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Attack resilient IoT security framework using multi head attention based representation learning with improved white shark optimization algorithm

Scientific Reports Jawhara Aljabri Apr 24, 2025 DOI: 10.1038/s41598-025-98180-z

‘Mind blowing’: quantum computer untangles the mathematics of knots

Nature Davide Castelvecchi Apr 24, 2025 DOI: 10.1038/d41586-025-01094-z

TIR1-produced cAMP as a second messenger in transcriptional auxin signalling

Nature Huihuang Chen, Linlin Qi, Minxia Zou et al. Apr 24, 2025 DOI: 10.1038/s41586-025-08669-w

Abstract The phytohormone auxin (Aux) is a principal endogenous developmental signal in plants. It mediates transcriptional reprogramming by a well-established canonical signalling mechanism. TIR1/AFB auxin receptors are F-box subunits of an ubiquitin ligase complex; after auxin perception, they associate with Aux/IAA transcriptional repressors and ubiquitinate them for degradation, thus enabling the activation of auxin response factor (ARF) transcription factors1–3. Here we revise this paradigm by showing that without TIR1 adenylate cyclase (AC) activity4, auxin-induced degradation of Aux/IAAs is not sufficient to mediate the transcriptional auxin response. Abolishing the TIR1 AC activity does not affect auxin-induced degradation of Aux/IAAs but renders TIR1 non-functional in mediating transcriptional reprogramming and auxin-regulated development, including shoot, root, root hair growth and lateral root formation. Transgenic plants show that local cAMP production in the vicinity of the Aux/IAA–ARF complex by unrelated AC enzymes bypasses the need for auxin perception and is sufficient to induce ARF-mediated transcription. These discoveries revise the canonical model of auxin signalling and establish TIR1/AFB-produced cAMP as a second messenger essential for transcriptional reprograming.

Inulin promotes appetite in mice by regulating the gut microbiota under conditions of rapid entry to the plateau

PLoS ONE Xiaoli Li, Shengcai Wu, Xiaonan Chen et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0322059

The objective of this study was to examine the mechanism of inulin by regulating the gut microbiota under conditions of rapid entry to the plateau stage. Fifty 7-week-old SPF-grade C57BL/6J male mice were used as experimental subjects and analysed. This study compared the structural and functional characteristics of food intake, body weight changes, serum appetite hormone levels, and intestinal flora of mice in different doses of inulin intervention and control groups in two distinct environments: plains and the rush-into plateau. The results demonstrated that inulin influenced the functional characteristics of the gut microbiota of mice in terms of energy production, conversion, carbohydrate transport, and metabolism. Furthermore, inulin enhanced the secretion of appetite hormones, resulting in appetite promotion under acute plateau conditions by increasing the relative abundance of beneficial bacteria. In addition, inulin significantly improved the body weight of mice under plateau conditions, particularly in the mid- and high-dose groups of inulin-treated mice.

Evolutionary fingerprints of epithelial-to-mesenchymal transition

Nature Luigi Perelli, Li Zhang, Sarah Mangiameli et al. Apr 24, 2025 DOI: 10.1038/s41586-025-08671-2

Midline catheter (10 cm) versus long peripheral intravenous catheter (6.4 cm): Randomized clinical trial protocol with economic analysis

PLoS ONE Tiago Oliveira Teixeira, Leandro Augusto Hansel, Rodrigo do Nascimento Ceratti et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0319587

