correlation and logistic analysis (univariate and multivariate) were applied to the…

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    Clinical determinants of the severity of COVID-19: A systematic review and meta-analysis

    Xinyang Li, Xianrui Zhong, Yongbo Wang, Xian‐Tao Zeng, Ting Luo and 1 more

    235 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250602OpenAlex

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    OBJECTIVE: We aimed to systematically identify the possible risk factors responsible for severe cases. METHODS: We searched PubMed, Embase, Web of science and Cochrane Library for epidemiological studies of confirmed COVID-19, which include information about clinical characteristics and severity of patients' disease. We analyzed the potential associations between clinical characteristics and severe cases. RESULTS: We identified a total of 41 eligible studies including 21060 patients with COVID-19. Severe cases were potentially associated with advanced age (Standard Mean Difference (SMD) = 1.73, 95% CI: 1.34-2.12), male gender (Odds Ratio (OR) = 1.51, 95% CI:1.33-1.71), obesity (OR = 1.89, 95% CI: 1.44-2.46), history of smoking (OR = 1.40, 95% CI:1.06-1.85), hypertension (OR = 2.42, 95% CI: 2.03-2.88), diabetes (OR = 2.40, 95% CI: 1.98-2.91), coronary heart disease (OR: 2.87, 95% CI: 2.22-3.71), chronic kidney disease (CKD) (OR = 2.97, 95% CI: 1.63-5.41), cerebrovascular disease (OR = 2.47, 95% CI: 1.54-3.97), chronic obstructive pulmonary disease (COPD) (OR = 2.88, 95% CI:…

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    Ecological momentary interventions for mental health: A scoping review

    Andreas Balaskas, Stephen Matthew Schueller, Anna Louise Cox, Gavin J. Doherty

    234 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0248152OpenAlex

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    BACKGROUND: The development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these "ecological momentary interventions" were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed. OBJECTIVE: To provide an overview of the definitions given for "ecological momentary interventions" in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions. METHODS: A systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using…

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    The roles of experienced and internalized weight stigma in healthcare experiences: Perspectives of adults engaged in weight management across six countries

    Rebecca M. Puhl, Leah M. Lessard, Mary S. Himmelstein, Gary D. Foster

    233 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251566OpenAlex

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    BACKGROUND/OBJECTIVES: Considerable evidence from U.S. studies suggests that weight stigma is consequential for patient-provider interactions and healthcare for people with high body weight. Despite international calls for efforts to reduce weight stigma in the medical community, cross-country research is lacking in this field. This study provides the first multinational investigation of associations between weight stigma and healthcare experiences across six Western countries. METHODS: Participants were 13,996 adults residing in Australia, Canada, France, Germany, the UK, and the US who were actively enrolled in an internationally available behavioral weight management program. Participants completed identical online surveys in the dominant language for their country that assessed experienced weight stigma, internalized weight bias, and healthcare behaviors and experiences including perceived quality of care, avoidance or delay of seeking care, experiences with providers, and perceived weight stigma from doctors. RESULTS: Among participants who reported a history of weight stigma…

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    Willingness to vaccinate against COVID-19 among Bangladeshi adults: Understanding the strategies to optimize vaccination coverage

    Minhazul Abedin, Mohammad Aminul Islam, Farah Naz Rahman, Hasan Mahmud Reza, Mohammad Zakir Hossain and 3 more

    233 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250495OpenAlex

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    BACKGROUND: Although the approved COVID-19 vaccine has been shown to be safe and effective, mass vaccination in Bangladeshi people remains a challenge. As a vaccination effort, the study provided an empirical evidence on willingness to vaccinate by sociodemographic, clinical and regional differences in Bangladeshi adults. METHODS: This cross-sectional analysis from a household survey of 3646 adults aged 18 years or older was conducted in 8 districts of Bangladesh, from December 12, 2020, to January 7, 2021. Multinomial regression examined the impact of socio-demographic, clinical and healthcare-releated factors on hesitancy and reluctance of vaccination for COVID-19. RESULTS: Of the 3646 respondents (2212 men [60.7%]; mean [sd] age, 37.4 [13.9] years), 74.6% reported their willingness to vaccinate against COVID-19 when a safe and effective vaccine is available without a fee, while 8.5% were reluctant to vaccinate. With a minimum fee, 46.5% of the respondents showed intent to vaccinate. Among the respondents, 16.8% reported adequate adherence to health safety regulations, and 35.5%…

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    Is the open access citation advantage real? A systematic review of the citation of open access and subscription-based articles

    Allison Langham-Putrow, Caitlin Bakker, Amy Riegelman

    232 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0253129OpenAlex

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    AIMS: Over the last two decades, the existence of an open access citation advantage (OACA)-increased citation of articles made available open access (OA)-has been the topic of much discussion. While there has been substantial research to address this question, findings have been contradictory and inconclusive. We conducted a systematic review to compare studies of citations to OA and non-OA articles. METHODS: A systematic search of 17 databases attempted to capture all relevant studies authored since 2001. The protocol was registered in Open Science Framework. We included studies with a direct comparison between OA and non-OA items and reported article-level citation as an outcome. Both randomized and non-randomized studies were included. No limitations were placed on study design, language, or publication type. RESULTS: A total of 5,744 items were retrieved. Ultimately, 134 items were identified for inclusion. 64 studies (47.8%) confirmed the existence of OACA, while 37 (27.6%) found that it did not exist, 32 (23.9%) found OACA only in subsets of their sample, and 1 study (0.8%)…

