Ecology and Evolution

Species distribution models (SDMs) increasingly inform conservation and biosecurity decisions in freshwater systems, where the reliability of its uncertainty estimates matters as much as its point predictions. Ensemble SDMs derive prediction intervals from across-replicate variance, but this variance captures systematic error only when replicates disagree about it, an assumption that fails when training data are contaminated with low-accuracy records, the norm in citizen-science datasets. Whether this failure is spatially uniform or concentrates in identifiable parts of a range is unknown. Using a panel of European freshwater crayfish spanning native headwater-associated species and invasive lowland colonizers, we show that contamination-induced calibration failure is strongly spatially structured: it concentrates at stream-network headwaters, the topological tops of the network, where upstream-aggregated predictors are structurally undefined, and scales with contamination severity, replicated across four species and both dominant ensemble protocols (replicate and consensus). The failure is driven by upward prediction bias, not by intervals failing to widen: contaminated ensembles overpredict suitability in headwaters, and because the bias is shared across ensemble members, the intervals do not flag it. This is a conservation-relevant blind spot, because headwaters are both refugia for threatened native crayfish and front lines for invasion; an SDM that silently overpredicts suitability there misdirects survey and management effort toward the segments where its predictions are least trustworthy. Standard leave-one-basin-out conformal calibration, the recommended panel-wide remedy, repairs marginal coverage but leaves headwaters undercovered, because a single calibration threshold is dominated by the abundant non-headwater segments. A group-conditional (Mondrian) variant, calibrating the two populations separately, restores reliable coverage in both at no extra cost and reallocates width where it is needed. We recommend network-position-stratified calibration as a default for ensemble SDMs in dendritic freshwater systems.

AO_SCPLOWBSTRACTC_SCPLOWO_LICommunity assembly graphs (CAGs) summarize which species combinations can coexist and how single-species invasions drive transitions between them, encoding the pathways, alternative endpoints, and cycles that make up a communitys assembly history. Constructing CAGs from dynamical models requires methods that are both computationally tractable and faithful to the underlying ecological dynamics. However, existing methods rely on restrictive assumptions, such as global stability, that exclude alternative stable states and non-equilibrium dynamics known to occur in empirical systems. C_LIO_LIWe develop a computational pipeline that constructs CAGs from any generalized Lotka-Volterra model. Building on the invasion graph framework and its connection to permanence, the pipeline verifies that community dynamics are bounded, identifies which subsets of species coexist in the sense of permanence, determines which single-species invasions are dynamically realized, and assigns each community a topographic height equal to the length of the longest assembly path leading to it. We also provide a numerical algorithm to simulate the dynamics of community assembly. C_LIO_LIWe prove several general properties of the resulting graphs, including that a successful invader is never subsequently excluded and that, in the absence of assembly cycles, permanent communities can be reassembled by introducing their species one at a time in the right order. We prove that the CAG faithfully reproduces the compositional shifts seen in the numerically simulated dynamics of assembly. Applying the pipeline to three empirically based models (a New Zealand grassland, a European pasture, and a Puerto Rican ant community), we show how competition strength and mutualistic feedbacks reshape the assembly landscape and how intransitive competition generates assembly cycles. C_LIO_LIOur approach accommodates alternative stable states and non-equilibrium dynamics without requiring global stability, and it turns the long-standing landscape metaphor into a quantitative, mechanistically grounded object by resolving what "height" means. More broadly, it makes the topography of the assembly pathways measurable, providing a way to compare the historical contingency and predictability of the assembly in ecological systems. C_LI

Reactive nitrogen species (RNS), particularly peroxynitrite generated from the reaction of superoxide and nitric oxide, are implicated in thermally-induced oxidative stress but remain difficult to resolve in live coral cells. We optimized fluorescent dye strategies to directly quantify superoxide, nitric oxide, and peroxynitrite production in thermally stressed Pocillopora acuta cell suspensions. Thermal stress was associated with an increase in intracellular peroxynitrite concentration, but not in its precursors, nitric oxide and superoxide, highlighting challenges with the application of fluorescent probes and their controls to live coral cells. Compounds developed for mammalian systems often translate poorly to non-model systems such as corals: strong endogenous fluorescence and multiple membrane barriers within the coral symbiocyte, for instance, limited the function of the nitric oxide probe, DAF-2DA. Despite these limitations, the detection of peroxynitrite in live, thermally stressed P. acuta cells represents a step forward in understanding the mechanism of coral bleaching. We also outline strategies for improving the performance of commercial dyes in non-model systems, including media optimization with EDTA treatment to preserve both cell viability and probe performance.