Introduction Midline catheters have stood out in the last decade in Europe and North America as peripheral venous access devices with fewer complications and greater durability. However, its cost may be an obstacle to the adoption of this technology in public institutions in Brazil, which use long peripheral intravenous catheters for the same purpose. Materials and Methods This is a randomized clinical trial protocol, registered on the ClinicalTrials.gov NCT05884294 platform, which will be conducted with two parallel, controlled, single-center, blinded groups for outcome analysis, where the groups are allocated in a 1:1 ratio, with patients over 18 years of age, admitted to clinical units of a public university hospital in Brazil who have difficult venous access defined by the Adult Difficult Intra Venous Access Scale (A-DIVA). The study intervention will be the insertion of a PowerGlide ProTM Midline 20G catheter (10 cm). The control group will receive an Introcan Safety Deep Access long peripheral intravenous catheter 20G (6.4 cm). The primary outcome will be the length of stay of vascular access free of complications (infiltration, phlebitis, occlusion, accidental withdrawal, catheter-associated bloodstream infection, and deep vein thrombosis). The economic analysis will follow micro-costing. Objective To compare the use of the midline catheter (10 cm) in terms of the length of stay free of complications with the use of a long peripheral intravenous catheter (6.4 cm) during continuous or intermittent intravenous therapy for more than five days in adult clinical patients, with difficult venous access, hospitalized in a public institution in Brazil. It also aims to carry out an economic analysis based on micro-costing. Conclusion The international literature, especially in North America and Europe, has shown that the use of midline catheters and long peripheral intravenous catheters have similarities regarding greater safety and lower risk of complications. The superiority related to the midline catheter in terms of the time of uncomplicated use in patients in need of peripherally appropriate solutions, but with high cost, is highlighted. The use of these devices remains incipient in Latin America, especially in Brazilian public institutions, requiring studies to evaluate evidence on the use and costs of these technologies in this specific population. Trial Registration: ClinicalTrials.gov. NCT05884294

Transforming ceria into 2D clusters enhances catalytic activity

Nature Konstantin Khivantsev, Hien Pham, Mark H. Engelhard et al. Apr 24, 2025 DOI: 10.1038/s41586-025-08684-x

Time perception of attractive male faces and voices: The role of women’s menstrual cycle

PLoS ONE Nuno Fernandes, Sandra Soares, Mavilde Arantes et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321956

Accurate time measurement is essential for organisms to synchronize their internal biological cycles with the external environment, crucial for reproductive success and survival. This study examines fluctuations in time perception across different phases of the menstrual cycle in response to visual and vocal attractiveness, building on previous research showing that women estimate longer viewing times for attractive male photos compared to unattractive ones. Forty-eight females participated in the experiment during both the menstruation and ovulation phases of their menstrual cycles, completing visual and auditory oddball tasks. Participants viewed a series of five stimuli and reproduced the duration of the last stimulus by pressing a mouse button. The final stimulus could be identical to the previous four (control trials), an attractive or unattractive male photo (visual attractiveness block), a masculinized or feminized male face (visual sexually dimorphic block), or a masculinized or feminized male voice (auditory sexually dimorphic block). Results indicated that duration estimates for masculinized male voices were significantly longer compared to feminized voices, while no differences were found for the menstruation phase. However, no differences were observed between the phases of the menstrual cycle in the visual conditions. Nevertheless, we replicate the temporal dilation effect associated with viewing attractive stimuli, suggesting an acceleration of the internal clock related to attractiveness perception. Our findings align with the literature on this phenomenon and provide initial evidence for an adaptive time perception mechanism influenced by the menstrual cycle, contributing to the understanding of the complex interactions between biological cycles and perceptual processes.

Interventions for combating COVID-19 misinformation: A systematic realist review

PLoS ONE Robert Dickinson, Dominique Makowski, Harm van Marwijk et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321818

Misinformation is a growing concern worldwide, particularly in public health following the COVID-19 pandemic in which misinformation has been attributed to tens of thousands of unnecessary deaths. Therefore a search for effective interventions against misinformation is underway, with widely varying proposed interventions, measures of efficacy, and groups targeted for intervention. This realist systematic review of proposed interventions against COVID-19 misinformation assesses the studies themselves, the characteristics and effectiveness of the interventions proposed, the durability of effect, and the circumstances and contexts within which these interventions function. We searched several databases for studies testing interventions published from 2020 onwards. The search results were sorted by eligibility, with eligible studies then being coded by themes and assessed for quality. Thirty-five studies were included, representing eight types of intervention. The results are promising to the advantages of game-type interventions, with other types scoring poorly on either scalability or impact. Backfire effects and effects on subgroups were reported on intermittently in the included studies, showing the advantages of certain interventions for subgroups or contexts. No one intervention appears sufficient by itself, therefore this study recommends the creation of packages of interventions by policymakers, who can tailor the package for contexts and targeted groups. There was high heterogeneity in outcome measures and methods, making comparisons between studies difficult; this should be a focus in future studies. Additionally, the theoretical and intervention literatures need connecting for greater understanding of the mechanisms at work in the interventions. Lastly, there is a need for work more explicitly addressing political polarisation and its role in the belief and spread of misinformation. This study contributes toward the expansion of realist review approaches, understandings of COVID-19 misinformation interventions, and broader debates around the nature of politicisation in contemporary misinformation.