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    Antimicrobial activities evaluation and phytochemical screening of some selected medicinal plants: A possible alternative in the treatment of multidrug-resistant microbes

    Taye Kebede, Eshetu Gadisa, Abreham Tufa

    231 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249253OpenAlex

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    BACKGROUND: Four out of five individuals rely on traditional medicine for their primary healthcare needs. Medicinal plants are endowed with diverse bioactive compounds to treat multidrug-resistant (MDR) microbes. So far, a less thorough examination has been made in this regard. This study aimed to evaluate antimicrobial activity and phytochemical screening of selected medicinal plants against MDR microbes. METHODS: In vitro experimental study was carried out to evaluate antimicrobial effects and phytochemical screening of Rumex abyssinicus, Cucumis pustulatus, Discopodium penninervium, Lippia adoensis, Euphorbia depauperata, Cirsium englerianum, and Polysphaeria aethiopica against MDR bacteria and fungi. Aqueous and 80% methanolic extraction methods were employed for extraction. The susceptibility test, minimum inhibitory concentration, and minimum bactericidal or fungicidal concentration were measured using disc diffusion or broth micro-dilution as per the CLSI protocols. RESULT: The 80% methanolic extraction method was a preferred method to aqueous. The phytochemical constituents…

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    Resting state EEG biomarkers of cognitive decline associated with Alzheimer’s disease and mild cognitive impairment

    Amir H. Meghdadi, Marija Stevanović Karić, Marissa McConnell, Greg Rupp, Christian Richard and 3 more

    231 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0244180OpenAlex

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    In this paper, we explore the utility of resting-state EEG measures as potential biomarkers for the detection and assessment of cognitive decline in mild cognitive impairment (MCI) and Alzheimer's disease (AD). Neurophysiological biomarkers of AD derived from EEG and FDG-PET, once characterized and validated, would expand the set of existing diagnostic molecular biomarkers of AD pathology with associated biomarkers of disease progression and neural dysfunction. Since symptoms of AD often begin to appear later in life, successful identification of EEG-based biomarkers must account for age-related neurophysiological changes that occur even in healthy individuals. To this end, we collected EEG data from individuals with AD (n = 26), MCI (n = 53), and cognitively normal healthy controls stratified by age into three groups: 18-40 (n = 129), 40-60 (n = 62) and 60-90 (= 55) years old. For each participant, we computed power spectral density at each channel and spectral coherence between pairs of channels. Compared to age matched controls, in the AD group, we found increases in both…

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    Sex differences in susceptibility, severity, and outcomes of coronavirus disease 2019: Cross-sectional analysis from a diverse US metropolitan area

    Farhaan Vahidy, Alan P. Pan, Hilda W. Ahnstedt, Yashasvee Munshi, Huimahn Alex Choi and 5 more

    231 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245556OpenAlex

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    INTRODUCTION: Sex is increasingly recognized as an important factor in the epidemiology and outcome of many diseases. This also appears to hold for coronavirus disease 2019 (COVID-19). Evidence from China and Europe has suggested that mortality from COVID-19 infection is higher in men than women, but evidence from US populations is lacking. Utilizing data from a large healthcare provider, we determined if males, as compared to females have a higher likelihood of SARS-CoV-2 susceptibility, and if among the hospitalized COVID-19 patients, male sex is independently associated with COVID-19 severity and poor in-hospital outcomes. METHODS AND FINDINGS: Using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines, we conducted a cross-sectional analysis of data from a COVID-19 Surveillance and Outcomes Registry (CURATOR). Data were extracted from Electronic Medical Records (EMR). A total of 96,473 individuals tested for SARS-CoV-2 RNA in nasopharyngeal swab specimens via Polymerized Chain Reaction (PCR) tests were included. For hospital-based…

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    Characteristics of gut microbiota in people with obesity

    Mengmeng Duan, Yuezhu Wang, Qiang Zhang, Rong Zou, Min Guo and 1 more

    229 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0255446OpenAlex

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    BACKGROUND: Obesity is the cause of cardiovascular diseases and other diseases, leading to increased medical costs, and causing a great burden to individuals, families and society. The prevalence of obesity is increasing and has become a global health problem. There is growing evidence that gut microbiota plays an important role in obesity. In this article, we revealed the differences in the gut microbiota between 21 people with obesity and 21 control subjects, and predicted the functional potential changes by 16S rRNA sequencing of the fecal bacteria of the subjects. METHODS: The raw sequencing data of 21 healthy Beijing volunteers was downloaded from Microbial Genome Database System. Microbial 16S rRNA genes of 21 adults with obesity were sequenced on an Illumina MiSeq instrument and analyzed by using bioinformatics and statistical methods. RESULTS: The diversity of gut microbiota in people with obesity decreased significantly. There were significant differences in gut microbiota between the Obesity and Control group at different levels. At the phylum level, Firmicutes,…

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    Gender gap in journal submissions and peer review during the first wave of the COVID-19 pandemic. A study on 2329 Elsevier journals

    Flaminio Squazzoni, Giangiacomo Bravo, Francisco Grimaldo, Daniel García-Costa, Mike Farjam and 1 more

    227 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0257919OpenAlex

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    During the early months of the COVID-19 pandemic, there was an unusually high submission rate of scholarly articles. Given that most academics were forced to work from home, the competing demands for familial duties may have penalized the scientific productivity of women. To test this hypothesis, we looked at submitted manuscripts and peer review activities for all Elsevier journals between February and May 2018-2020, including data on over 5 million authors and referees. Results showed that during the first wave of the pandemic, women submitted proportionally fewer manuscripts than men. This deficit was especially pronounced among more junior cohorts of women academics. The rate of the peer-review invitation acceptance showed a less pronounced gender pattern with women taking on a greater service responsibility for journals, except for health & medicine, the field where the impact of COVID-19 research has been more prominent. Our findings suggest that the first wave of the pandemic has created potentially cumulative advantages for men.