1. Sandy beaches along urbanized coasts are increasingly managed through beach nourishment and hard infrastructure, yet these interventions often constrain natural dune-building processes. Along the Belgian coast, where much of the beach-dune interface is bordered by dikes, promenades and intensive recreation, strandline vegetation may provide an overlooked mechanism for retaining sand and initiating embryo dune development. 2. We assessed the potential for four pioneer dune plant species (Cakile maritima, Calamagrostis arenaria, Elymus farctus and Salsola kali) to establish, develop vegetation cover and contribute to sand accumulation along the Belgian coast. Using field surveys from 2017-2023, LiDAR-derived beach elevation and annual sediment dynamics, we modelled species occurrence and abundance/cover in low-disturbance reference zones and projected these relationships across the wider coastline. 3. Occurrence models identified where abiotic conditions allow plants to establish and persist until the late growing season, whereas zero-inflated abundance/cover models estimated expected vegetation development across environmental gradients. Predicted occurrence was widespread for several species, suggesting that the abiotic gradients modelled here are not the primary constraints on potential establishment across large parts of the coast. In contrast, expected abundance/cover showed stronger species-specific responses, particularly to sand accretion, indicating that sediment dynamics mainly affect post-establishment vegetation development rather than occurrence alone. 4. Independent field measurements of embryo dunes showed positive relationships between vegetation cover and local sand accumulation for all four species. When scaled using spatial predictions of potential abundance/cover, pioneer vegetation could retain substantial volumes of sand, with Cakile maritima contributing the largest share, followed by Salsola kali, Elymus farctus and Calamagrostis arenaria. Estimated volumes depended on assumptions about whether vegetation occurs as dispersed units or aggregated patches. 5. Synthesis and applications. Our results show that, even along a heavily urbanized and nourished coastline, abiotic conditions can support strandline vegetation and embryo dune initiation where disturbance is reduced. Management actions such as limiting trampling, adapting beach cleaning and protecting strandline vegetation could enhance the retention of nourished sand and support nature-based coastal defense. Rather than replacing engineered interventions, strandline vegetation may increase the efficiency with which available sediment is retained within the beach-dune system.

Does the distribution of fitness effects of new mutations vary across the genome? Under the classical Fisher Geometric Model (FGM) we might not expect it to. In FGM, phenotypic traits are envisioned as dimensions of a landscape, with fitness determined by position in the landscape, i.e., the particular combination of traits of an individual. New mutations are represented by vectors that move from an ancestral to a new phenotype. In classical FGM these vectors affect all trait dimensions simultaneously (universal pleiotropy). However, introducing partial and modular pleiotropy into an FGM framework leads to an expectation that parameters of the DFE will vary with mutational pleiotropy-the number of traits affected by individual mutations. Here we address this prediction by investigating whether traits related to mutational pleiotropy, expression level and network connectivity, affect the parameters of the DFE using whole genome data from A. thaliana and C. grandiflora, two closely related Brassica species that vary significantly in their demography and mating system, and therefore, in effective population size and the effects of linked selection. Results were similar across both species. We found that expression level and network connectivity were predictive of the parameters of the deleterious DFE, even once co-correlations among genome biology traits were accounted for. Our results suggest that, across the genome, molecular evolutio(high mutational pleiotropy). nary patterns agree with the predictions of FGM, albeit relaxing the assumption of universal pleiotropy, and that variation in mutational pleiotropy among genes is sufficient to have detectible effects on the DFE. Significance statementHow do the effects of new mutations vary across the genome? If mutations in some genes affect many traits (high mutational pleiotropy), we hypothesise they will be more strongly deleterious, with lower variance in their selective effects. We test this by investigating the distribution of effects of new mutations across genes that vary in features that are related to mutational pleiotropy: expression level, gene network connectivity, and number of associated GO terms. The mean strength and coefficient of variation of selection of new mutations varied across genes with different features in the manner expected by our hypothesis. This demonstrates that important parameters of molecular evolution can vary across the genome with genome architecture.