Research on mechanical automatic food packaging defect detection model based on improved YOLOv5 algorithm

PLoS ONE Guanyong Liu, Shuai Zhang, Lixin Wang et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321971

With the rapid development of industrial automation, traditional manual detection methods are inefficient and error-prone, which cannot meet the needs of modern production for high efficiency and high precision. Therefore, it is particularly important to develop a mechanical automatic inspection system that can automatically identify food packaging defects. In this study, aiming at the limitations of existing technologies in identifying small targets and subtle defects, an enhanced YOLOv5-based model for detecting food packaging flaws is introduced. Firstly, we integrated a Convolutional Attention module (CBAM) to enhance the model’s attention on crucial image features. This mechanism prioritizes significant features by weighting the feature map in channel and spatial dimensions, which improves accuracy in detecting minor defects and small objects. Secondly, feature fusion across scales is achieved with pyramid and aggregation networks, so that the model can capture defects of different sizes at the same time, which enhances the recognition ability of diverse defects in food packaging. In addition, this study also optimizes the backbone network structure of YOLOv5. By integrating the streamlined YOLOv5s model and adding an Adaptive Spatial Feature Fusion module (ASFF), the model’s ability to blend features from different scales was enhanced. In this study, 7400 images with 512×512 resolutions were applied to develop the proposed model. The experimental results show that the improved model outperforms the original YOLOv5 model in terms of Accuracy (Ac), Recall (Re), and F1 score, with values of 0.96, 0.94, and 0.94, respectively, effectively improving the automation and accuracy of food packaging defect detection when compared with YOLOv5+ASFF (Ac=0.94, Re=0.95, and F1=0.94), original YOLOv5 (Ac=0.82, Re=0.85, and F1=0.88), and YOLOv5+CBAM (Ac=0.88, Re=0.9, and F1=0.89). Additionally, the present performance of an improved YOLOv5 model (CBAM+Fusion Pyramid Network (FPN)+Path Aggregation network (PANet)+ASFF) was significantly comparable to the related research works.

Communication and relationship satisfaction of Fly-in, Fly-out workers and partners

PLoS ONE Ashlee Forshaw, Kristie-Lee Alfrey, Corneel Vandelanotte et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0322337

Fly-in fly-out (FIFO) work involves commuting long distances and living in provided accommodation for 1–4 weeks while on shift. Little is known about couple communication and relationship satisfaction of this population. Separate cohorts of FIFO workers and partners of FIFO workers completed daily surveys to self-report time spent communicating with their partner (in person, over the computer, and by phone) and relationship satisfaction for up to 7 days during on-shift and 7 days during off-shift periods (806 observations from N = 106 with 19 couples). For FIFO workers, but not partners of FIFO workers, relationship satisfaction was lower during on-shift days than off-shift days. This difference was completely mediated by time spent communicating with romantic partner, such that after accounting for the impact of lower time spent communicating on relationship satisfaction, there remained no significant difference in relationship satisfaction on-shift vs off-shift. Communication between FIFO workers and their romantic partners is essential to ensure the relationship does not suffer while the worker is away from home. FIFO organisations need to investigate ways to ensure quality communication between romantic partners can be maintained while the worker is on-site and partner spend long periods of time away from one another.

The importance of human interaction for curriculum and school life satisfaction among Japanese medical graduates: A web-based survey study

PLoS ONE Nobuyasu Komasawa, Masanao Yokohira Apr 24, 2025 DOI: 10.1371/journal.pone.0319683