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    Knowledge, acceptance and perception on COVID-19 vaccine among Malaysians: A web-based survey

    Nurul Azmawati Mohamed, Hana Maizuliana Solehan, Mohd Dzulkhairi Mohd Rani, Muslimah Ithnin, Ilina Isahak

    226 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256110OpenAlex

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    BACKGROUND: Coronavirus disease 2019 or COVID-19 is caused by a newly discovered coronavirus, SARS-CoV-2. The Malaysian government has planned to procure COVID-19 vaccine through multiple agencies and companies in order to vaccinate at least 70% of the population. This study aimed to determine the knowledge, acceptance and perception of Malaysian adults regarding the COVID-19 vaccine. METHODOLOGY: An online survey was conducted for two weeks in December 2020. A bilingual, semi-structured questionnaire was set up using Google Forms and the generated link was shared on social media (i.e., Facebook and WhatsApp). The questionnaire consisted of questions on knowledge, acceptance and perception of COVID-19 vaccine. The association between demographic factors with scores on knowledge about COVID-19 vaccine were analysed using the Mann-Whitney test for two categorical variables, and the Kruskal-Wallis test used for more than two categorical variables. RESULTS: A total of 1406 respondents participated, with the mean age of 37.07 years (SD = 16.05) years, and among them 926 (65.9%) were…

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    Crop yield prediction integrating genotype and weather variables using deep learning

    Johnathon M. Shook, Tryambak Gangopadhyay, Linjiang Wu, Baskar Ganapathysubramanian, Soumik Sarkar and 1 more

    223 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0252402OpenAlex

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    Accurate prediction of crop yield supported by scientific and domain-relevant insights, is useful to improve agricultural breeding, provide monitoring across diverse climatic conditions and thereby protect against climatic challenges to crop production. We used performance records from Uniform Soybean Tests (UST) in North America to build a Long Short Term Memory (LSTM)-Recurrent Neural Network based model that leveraged pedigree relatedness measures along with weekly weather parameters to dissect and predict genotype response in multiple-environments. Our proposed models outperformed other competing machine learning models such as Support Vector Regression with Radial Basis Function kernel (SVR-RBF), least absolute shrinkage and selection operator (LASSO) regression and the data-driven USDA model for yield prediction. Additionally, for providing interpretability of the important time-windows in the growing season, we developed a temporal attention mechanism for LSTM models. The outputs of such interpretable models could provide valuable insights to plant breeders.

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    D-dimer as a biomarker for assessment of COVID-19 prognosis: D-dimer levels on admission and its role in predicting disease outcome in hospitalized patients with COVID-19

    Ayusha Poudel, Yashasa Poudel, Anurag Raj Adhikari, Barun Babu Aryal, Debika Dangol and 3 more

    222 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256744OpenAlex

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    INTRODUCTION: Coronavirus Disease 2019 is a primarily respiratory illness that can cause thrombotic disorders. Elevation of D-dimer is a potential biomarker for poor prognosis in COVID-19, though optimal cutoff value for D-dimer to predict mortality has not yet been established. This study aims to assess the accuracy of admission D-dimer in the prognosis of COVID-19 and to establish the optimal cutoff D-dimer value to predict hospital mortality. METHODS: Clinical and laboratory parameters and outcomes of confirmed COVID-19 cases admitted to four hospitals in Kathmandu were retrospectively analyzed. Admitted COVID-19 cases with recorded D-dimer and definitive outcomes were included consecutively. D-dimer was measured using immunofluorescence assay and reported in Fibrinogen Equivalent Unit (μg/ml). The receiver operating characteristic curve was used to determine the accuracy of D-dimer in predicting mortality, and to calculate the optimal cutoff value, based on which patients were divided into two groups and predictive value of D-dimer for mortality was measured. RESULTS: 182…

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    Examining the effect of information channel on COVID-19 vaccine acceptance

    Rachael N. Piltch-Loeb, Elena Savoia, Beth Goldberg, Brian Hughes, Tanner Verhey and 3 more

    217 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251095OpenAlex

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    Hesitancy towards the COVID-19 vaccine remains high among the US population. Now that the vaccine is available to priority populations, it is critical to convince those that are hesitant to take the vaccine. Public health communication about the vaccine as well as misinformation on the vaccine occurs through a variety of different information channels. Some channels of information are more commonly found to spread misinformation. Given the expansive information environment, we sought to characterize the use of different media channels for COVID-19 vaccine information and determine the relationship between information channel and vaccine acceptance. We used quota sampling of vaccine priority groups [N = 2,650] between December 13 and 23, 2020 and conducted bivariate chi-squared tests and multivariable multinomial logistic regression analyses to determine the relative impact of channels of information on vaccine acceptance. We found traditional channels of information, especially National TV, National newspapers, and local newspapers increased the likelihood of vaccine acceptance.…