Sakumo Lagoon, a small (1 km2) semi-open coastal lagoon in Ghana, lies between the cities of Accra and Tema. The lagoon and its surrounding wetland were designated a Ramsar Site in 1992, mainly because it served as a refuge for 66 local and migratory bird species. Its ecology, and the biology of its major fish species, notably the blackchin tilapia (Sarotherodon melanotheron) were thoroughly studied in 1971, when the lagoon was a diverse, mainly brackish ecosystem supporting a traditionally and well-managed fishery. In 2016-2017, another study found the lagoon mostly covered by floating vegetation and plastic waste. Finally, in 2024, a visual survey established that the floating vegetation had been almost completely replaced by terrestrial plants, with only a few square meters of garbage-strewn water in front of a culvert connecting the lagoon to the open sea. Several lagoons along the coast of Ghana have been similarly lost to urban sprawl and its various forms of pollution, but Sakumo Lagoon is a Ramsar Site, and its imminent disappearance should not remain undocumented.

Green algae must continuously balance resource availability to maintain photosynthetic performance. The O2:CO2 ratio is a key determinant of their metabolic mode. Under hyperoxia or low CO2, many algae induce a carbon concentrating mechanism (CCM). In the model green alga Chlamydomonas reinhardtii, the CCM relies on a pyrenoid, a specialized microcompartment that elevates CO2 around rubisco. While ambient CO2 acclimation is well-studied, responses to hyperoxia remain poorly understood, despite its frequent occurrence in nature under high light. Using controlled bioreactors, we exposed two diverse Chlamydomonas ecotypes, CC1009 and CC2343, to 95% oxygen to analyze time-dependent, genome-wide transcriptomic and phenotypic changes. Both ecotypes induced CCM genes, but they exhibited distinct molecular and physiological phenotypes. The tolerant ecotype (CC1009) successfully adapted, developing a functional CCM with a structured starch sheath. Conversely, the sensitive ecotype (CC2343) suffered growth arrest and formed malformed pyrenoids. Transcriptomics revealed that CC1009 initiated a rapid initial response, upregulating chloroplast proteostasis and downregulating nucleotide metabolism. CC2343 showed a massive, delayed transcriptional response, downregulating genes coding for photosystems and tetrapyrrole biosynthesis. This unbiased transcriptomic approach identifies key candidate genes driving algal acclimation to hyperoxic stress in natural, high-light environments.

Multi-omics and spatial-omics technologies are exploding in use, producing increasingly complex datasets. Existing bioinformatics tools are developing rapidly but fail to fully enforce the FAIR principles, leaving the field vulnerable to escalating issues in computational reproducibility. Here, we introduce a reproducible-by-design paradigm represented in an omics data processing package, RomicsProcessor. At its core, the "Romics_object", which is a self-contained digital artifact that encapsulates the full history of the data from the original data to the fully processed state, capturing the details of the transformative steps and the required dependencies. This architecture ensures that computational workflows are fully portable and reproducible. In this manuscript, we demonstrate RomicProcessors computational capabilities and scalability on diverse datasets, including bulk proteomics, large-scale multiplexed immunofluorescence, and multi-batch mass spectrometry imaging. Providing a robust framework for truly FAIR Data Principles-based analysis, RomicsProcessor is a blueprint for the next generation of reproducible bioinformatics tools that can dramatically accelerate discovery in multi-omics biology in the era of artificial intelligence.