Background This study aimed to assess the curriculum and school life of Japanese medical students on the verge of graduation. Methods A web-based questionnaire survey was conducted to gauge the goals of graduating medical students across various themes: Subjective academic achievement in each curriculum, Length of each curriculum, Timing for summative examination preparation, and Satisfaction with total medical school life, accomplishments, extracurricular activities, and friendships. Results With a 67.8% response rate (80/118), the study found that subjective accomplishment in Clinical Clerkship (CC) was significantly lower than in other curriculums (P<0.05 each). Social medicine had significantly lower subjective accomplishment compared to basic medicine (P=0.040). Graduating students reported that the basic medicine curriculum was significantly longer than clinical medicine, CC, and general education (P < 0.05 each). Preparation timing for Pre-CC and Post-CC OSCE was significantly later compared to other summative tests (P < 0.05 each). Total satisfaction with medical school life correlated significantly with school friendships (P < 0.001), while subjective accomplishment and extracurricular activity did not. Conclusion Graduating medical students express lower subjective accomplishment in CC compared to other curriculums, suggesting a need for CC content improvement. Additionally, the study highlights the significant role of school friendships in influencing total medical school life satisfaction.

Patient-centered perspectives: A qualitative evaluation of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER)

PLoS ONE Aditya Dhariwal, Somayyeh Mohammadi, Ethan Simpson et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0322114

Over 55,000 total hip replacement (THR) surgeries were performed in Canada in 2021, with the number rising each year. Excluding rehabilitation, the cost of hip replacement procedures exceeded $675 million, a large burden on the Canadian healthcare system. Considering this large financial impact, prehabilitation delivered through electronic health (eHealth) can improve post-surgical outcomes and reduce overall healthcare expenditures by enhancing recovery and reducing hospital length of stay. This study utilized grounded theory to examine user experience of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Participants were purposively sampled and conventional content analysis was conducted on 18 transcribed semi-structured interviews with participants who completed the HIPPER program in preparation for THR surgery. We identified three categories and seven subcategories: 1) ‘That wasn’t so hard!’, with the subcategories easy to use, learning information and appreciating HIPPER, which describe how participants were able to learn information and use the modules easily; 2) ‘I’m ready’, comprising of the subcategories being prepared for surgery and having a smooth and good experience which relates to how participants were prepared and confident going into surgery; 3) ‘I’d like to have seen’, including the subcategories having differing experiences and suggesting additions, which explore participants’ constructive criticism and ideas for improvement. Our results show useful features to include in eHealth programs and demonstrate how educational prehabilitation in the form of eHealth is helpful and usable for older adults undergoing THR. We also discuss and inform the integration of feedback and development of eHealth programs for elective surgical procedures. This study was registered with ClinicalTrials.gov on November 21, 2016 with the registration number NCT02969512.

DYNAMO-A: A generic simulation model coupling crop growth and disease epidemic

PLoS ONE Laetitia Willocquet, Simone Bregaglio, Roberto Ferrise et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321261

Very few dynamic simulation models truly involve explicit, quantitative, two-way couplings of epidemiological and agrophysiological processes. Our aim is to develop a generic, transparent and simple, coupled disease-crop model, DYNAMO-A, where a polycyclic epidemic develops within the canopy of an annual crop. DYNAMO-A builds upon existing models, RICEPEST and WHEATPEST, respectively designed as crop loss simulation platforms for rice and wheat, and the generic model GENEPEST, which was designed for further crop-specific development and educational purposes. Two intertwined components constitute DYNAMO-A: (1) an agrophysiological component simulates crop growth, which alters the carrying capacity of epidemics; and (2) an epidemiological component simulates epidemics, which affect crop growth through damage mechanisms. Analyses using DYNAMO-A consider different simulation scenarios according to the pathogen lifestyle (trophism) and production situations. First, scenarios consider a biotrophic ideotype which is a light stealer and assimilate diverter, and a necrotrophic ideotype which is a light stealer and an accelerator of leaf senescence. Second, scenarios consider two production situations (favourable or less favourable), i.e., two contexts leading to differing attainable (un-injured) crop yields (good or average). Epidemics caused by a biotrophic pathogen reduce the green leaf area and diverts plant assimilates to the pathogen tissues, resulting in a decrease in yield. In epidemics caused by a necrotrophic pathogen, both diseased and green leaf areas are reduced because of disease-induced senescence, resulting also in yield loss. Overall, at a given level of disease epidemic, absolute yield losses are higher with a biotrophic pathogen in a more favourable production situation, whereas yield losses to a necrotrophic pathogen tend to be similar irrespective of production situations. Our results concur with previous studies, both field-experiment and model-based, on several crop-disease systems. Future modelling with DYNAMO-based models should enable interdisciplinary research addressing plant disease impacts on current and future agricultural production.