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    Impact of COVID-19 on mental health and quality of life: Is there any effect? A cross-sectional study of the MENA region

    Ayesha Salem Al Dhaheri, Mo’ath F. Bataineh, Maysm N. Mohamad, Abir Ajab, Amina M Al Marzouqi and 14 more

    217 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249107OpenAlex

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    The COVID-19 pandemic is a major health crisis that has changed the life of millions globally. The purpose of this study was to assess the effect of the pandemic on mental health and quality of life among the general population in the Middle East and North Africa (MENA) region. A total of 6142 adults from eighteen countries within the MENA region completed an online questionnaire between May and June 2020. Psychological impact was assessed using the Impact of Event Scale-Revised (IES-R) and the social and family support impact was assessed with questions from the Perceived Support Scale (PSS). The IES-R mean score was 29.3 (SD = 14.8), corresponding to mild stressful impact with 30.9% reporting severe psychological impact. Most participants (45%-62%) felt horrified, apprehensive, or helpless due to COVID-19. Furthermore, over 40% reported increased stress from work and financial matters. Higher IES-R scores were found among females, participants aged 26-35 years, those with lower educational level, and participants residing in the North Africa region (p<0.005). About 42% reported…

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    Altered smell and taste: Anosmia, parosmia and the impact of long Covid-19

    Duika Burges Watson, Miglena Campbell, Claire L Hopkins, Barry Smith, Chris Kelly and 1 more

    216 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256998OpenAlex

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    BACKGROUND: Qualitative olfactory (smell) dysfunctions are a common side effect of post-viral illness and known to impact quality of life and health status. Evidence is emerging that taste and smell loss are common symptoms of Covid-19 that may emerge and persist long after initial infection. The aim of the present study was to document the impact of post Covid-19 alterations to taste and smell. METHODS: We conducted exploratory thematic analysis of user-generated text from 9000 users of the AbScent Covid-19 Smell and Taste Loss moderated Facebook support group from March 24 to 30th September 2020. RESULTS: Participants reported difficulty explaining and managing an altered sense of taste and smell; a lack of interpersonal and professional explanation or support; altered eating; appetite loss, weight change; loss of pleasure in food, eating and social engagement; altered intimacy and an altered relationship to self and others. CONCLUSIONS: Our findings suggest altered taste and smell with Covid-19 may lead to severe disruption to daily living that impacts on psychological…

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    Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh

    Tahia Anan Dhira, Mahir A. Rahman, Abdur Razzaque Sarker, Jeenat Mehareen

    215 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0261590OpenAlex

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    This study investigated the reliability and factorial validity of General Anxiety Disorder-7 (GAD-7) in the context of university students in Bangladesh. The research aimed to assess whether the original one-dimensional model or a model containing both somatic and cognitive-emotional factors is appropriate. A repeated cross-sectional survey design based on convenience sampling was used to collect data from 677 university students. The factor structure of the GAD-7 was assessed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), and its convergent validity was determined by investigating its correlations with Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS). Results showed excellent reliability of GAD-7 as measured by Cronbach's α. CFA suggested that a modified one-factor model is appropriate for the sample. This model provided high values of comparative fit index (CFI), goodness of fit index (GFI), and Tucker Lewis Index (TLI), low value of standardized root mean square residual (SRMR) and a…

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    Healthcare worker stress, anxiety and burnout during the COVID-19 pandemic in Singapore: A 6-month multi-centre prospective study

    Irene Teo, Junxing Chay, Yin Bun Cheung, Sharon Cohan Sung, Komal G. Tewani and 19 more

    215 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0258866OpenAlex

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    AIM: The long-term stress, anxiety and job burnout experienced by healthcare workers (HCWs) are important to consider as the novel coronavirus disease (COVID-19) pandemic stresses healthcare systems globally. The primary objective was to examine the changes in the proportion of HCWs reporting stress, anxiety, and job burnout over six months during the peak of the pandemic in Singapore. The secondary objective was to examine the extent that objective job characteristics, HCW-perceived job factors, and HCW personal resources were associated with stress, anxiety, and job burnout. METHOD: A sample of HCWs (doctors, nurses, allied health professionals, administrative and operations staff; N = 2744) was recruited via invitation to participate in an online survey from four tertiary hospitals. Data were gathered between March-August 2020, which included a 2-month lockdown period. HCWs completed monthly web-based self-reported assessments of stress (Perceived Stress Scale-4), anxiety (Generalized Anxiety Disorder-7), and job burnout (Physician Work Life Scale). RESULTS: The majority of the…

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    Male gender is a predictor of higher mortality in hospitalized adults with COVID-19

    Ninh T. Nguyen, Justine O. Chinn, MORGAN DE FERRANTE, Katharine A. Kirby, Samuel F. Hohmann and 1 more