Symbiotic interactions between plants and nitrogen-fixing microorganisms are essential for sustainable agriculture, yet the molecular mechanisms underlying plant-cyanobacterium symbiosis remain poorly understood. In particular, the nature of the signalling mechanisms mediating partner recognition in associations involving Nostoc species is largely unknown. Recent proteomic analyses have identified proteins homologous to rhizobial Nod factors biosynthetic enzymes in Nostoc punctiforme, suggesting the existence of a Nod-like signalling system. However, the functional role of these components has not been experimentally validated. Here, we investigate the contribution of nod-like biosynthetic and regulatory genes to symbiosis by analysing mutants of N. punctiforme affected in genes with homology to nodB and nodD. Phenotypic characterization revealed that disruption of nodB-like genes does not impair free-living growth but affects early stages of plant association and colonization. Specifically, the nodB1 mutant is impaired in plant association and shows a mild defect in colonization, whereas the nodB3 mutant exhibits a severe defect in colonization. In contrast, nodD-like mutants exhibited altered symbiotic phenotypes, with specific regulators differentially affecting interaction and colonization efficiency in rice (Oryza sativa). In particular, mutation of nodD2 and nodD3 reduced plant association and severely compromised colonization in Oryza sativa, with a more pronounced phenotype in nodD3 mutant. Altogether, our results provide genetic evidence supporting the involvement of Nod-like components in cyanobacterial symbiosis and suggest the existence of a regulatory and biosynthetic module contributing to plant colonization. These findings shed new light on the evolution and diversity of symbiotic signalling mechanisms across plant-microbe interactions.

Collective animal behavior occurs in high-stakes contexts where failing to coordinate effectively with group-mates can spell disaster for individuals. Yet, identifying instances of coordination failure is challenging, meaning their evolutionary effects remain mysterious. Synchronous calls in alternating frog choruses (i.e., inadvertent signal collisions) are unambiguous failure events that impose steep attractiveness costs. We modeled tungara frog chorusing dynamics to reveal the sensorimotor and social mechanisms underpinning synchrony. Ultimately, inter-male variation in two key sensorimotor attributes, the periods of male calling rhythms and call latencies, generated divergent synchrony engagement patterns. Modeling female preferences revealed that these varied behavioral outcomes then yielded disparate attractiveness consequences. By mechanistically linking the causes and consequences of coordination failure, we demonstrate that non-random failure patterns in collectives generate selection gradients that refine sensorimotor tuning.

The article introduces a new Forest Stress Index (ISF) based on a plant hydraulic modelling approach rather than classical climatic drought indices. Unlike other index like scPDSI or SPEI, ISF is grounded in xylem embolism dynamics simulated with the mechanistic SurEau model. The goal is to better link climatic anomalies to tree physiological functioning and mortality risk. ISF is defined using a locally adapted ideotype characterized by an optimal P50 value under a reference hydraulic functioning threshold. Simulations are performed across Europe and France using multiple climate datasets. The index is robust to model parameterization choices and assumptions about plant functional traits. Results show strong spatial and temporal consistency and significant correlations with SPEI and scPDSI. However, ISF more strongly highlights extreme drought years and exhibits a more skewed distribution. Future projections under SSP5-8.5 indicate a widespread increase in hydraulic stress with strong regional contrasts. Overall, ISF provides a mechanistic and complementary drought indicator more directly linked to forest mortality processes.

Plant-associated bacteria can improve plant performance under abiotic stress, but beneficial functions in plant microbiomes may depend on defined combinations of microorganisms rather than individual isolates alone. Here, we developed a cube-based screening strategy to identify functional synthetic microbial communities (SynComs) from 135 quinoa-associated bacterial isolates while preserving combinatorial diversity and traceability of isolate-level contributions. The isolates were divided into five 27-isolate sets, each arranged as a 3 x 3 x 3 cube in which each 3 x 3 layer was defined as a 9-isolate SynCom, generating 45 SynComs in total. Screening under 100 mM NaCl identified SynCom DY1 (SCDY1) as a candidate salt stress-mitigating consortium. SCDY1 consisted of nine taxonomically diverse isolates and exhibited a multifunctional profile, including siderophore production, phosphate solubilization, carboxymethyl cellulose degradation, indole compound production, and growth under saline conditions. In Arabidopsis thaliana, SCDY1 promoted primary root elongation and biomass accumulation in a salinity-dependent manner, with the clearest effect under 120 mM NaCl, and at least a subset of constituent bacteria was recoverable from inoculated seedlings. RNA sequencing and targeted RT-qPCR indicated that SCDY1 modulated host gene expression under moderate salinity stress, with responsive genes associated with oxidative stress, water- and oxygen-related processes, phenylpropanoid biosynthesis, glutathione metabolism, and root epidermis-related processes. Root hair phenotyping further showed that SCDY1 enhanced root hair-related traits and shifted visible root hair formation closer to the root apex. These findings identify a quinoa-derived SynCom that improves plant performance under salinity stress and provide a practical, traceable framework for discovering beneficial microbial consortia from plant-associated bacterial collections. Scope statementThis manuscript fits the Research Topic "Harnessing Plant Microbiomes for Climate Resilience: From Ecological Insight to Synthetic Community Design" in Frontiers in Plant Science because it presents a traceable strategy for discovering functional synthetic microbial communities from a stress-adapted plant-associated bacterial collection. We developed a cube-based screening strategy using 135 quinoa-associated bacterial isolates and identified a nine-isolate synthetic microbial community, SCDY1, that promotes Arabidopsis growth under moderate salinity stress. The study integrates microbiological screening, characterization of plant growth-promoting traits, bacterial re-isolation, plant growth phenotyping, RNA-seq, RT-qPCR, and root hair phenotyping. These analyses link SCDY1 treatment to salinity-dependent growth promotion, recoverable bacterial members, stress- and redox-associated transcriptional changes, phenylpropanoid-related responses, and modulation of root epidermal phenotypes. By connecting a defined SynCom with host transcriptional and root epidermal responses, this work advances understanding of beneficial plant-microbe interactions under salt stress. The cube-based design also provides a practical and traceable framework for discovering functional SynComs from large plant-associated bacterial collections, which should be of interest to researchers studying plant symbiosis, microbiome engineering, abiotic stress tolerance, and sustainable crop improvement.