Ultra-broadband optical amplification using nonlinear integrated waveguides

Nature Ping Zhao, Vijay Shekhawat, Marcello Girardi et al. Apr 24, 2025 DOI: 10.1038/s41586-025-08824-3

Abstract Four-wave mixing is a nonlinear optical phenomenon that can be used for wideband low-noise optical amplification and wavelength conversion. It has been extensively investigated for applications in communications 1 , computing 2 , metrology 3 , imaging 4 and quantum optics 5 . With its advantages of small footprint, large nonlinearity and dispersion-engineering capability, optical integrated waveguides are excellent candidates for realizing high-gain and large-bandwidth four-wave mixing for which anomalous dispersion is a key condition. Various waveguides based on, for example, silicon, aluminium gallium arsenide and nonlinear glass have been studied 6–10 , but suffer from considerable gain and bandwidth reductions, as conventional design approaches for anomalous dispersion result in multi-mode operation. We present a methodology for fabricating nonlinear waveguides with simultaneous single-mode operation and anomalous dispersion for ultra-broadband operation and high-efficiency four-wave mixing. Although we implemented this in silicon nitride waveguides, the design approach can be used with other platforms as well. By using higher-order dispersion, we achieved unprecedented amplification bandwidths of more than 300 nm in these ultra-low-loss integrated waveguides. Penalty-free all-optical wavelength conversion of 100 Gbit s −1 data in a single optical channel of over 200 nm was realized. These single-mode dispersion-engineered nonlinear waveguides could become practical building blocks in various nonlinear photonics applications.

Amyloid β induces hormetic-like effects through major stress pathways in a C. elegans model of Alzheimer’s Disease

PLoS ONE James D. Lichty, Hrishikesh Mane, Victoria R. Yarmey et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0315810

Amyloid β (Aβ) is a peptide known for its characteristic aggregates in Alzheimer’s Disease and its ability to induce a wide range of detrimental effects in various model systems. However, Aβ has also been shown to induce some beneficial effects, such as antimicrobial properties against pathogens. In this work, we explore the influence of Aβ in stress resistance in a C. elegans model of Alzheimer’s Disease. We found that C. elegans that express human Aβ exhibit increased resistance to heat and anoxia, but not to oxidative stress. This beneficial effect of Aβ was driven from Aβ in neurons, where the level of induction of Aβ expression correlated with stress resistance levels. Transcriptomic analysis revealed that this selective stress resistance was mediated by the Heat Shock Protein (HSPs) family of genes. Furthermore, neuropeptide signaling was necessary for Aβ to induce stress resistance, suggesting neuroendocrine signaling plays a major role in activating organismal stress response pathways. These results highlight the potential beneficial role of Aβ in cellular function, as well as its complex effects on cellular and organismal physiology that must be considered when using C. elegans as a model for Alzheimer’s Disease.

Nutritional and microbiological dynamics in the preparation of prahoc fish paste

PLoS ONE Channmuny Thanh, Sylvie Avallone, Vincent Chochois et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321834

Prahoc is a traditional fermented fish widely consumed in Cambodia. Nevertheless, the processing and nutritional values of this daily-consumed product were poorly described. This study offers a detailed analysis of the biochemistry, nutritional composition, and microbiota during the six-month Prahoc incubation. Macronutrients (e.g. lipids, proteins) are rather well preserved during the preparation of the fish paste but the fatty acid and amino acid profiles are slightly modified at the end of the unit operation. Free amino acids increased, which facilitates the in vitro digestibility of the final paste, while beneficial fatty acids, such as eicosapentaenoic and docosahexaenoic acids, decreased. At the end of the process, the peroxide value was nearly five times greater than the limit set by the Codex Alimentarius (10 meq O2/kg). Biogenic amines, particularly cadaverine, were present but remained within acceptable limits. Metabarcoding analysis revealed that salt-tolerant bacteria dominated the fermentation process, while fungal activity was minimal. Lactic acid bacteria, such as Vagococcus and Streptococcus, were predominant before salt addition, while the fish pathogen Aeromonas established itself immediately after. Clostridium remained steady throughout, and Lentibacillus became dominant after six months. Food safety concerns related to biogenic amines, peroxides, and Clostridium highlight the need for establishing standard operational practices among national processors to mitigate food risks.