    215 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0254066OpenAlex

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    INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic continues to be a global threat, with tremendous resources invested into identifying risk factors for severe COVID-19 illness. The objective of this study was to analyze the characteristics and outcomes of male compared to female adults with COVID-19 who required hospitalization within US academic centers. METHODS: Using the Vizient clinical database, discharge records of adults with a diagnosis of COVID-19 between March 1, 2020 and November 30, 2020 were reviewed. Outcome measures included demographics, characteristics, length of hospital stay, rate of respiratory intubation and mechanical ventilation, and rate of in-hospital mortality of male vs female according to age, race/ethnicity, and presence of preexisting comorbidities. RESULTS: Among adults with COVID-19, 161,206 were male while 146,804 were female. Adult males with COVID-19 were more likely to have hypertension (62.1% vs 59.6%, p <0.001%), diabetes (39.2% vs 36.0%, p <0.001%), renal failure (22.3% vs 18.1%, p <0.001%), congestive heart failure (15.3% vs…

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    MultipleTesting.com: A tool for life science researchers for multiple hypothesis testing correction

    Otília Menyhárt, Boglárka Weltz, Balázs Győrffy

    215 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0245824OpenAlex

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    Scientists from nearly all disciplines face the problem of simultaneously evaluating many hypotheses. Conducting multiple comparisons increases the likelihood that a non-negligible proportion of associations will be false positives, clouding real discoveries. Drawing valid conclusions require taking into account the number of performed statistical tests and adjusting the statistical confidence measures. Several strategies exist to overcome the problem of multiple hypothesis testing. We aim to summarize critical statistical concepts and widely used correction approaches while also draw attention to frequently misinterpreted notions of statistical inference. We provide a step-by-step description of each multiple-testing correction method with clear examples and present an easy-to-follow guide for selecting the most suitable correction technique. To facilitate multiple-testing corrections, we developed a fully automated solution not requiring programming skills or the use of a command line. Our registration free online tool is available at www.multipletesting.com and compiles the five…

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    Prevalence of loneliness amongst older people in high-income countries: A systematic review and meta-analysis

    Kavita Chawla, Patience Kunonga, Daniel Stow, Robert Barker, Dawn Craig and 1 more

    214 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0255088OpenAlex

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    BACKGROUND AND OBJECTIVE: Loneliness is associated with increased rates of morbidity and mortality, and is a growing public health concern in later life. This study aimed to produce an evidence-based estimate of the prevalence of loneliness amongst older people (aged 60 years and above). STUDY DESIGN AND SETTING: Systematic review and random-effects meta-analysis of observational studies from high income countries 2008 to 2020, identified from searches of five electronic databases (Medline, EMBASE, PsychINFO, CINAHL, Proquest Social Sciences Premium Collection). Studies were included if they measured loneliness in an unselected population. RESULTS: Thirty-nine studies reported data on 120,000 older people from 29 countries. Thirty-one studies were suitable for meta-analysis. The pooled prevalence estimate of loneliness was 28.5% (95%CI: 23.9% - 33.2%). In twenty-nine studies reporting loneliness severity, the pooled prevalence was 25.9% (95%CI: 21.6% - 30.3%) for moderate loneliness and 7.9% (95%CI: 4.8% - 11.6%) for severe loneliness (z = -6.1, p < 0.001). Similar pooled prevalence…

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    Determination of hemicellulose, cellulose, holocellulose and lignin content using FTIR in Calycophyllum spruceanum (Benth.) K. Schum. and Guazuma crinita Lam.

    Rosario Javier-Astete, Jorge Jiménez-Dávalos, Gastón Zolla

    213 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256559OpenAlex

    Show abstract

    Capirona (Calycophyllum spruceanum (Benth.) K. Schum.) and Bolaina (Guazuma crinita Lam.) are fast-growing Amazonian trees with increasing demand in timber industry. Therefore, it is necessary to determine the content of cellulose, hemicellulose, holocellulose and lignin in juvenile trees to accelerate forest breeding programs. The aim of this study was to identify chemical differences between apical and basal stem of Capirona and Bolaina to develop models for estimating the chemical composition using Fourier transform infrared (FTIR) spectra. FTIR-ATR spectra were obtained from 150 samples for each species that were 1.8 year-old. The results showed significant differences between the apical and basal stem for each species in terms of cellulose, hemicellulose, holocellulose and lignin content. This variability was useful to build partial least squares (PLS) models from the FTIR spectra and they were evaluated by root mean squared error of predictions (RMSEP) and ratio of performance to deviation (RPD). Lignin content was efficiently predicted in Capirona (RMSEP = 0.48, RPD > 2) and…

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    The incidence, characteristics and outcomes of pregnant women hospitalized with symptomatic and asymptomatic SARS-CoV-2 infection in the UK from March to September 2020: A national cohort study using the UK Obstetric Surveillance System (UKOSS)

    Covid-19 in pregnancy, Nicola Vousden, Kathryn Bunch, Edward Morris, Nigel Simpson and 6 more

    213 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0251123OpenAlex

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    ABSTRACT Background Evidence on risk factors, incidence and impact of SARS-CoV-2 infection in pregnant mothers and their babies has rapidly expanded but there is a lack of population level data to inform accurate incidence rates and unbiased descriptions of characteristics and outcomes. The primary aim of this study was to describe the incidence, characteristics and outcomes of hospitalized pregnant women with symptomatic and asymptomatic SARS-CoV-2 in the UK compared to pregnant women without SARS-CoV-2 in order to inform future clinical guidance and management. Methods and Findings We conducted a national, prospective cohort study of all hospitalized pregnant women with confirmed SARS-CoV-2 from 1st March 2020 to 31 st August 2020 using the UK Obstetric Surveillance System (UKOSS) across all 194 hospitals in the UK with a consultant-led maternity unit. Incidence was estimated using the latest national maternity data. Overall, 1148 hospitalized women had confirmed SARS-CoV-2 in pregnancy, 63% of which were symptomatic. Therefore, the estimated incidence of hospitalization with…