"Mirror life", self-replicating organisms composed of non-natural-chirality biomacromolecules, presents a future threat with potentially global consequences. Consequently, there is strong agreement among experts that it should not be created. However, there is some disagreement over how effective existing medical countermeasures might prove against mirror bacteria in the event that they were created. Here, we leverage computational chemistry methods including docking and molecular dynamics to determine the likely binding efficacy of existing antibiotics against natural and mirror bacterial protein targets. We find that most existing antibiotics fail to bind to mirror bacterial protein targets, unlike their natural-chirality targets. This suggests altered binding of current medical countermeasures, which may impact the antimicrobial activity against mirror bacteria were the latter were created.

BACKGROUND: Since South Africa's democratic transition in 1994, the country has undergone profound social, demographic and public health change. We analysed national recorded live-birth data from 1994-2024 to identify major signals of population reproduction. METHODS: Monthly recorded live births from January 1994 to December 2024 were obtained from Statistics South Africa. Birth seasonality, sex ratio at birth (SRB) [male/total live births] and annual recorded live births were analysed using time-series and forecasting methods. RESULTS: From 1994-2014, September was the peak birth month in all 21 years, consistent with conceptions during the Christmas-New Year holiday period nine months earlier. From 2015 onwards, March became the most frequent peak month, with April emerging as the peak month in 2024, indicating a shift towards winter conceptions. The SRB declined to 49.996% in June 2021 (95% prediction interval 50.165%-50.749%) and remained below the lower prediction bound from May to July 2021 (combined p<0.001). November 2021 recorded the highest monthly SRB in the 31-year study period (50.983%), exceeding the upper 95% prediction interval. Annual recorded live births peaked at 1,112,378 in 2008 and declined to 798,556 in 2024; births from 2022-2024 fell below the 95% confidence interval of the historical trend. CONCLUSIONS: Three prominent demographic signals emerged: a shift from Christmas holiday conceptions towards winter conceptions; a rare inversion (SRB <50%) and sustained depression of the SRB during May-July 2021, occurring within the 3-5-month stress-sensitive window after the January 2021 Beta-wave mortality peak, followed by the highest monthly SRB of the study period in November, nine months after the easing of COVID-19 restrictions in February 2021; and an accelerated decline in annual recorded live births after 2021, culminating in the lowest level observed in 2024. These findings indicate changes in reproductive timing, stress-sensitive sex-ratio patterning and fertility in South Africa.

Ecological roles are treated as discrete, bounded units of biological organization, even as evidence shows that many taxa are versatile, performing more than one of them. Each record of versatility represents a boundary crossing, yet current categorical paradigms prevent this cumulative evidence from reshaping the roles themselves. We solve this by introducing the ecological multiverse, a self-correcting framework that turns boundary crossings into a network of role connectivity. Applied to Fungi, the multiverse recasts the major form of plant pathogenicity from an isolated disease role into a central hub linking much of fungal functional space, especially benign plant symbioses and decomposition. By exposing this topology, the multiverse transforms categorical views of ecological function into a dynamic map, revealing pathways of role change as organisms and knowledge evolve.