A systematic narrative review of the research evidence of the impact of intersectionality on service engagement and help-seeking across different groups of women, trans women, and non-binary individuals experiencing homelessness and housing exclusion

PLoS ONE Carolin Hess, Zahra Abdulla, Lydia Finzel et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0321300

Background Women with experience of homelessness face severe health inequalities, with their average age at death being nearly half that of the general population. Recent research emphasises the compound challenges women with homeless experiences face in seeking help,accessing and engaging with support services, but we know little about the influence of different intersectional dimensions on their support access and experiences. The paper aims to review the evidence and critically engage with the impact of gender/sex, race, ethnicity, age, disability, class/poverty, migration status, religion, pregnancy/maternity and sexual orientation on women’s homelessness trajectories and engagement with services. Methods We conducted a systematic narrative review of studies in 2023 investigating the impact of intersectional dimensions on women, trans women, and non-binary individuals with experiences of homelessness’ engagement with services and help-seeking. Primary qualitative, quantitative or mixed method research, written in English and published after 2010, was included. Narrative methods were utilised in the synthesis and analysis of the research. Results The search identified 4109 articles after deduplication from which 52 were included for review. The findings highlighted intersectional experiences in help-seeking and engagement across housing, healthcare, the police, social services, and voluntary organisations. The women, trans women and non-binary individuals included in the studies reported a range of barriers, stigma, and discrimination, often rooted in systematic and intersectional disadvantage which delayed or prevented help-seeking and recovery. Conclusion The review investigates the multiple challenges faced by women, trans women and non-binary individuals with experiences of homelessness, highlighting systemic and intersectional disadvantages which impinge on their agency. Changes in policy and practice are recommended to develop more effective person-centred, culturally and gender-sensitive approaches that can transform intersectional dimensions into strengths, empowering women and improving their recovery and engagement with services.

A wetter ancient Arabia could have enabled easier intercontinental species dispersal

Nature Faysal Bibi Apr 24, 2025 DOI: 10.1038/d41586-025-00905-7

The mHealth clinical decision-making tools for maternal and perinatal health care in Sub-Saharan Africa: A systematic review

PLoS ONE Gaudensia A. Olomi, Rachel Manongi, Charles E. Makasi et al. Apr 24, 2025 DOI: 10.1371/journal.pone.0319510

Introduction mobile Health (mHealth) refers to use of mobile wireless technologies for health. The potential for mHealth to enhance healthcare delivery is supported by near-universal availability of mobile phones and their expanding coverage in low- and middle-income countries. This systematic review analyses the available evidence on mHealth clinical decision-making tools in maternal and perinatal health, and whether they lead to improved maternal and perinatal health outcomes in Sub-Saharan Africa (SSA). Methods Eligibility criteria: Studies conducted in SSA describing mHealth tools piloted or used for clinical decision-making in maternal or perinatal healthcare. Exclusion criteria included mHealth tools used outside of maternal and perinatal healthcare, publications lacking sufficient detail (where information couldn’t be obtained through contacting authors), articles where tools were used on a laptop or desktop computer, and articles not published in English. Data sources: PubMed, CINAHL, EMBASE, Global Health, and Web of Science were searched for relevant articles following a predetermined search strategy with no date restrictions. A limited grey literature search was conducted. Risk of bias: We assessed the quality of included studies using the Cochrane Risk of bias 2 tool, Newcastle- Ottawa scale and COREQ. This comprehensive approach ensured a rigorous evaluation of bias and validity in our systematic review. Data extraction and synthesis: Two independent reviewers screened articles and extracted data. Results 1119 records were screened, and 36 articles met the inclusion criteria. Fifteen mHealth tools were identified across 11 SSA countries. Conclusion mHealth tools for clinical decision-making in maternal and perinatal care were found to be feasible, usable, and acceptable. They demonstrated adequate user satisfaction, and some demonstrated improvement of pregnancy outcomes. However, technologies lack scalability, with only one scaled up nationally, and few tools interacted with existing health information systems or had plans for sustainability. This review will help establish best practice for developing and scaling up mHealth clinical decision-making tools, helping to improve maternal and perinatal healthcare in SSA.