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    What motivates consumers to buy organic foods? Results of an empirical study in the United States

    Raghava R. Gundala, Anupam Singh

    211 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0257288OpenAlex

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    Consumers perceive organic foods as more nutritious, natural, and environmentally friendly than non-organic or conventional foods. Since organic foods developed, studies on consumer behavior and organic foods have contributed significantly to its development. The presesent study aims to identify the factors affecting consumer buying behaviour toward organic foods in the United States. Survey data are collected from 770 consumers in the Midwest, United States. ANOVA, multiple linear regression, factor analysis, independent t-tests, and hierarchical multiple regression analysis are used to analyze the collected primary data. This research confirms health consciousness, consumer knowledge, perceived or subjective norms, and perception of price influence consumers' attitudes toward buying organic foods. Availability is another factor that affected the purchase intentions of consumers. Age, education, and income are demographic factors that also impact consumers' buying behavior. The findings help marketers of organic foods design strategies to succeed in the US's fast-growing organic…

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    Determinants of individuals’ belief in fake news: A scoping review determinants of belief in fake news

    Kirill Bryanov, Victoria Vziatysheva

    211 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0253717OpenAlex

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    BACKGROUND: Proliferation of misinformation in digital news environments can harm society in a number of ways, but its dangers are most acute when citizens believe that false news is factually accurate. A recent wave of empirical research focuses on factors that explain why people fall for the so-called fake news. In this scoping review, we summarize the results of experimental studies that test different predictors of individuals' belief in misinformation. METHODS: The review is based on a synthetic analysis of 26 scholarly articles. The authors developed and applied a search protocol to two academic databases, Scopus and Web of Science. The sample included experimental studies that test factors influencing users' ability to recognize fake news, their likelihood to trust it or intention to engage with such content. Relying on scoping review methodology, the authors then collated and summarized the available evidence. RESULTS: The study identifies three broad groups of factors contributing to individuals' belief in fake news. Firstly, message characteristics-such as belief…

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    Small-sided games: An umbrella review of systematic reviews and meta-analyses

    Filipe Manuel Clemente, José Roberto Afonso, Hugo Sarmento

    210 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0247067OpenAlex

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    OBJECTIVE: This umbrella review was conducted to summarize the evidence and qualify the methodological quality of SR and SRMA published on small-sided games in team ball sports. METHODS: A systematic review of Web of Science, PubMed, Cochrane Library, Scopus, and SPORTDiscus databases was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. RESULTS: From the 176 studies initially identified, 12 (eight SR and four SRMA) were fully reviewed, and their outcome measures were extracted and analyzed. Methodological quality (with the use of AMSTAR-2) revealed that seven reviews had low quality and five had critically low quality. Two major types of effects of SSGs were observed: (i) short-term acute effects and (ii) long-term adaptations. Four broad dimensions of analysis were found: (i) physiological demands (internal load); (ii) physical demands (external load) or fitness status; (iii) technical actions; and (iv) tactical behavior and collective organization. The psychological domain was reduced to an analysis of enjoyment.…

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    Racial and ethnic differentials in COVID-19-related job exposures by occupational standing in the US

    Noreen Goldman, Anne R. Pebley, Keunbok Lee, Theresa Andrasfay, Boriana Pratt

    209 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0256085OpenAlex

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    Researchers and journalists have argued that work-related factors may be partly responsible for disproportionate COVID-19 infection and death rates among vulnerable groups. We evaluate these issues by describing racial and ethnic differences in the likelihood of work-related exposure to COVID-19. We extend previous studies by considering 12 racial and ethnic groups and five types of potential occupational exposure to the virus: exposure to infection, physical proximity to others, face-to-face discussions, interactions with external customers and the public, and working indoors. Most importantly, we stratify our results by occupational standing, defined as the proportion of workers within each occupation with at least some college education. This measure serves as a proxy for whether workplaces and workers employ COVID-19-related risk reduction strategies. We use the 2018 American Community Survey to identify recent workers by occupation, and link 409 occupations to information on work context from the Occupational Information Network to identify potential COVID-related risk factors.…

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    Predicting student satisfaction of emergency remote learning in higher education during COVID-19 using machine learning techniques

    Indy Man Kit Ho, Kai Yuen Cheong, Anthony Weldon

    208 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0249423OpenAlex

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    Despite the wide adoption of emergency remote learning (ERL) in higher education during the COVID-19 pandemic, there is insufficient understanding of influencing factors predicting student satisfaction for this novel learning environment in crisis. The present study investigated important predictors in determining the satisfaction of undergraduate students (N = 425) from multiple departments in using ERL at a self-funded university in Hong Kong while Moodle and Microsoft Team are the key learning tools. By comparing the predictive accuracy between multiple regression and machine learning models before and after the use of random forest recursive feature elimination, all multiple regression, and machine learning models showed improved accuracy while the most accurate model was the elastic net regression with 65.2% explained variance. The results show only neutral (4.11 on a 7-point Likert scale) regarding the overall satisfaction score on ERL. Even majority of students are competent in technology and have no obvious issue in accessing learning devices or Wi-Fi, face-to-face learning…