Background and AimsThe development of unisexual flowers relies on the tight coordination of flower organ identity and sex determination. The genus Quercus is typically considered strictly monoecious, bearing fully segregated male and female flowers within the same individual tree. However, several reports of atypical flowering across the genus challenge this canonical view, suggesting that flowering in oaks may be more flexible than traditionally assumed. In this work, the dynamics of flower development in Quercus orocantabrica were examined to correlate contrasting floral morphologies with divergent molecular profiles. MethodsThe flowering phenology of Q. orocantabrica trees was closely monitored over several individuals and years, together with a detailed floral morphological analysis of male, female and atypical flowers. Key floral homeotic gene homologues were identified, and their expression assayed in the development of different flowers. Key ResultsRecurrent and widespread hermaphroditic flowering was detected in several Q. orocantabrica trees, frequently associated with unseasonal flowering events. Gene expression analysis of male, female and hermaphroditic flowers revealed a sex-biased expression of Q. orocantabrica B- and C-class genes, with the B-class gene QoPI in particular being tightly associated with the presence of fully-developed stamens. In addition, the expression of the C-class gene QoSHP contrasted with reports in other Fagaceae, highlighting a potential functional divergence of the C/D-class lineage within the family. ConclusionsThe results here depicted indicate that the dynamics of floral sex identity in oaks are more plastic than traditionally assumed, supporting a reinterpretation of oak reproductive biology based on a versatile and resilient framework responsive to different developmental contexts.

AO_SCPLOWBSTRACTC_SCPLOWCell fate decisions are driven by gene regulatory networks (GRNs). While the mutually inhibitory toggle switch effectively models binary fate decisions, fully connected inhibitory networks with more than two nodes fail to capture multi-fate decisions due to the low prevalence of "single high states", where only a single master regulator is highly expressed. The goal of this study is to find network structures that support all single high states. We find that the only network that attains the highest possible prevalence of all single high states within the set of monotone Boolean (MB) models is completely disconnected. Since biological networks typically require connectivity, we investigate network structures that support equipotency, where all single high states have equal prevalence within MB models. Finally, we characterize the networks that support multistability between all single high states, finding that it is possible only in networks in which each node either has self-activations or is inhibited by every other network node. Our findings provide a theoretical framework for understanding the network design principles that can support simultaneous differentiation into multiple distinct cell types.

Background: Actigraphy-derived rest-activity rhythm (RAR) features are widely used to characterize clinical states in bipolar disorder (BD). Both mean levels and temporal variability of these features have been associated with mood episodes; however, variability measures are often statistically coupled with the mean, particularly in skewed distributions. This raises a question as to whether variability reflects a separate characteristic of the data or whether the observed association arises from statistical properties of the data. Objective: In this study, we aim to determine whether temporal variability of actigraphy-derived RAR features provides standalone information on mood episodes in BD beyond mean activity levels after accounting for mean-variance dependence. Methods: We analyzed actigraphy data from a subset of 72 participants with BD drawn from a larger longitudinal study, extracting 22 daily RAR features aggregated weekly as sample mean (MEAN) and within-week temporal variability computed as sample standard deviation (VAR). Variance-stabilizing transformations (Box-Cox or Yeo-Johnson) were applied to the entire study cohort to reduce mean-variance dependence. Associations with mood episodes and remission (mania: n=34; depression: n=58 annotated participants) were evaluated using generalized linear mixed-effects models with a logistic link function, including univariate (MEAN or VAR) and multivariate (MEAN+VAR) specifications, assessed by likelihood-based metrics and the area under the receiver operating characteristic curve (AUC). Results: Transformations reduced mean-absolute correlations from 0.43 to below 0.06. Temporal variability remained significantly associated with clinical state for 11/22 RAR features in mania and 16/22 features in depression, with all significant associations remaining after false discovery rate correction (p<0.05). Joint models showed modest incremental gains (AUC 3%-4% overall; up to 12% in mania, 7% in depression), with absolute performance remaining limited (AUC 0.50-0.66). In both mania and depression, nearly all significant variability-based regressors contributed incremental information beyond mean-based models. Only sleep duration and activity changes around wake time (+-1 hour), did not improve discrimination between mania and remission. Conclusions: Temporal variability in RAR features can be considered a standalone state marker of mood episodes not captured by mean activity. We found it to be more consistently associated with depression than mania. Its incremental discriminative contribution is modest, suggesting greater utility within multivariate or multimodal frameworks.

Objective: Photobiomodulation therapy has emerged as a promising modality to facilitate scar healing and pain management in dermatology and plastic surgery. However, its role in postoperative care following spine surgeries remains understudied. This double-blinded, placebo-controlled study aimed to investigate the effects of photobiomodulation in patients with chronic lower back pain undergoing lumbar decompression, with postoperative wound healing as the primary outcome and pain reduction and functional recovery as secondary outcomes. Methods: Patients were randomized to receive either active photobiomodulation braces (N=13) or placebo braces (N=12). Follow-up assessments were performed at 2, 4, 6, 8, and 12 weeks postoperatively. Outcomes included wound healing (Stony Brook Scar Evaluation Scale), back and leg pain (Visual Analog Scale), quality of life (EuroQol 5D), and functional status (Oswestry Disability Index). Results: Compared to the placebo group, the photobiomodulation treatment group had a 4.12-fold cumulative improvement in final scar scores, with significant between-group differences at postoperative weeks 6, 8, and 12 (p = 0.0062, 0.010, 0.042). Among patients with severe preoperative disability, treatment resulted in a 1.89-fold faster improvement in back pain (p=0.025) and a 1.80-fold faster improvement in ODI scores (p=0.025); and superior treatment effect on wound healing were again observed at weeks 6, 8, and 12. Among patients with poor initial scars, treatment led to a significantly better scar outcome than placebo at week 6 and a 1.94-fold faster EQ5D improvement (p=0.052), with significant gains observed as early as two weeks after surgery. There were no adverse events associated with photobiomodulation treatment. Conclusions: Photobiomodulation significantly promoted postoperative wound healing following lumbar decompression surgery, with therapeutic benefits preserved even in patients with poor baseline scar scores and functional impairment. This indicates that the efficacy of photobiomodulation is not limited by the initial scar condition or disability, supporting its broad clinical applicability. Additionally, patients with severe preoperative disability experienced greater benefits from photobiomodulation than placebo, including faster reduction in back pain and more rapid improvement in functional capacity, highlighting its role in postoperative pain management and rehabilitation. These therapeutic effects are likely mediated by photobiomodulation-induced reduction of inflammation and enhancement of tissue repair. Together, this study suggests that photobiomodulation can be a promising adjunct therapy to facilitate postoperative recovery in patients undergoing spine surgery.

Background. UK clinical guidance recommends that structured risk prediction tools and risk stratification should not be used in self-harm, to predict suicide or determine who is offered treatment. Underpinning this position is the premise that routinely collected health data contain no useful predictive signal, which has received little direct scrutiny. Objective. To test whether routinely collected electronic health record data can distinguish groups at higher and lower risk of severe outcomes following paracetamol overdose. Methods. We analysed 4,095 adults presenting to NHS Lothian emergency departments with paracetamol overdose (2017-2023). Elastic-net logistic regression was fitted to 37 routinely collected electronic health record features to predict a composite of death or mental health inpatient admission at 0-7, 8-30 and 31-365 days following attendance, evaluated on a held-out 20% test set with bootstrapping. Findings. Events occurred in 5.5% of patients at 0-7 days, 2.0% at 8-30 days and 7.9% at 31-365 days, dominated by mental health admission. Bootstrap AUROC 95% confidence intervals lay above 0.5 in every window (0.65-0.82, 0.63-0.90, 0.71-0.85): models ranked patients better than chance. Calibration slopes (1.04, 1.14, 1.07) were close to one. Ranking drew primarily on mental health-related features. Conclusions. Routinely collected health data carried predictive signal for severe outcomes after paracetamol overdose, although discrimination fell short of what is needed for individual-level clinical use. Clinical implications. These models are not proposed for clinical deployment; however, treating risk prediction as a settled question will redirect research efforts, potentially excluding this patient population from machine learning advances driving improvements in care in other medical specialties.