  92. 92
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    Stopwords in technical language processing

    Serhad Sarica, Jianxi Luo

    207 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0254937OpenAlex

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    There are increasing applications of natural language processing techniques for information retrieval, indexing, topic modelling and text classification in engineering contexts. A standard component of such tasks is the removal of stopwords, which are uninformative components of the data. While researchers use readily available stopwords lists that are derived from non-technical resources, the technical jargon of engineering fields contains their own highly frequent and uninformative words and there exists no standard stopwords list for technical language processing applications. Here we address this gap by rigorously identifying generic, insignificant, uninformative stopwords in engineering texts beyond the stopwords in general texts, based on the synthesis of alternative statistical measures such as term frequency, inverse document frequency, and entropy, and curating a stopwords dataset ready for technical language processing applications.

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    Development and validation of a self-report measure of epistemic trust

    Chloë Campbell, Michal Tanzer, Rob Saunders, Thomas L. Booker, Elizabeth Allison and 4 more

    206 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250264OpenAlex

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    Epistemic trust (ET) refers to trust in communicated knowledge. This paper describes the development and validation of a new self-report questionnaire, the Epistemic Trust, Mistrust and Credulity Questionnaire (ETMCQ). We report on two studies (Study 1, n = 500; Study 2, n = 705) examining the psychometric properties of the ETMCQ and the relationship between EMTCQ scores (i.e., an individual's epistemic stance) and exposure to adverse childhood experiences, mental health symptoms, attachment, mentalizing and general self-efficacy. The factor structure of the ETMCQ was examined using Exploratory and Confirmatory Factor Analyses, and its reliability and test-retest reliability were tested. Both studies yielded three correlated yet distinct factors-Trust, Mistrust and Credulity-and confirmed the reliability and validity of the ETMCQ. Preregistered hypotheses were confirmed and replicated across both studies. Main findings suggest intriguing links between the ETMCQ and developmental psychopathology constructs and are consistent with thinking on the role of epistemic stance in…

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    Individual determinants of COVID-19 vaccine hesitancy

    Philip Gerretsen, Julia Kim, Fernando Caravaggio, Lena Catherine Quilty, Marcos Sanches and 5 more

    205 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0258462OpenAlex

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    BACKGROUND: Novel coronavirus disease 2019 (COVID-19) vaccine hesitancy is a barrier to achieving herd immunity, and thus, a prominent public health concern. This study aimed to identify the determinants of COVID-19 vaccine hesitancy based on the World Health Organization's '3Cs' model (i.e., confidence, complacency, and convenience) in the United States (U.S.) and Canada. METHODS: Data from 7678 adults ages 18 or older were collected from the four most populous U.S. States, specifically New York, California, Florida, and Texas, and from English-speaking Canada at three timepoints, in May and July 2020, and March 2021 using a web-based survey (www.covid19-database.com). Sociodemographic information was collected, and comprehensive psychological assessments were administered. Univariate analyses were performed to identify the individual determinants of vaccine hesitancy, which were categorized as: 1) vaccine confidence, 2) vaccine complacency, 3) sociodemographic, and 4) other psychological factors. A series of models were computed using these categorizations. RESULTS: Mistrust of…

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    Physical activity motives, barriers, and preferences in people with obesity: A systematic review

    Aurélie Baillot, Stéphanie Chenail, Naiara Barros Polita, Mylène Simoneau, Mathilde Libourel and 4 more

    203 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0253114OpenAlex

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    BACKGROUND: Although the benefits of physical activity (PA) are well known, physical inactivity is highly prevalent among people with obesity. The objective of this systematic review was to i) appraise knowledge on PA motives, barriers, and preferences in individuals with obesity, and ii) quantify the most frequently reported PA motives, barriers and preferences in this population. METHODS: Six databases (Pubmed, CINAHL, Psyarticle, SportDiscus, Web of science and Proquest) were searched by independent reviewers to identify relevant quantitative or qualitative articles reporting PA motives, barriers or preferences in adults with body mass index ≥ 30 kg/m2 (last searched in June 2020). Risk of bias for each study was assessed by two independent reviewers with the Mixed Methods Appraisal Tool (MMAT). RESULTS: From 5,899 papers identified, a total of 27 studies, 14 quantitative, 10 qualitative and 3 mixed studies were included. About 30% of studies have a MMAT score below 50% (k = 8). The three most reported PA motives in people with obesity were weight management, energy/physical…

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    A city of cities: Measuring how 15-minutes urban accessibility shapes human mobility in Barcelona

    Eduardo Graells-Garrido, Feliu Serra-Burriel, Francisco Rowe, Fernando Cucchietti, Patricio Reyes

    203 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0250080OpenAlex

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    As cities expand, human mobility has become a central focus of urban planning and policy making to make cities more inclusive and sustainable. Initiatives such as the "15-minutes city" have been put in place to shift the attention from monocentric city configurations to polycentric structures, increasing the availability and diversity of local urban amenities. Ultimately they expect to increase local walkability and increase mobility within residential areas. While we know how urban amenities influence human mobility at the city level, little is known about spatial variations in this relationship. Here, we use mobile phone, census, and volunteered geographical data to measure geographic variations in the relationship between origin-destination flows and local urban accessibility in Barcelona. Using a Negative Binomial Geographically Weighted Regression model, we show that, globally, people tend to visit neighborhoods with better access to education and retail. Locally, these and other features change in sign and magnitude through the different neighborhoods of the city in ways that…

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    Effects of phosphorus deficiency on the absorption of mineral nutrients, photosynthetic system performance and antioxidant metabolism in Citrus grandis

    Xin Meng, Weiwei Chen, Yanyu Wang, Zeng-Rong Huang, Xin Ye and 2 more

    203 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0246944OpenAlex

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    Phosphorus (P) is an essential macronutrient for plant growth, development and production. However, little is known about the effects of P deficiency on nutrient absorption, photosynthetic apparatus performance and antioxidant metabolism in citrus. Seedlings of 'sour pummelo' (Citrus grandis) were irrigated with a nutrient solution containing 0.2 mM (Control) or 0 mM (P deficiency) KH2PO4 until saturated every other day for 16 weeks. P deficiency significantly decreased the dry weight (DW) of leaves and stems, and increased the root/shoot ratio in C. grandis but did not affect the DW of roots. The decreased DW of leaves and stems might be induced by the decreased chlorophyll (Chl) contents and CO2 assimilation in P deficient seedlings. P deficiency heterogeneously affected the nutrient contents of leaves, stems and roots. The analysis of Chl a fluorescence transients showed that P deficiency impaired electron transport from the donor side of photosystem II (PSII) to the end acceptor side of PSI, which showed a greater impact on the performance of the donor side of PSII than that of…

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    The impact of COVID-19 on hospital admissions and emergency department visits: A population-based study

    Elissa Rennert‐May, Jenine R. Leal, Nguyễn Xuân Thành, Eddy Lang, Shawn K. Dowling and 3 more

    202 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0252441OpenAlex

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    BACKGROUND: As a result of the novel coronavirus disease 2019 (COVID-19), there have been widespread changes in healthcare access. We conducted a retrospective population-based study in Alberta, Canada (population 4.4 million), where there have been approximately 1550 hospital admissions for COVID-19, to determine the impact of COVID-19 on hospital admissions and emergency department (ED visits), following initiation of a public health emergency act on March 15, 2020. METHODS: We used multivariable negative binomial regression models to compare daily numbers of medical/surgical hospital admissions via the ED between March 16-September 23, 2019 (pre COVID-19) and March 16-September 23, 2020 (post COVID-19 public health measures). We compared the most frequent diagnoses for hospital admissions pre/post COVID-19 public health measures. A similar analysis was completed for numbers of daily ED visits for any reason with a particular focus on ambulatory care sensitive conditions (ACSC). FINDINGS: There was a significant reduction in both daily medical (incident rate ratio (IRR) 0.86,…

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    The h-index is no longer an effective correlate of scientific reputation

    Vladlen Koltun, David Hafner

    201 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0253397OpenAlex

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    The impact of individual scientists is commonly quantified using citation-based measures. The most common such measure is the h-index. A scientist's h-index affects hiring, promotion, and funding decisions, and thus shapes the progress of science. Here we report a large-scale study of scientometric measures, analyzing millions of articles and hundreds of millions of citations across four scientific fields and two data platforms. We find that the correlation of the h-index with awards that indicate recognition by the scientific community has substantially declined. These trends are associated with changing authorship patterns. We show that these declines can be mitigated by fractional allocation of citations among authors, which has been discussed in the literature but not implemented at scale. We find that a fractional analogue of the h-index outperforms other measures as a correlate and predictor of scientific awards. Our results suggest that the use of the h-index in ranking scientists should be reconsidered, and that fractional allocation measures such as h-frac provide more…

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    Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia

    Miguel Alejandro Pinzón, Santiago Ortiz, Héctor Holguín, Juan Felipe Betancur, Doris Cardona Arango and 6 more

    201 citationsOpen access (CC-BY)doi:10.1371/journal.pone.0252057OpenAlex

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    BACKGROUND: There is no effective therapy for the severe acute respiratory syndrome by coronavirus 2 (SARS-CoV2) responsible for the Coronavirus disease 2019 (Covid-19). To date, dexamethasone has shown a decrease in mortality in patients who require oxygen, especially those with invasive mechanical ventilation. However, it is unknown if another corticosteroid can be used, the optimal dose and its duration, to achieve a better clinical outcome. The objective of the study was to compare the differences in clinical outcome and laboratory results in hospitalized patients with severe SARS-CoV2 Pneumonia treated with dexamethasone at 6 mg doses versus patients treated with high-dose methylprednisolone. MATERIALS AND METHODS: Ambispective cohort study with survival analysis of 216 patients diagnosed with severe Covid-19 pneumonia confirmed by polymerase chain reaction for SARS-CoV2 by Berlin protocol, who were hospitalized in a high-complexity clinic in Medellín, Colombia. The patients should also have supplementary oxygen and radiological confirmation of Pneumonia by chest tomography.…

How to read this list

The cohort is every article, review and book chapter OpenAlex attributes to PLoS ONE with publication year 2021, excluding retracted works and paratext such as editorials and errata. The top 100 by citation count are listed; the percentile is the rank divided by the cohort size. 100 of the 100 entries have an abstract in OpenAlex. Counts were read on 29 October 2026 and will not be updated on this page, so a quoted rank stays verifiable. Full rules on the methodology page.

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