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Implementation of point-of-care ultrasound in the medical intensive care unit: A retrospective analysis of physician practices and patient outcomes
Background Point of care ultrasound (POCUS) use has become ubiquitous in the ICU setting. Despite this, there remains a paucity of data regarding how its use impacts patient outcomes. We sought to determine if physician attitudes toward and use of POCUS impact patient outcomes. Objectives To evaluate the impact of physician use of POCUS in the medical intensive care unit (MICU) on patient care outcomes. Methods A longitudinal, single-center retrospective study of adult patients in a tertiary care center MICU was conducted between 2016 and 2017. A total of 512 patient encounters were analyzed for: number of ventilator days, number of vasopressor days, and MICU length of stay. The outcomes were then compared between attending physicians who showed high, medium, and low self-reported POCUS implementation and confidence scores by questionnaire. Results Patients of physicians in the low POCUS confidence group had a statistically significant increase in MICU length of stay (IRR = 1.19, 95% CI: 1.06–1.32, p = 0.0022) and ventilator days (IRR = 1.18, 95% CI: 1.03–1.36, p = 0.0197) compared to the medium confidence group. Conclusions Our investigation found a statistically significant relationship between self-reported confidence in POCUS by MICU physicians and MICU length of stay as well as total days spent on mechanical ventilation. Increased self-reported use of POCUS by physicians did not impact patient outcomes in this population. There was similarly no evidence of increased harm or adverse outcomes in high-POCUS implementation groups.
Recapitulating dengue virus infection with human pluripotent stem cell-derived liver organoids for antiviral screening
Visualization of multidrug-resistant bacterial infection trends in the intensive care units
Background The Korean National Healthcare–associated Infections Surveillance System (KONIS) monitors multidrug–resistant (MDR) bacterial infections in intensive care units (ICUs). However, simultaneously monitoring hundreds of ICUs remains challenging. Our study aimed to visualize the trends of MDR gram–negative bacterial infections in ICUs monitored by KONIS. Methods We evaluated KONIS data from 137 ICUs (2006–2011) and from 368 ICUs (2017–2022). Pneumonia, urinary tract infection, and bloodstream infection caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii were analyzed. Transformation was employed to convert the infection rate graphs of each ICU into arrows. The length and angle of the arrows reflect changes in carbapenem susceptibility and infection rate, respectively. ICUs are categorized into red (rapid shift from susceptible to resistant bacteria and increased infection rate), yellow (slow shift from susceptible to resistant bacteria and decreased infections rate), and green (shift from resistant to susceptible bacteria) groups. The proportional changes in each ICU category were compared during the first and last five years of the study periods. Results For K. pneumoniae, the proportion of red category ICUs increased (0% to 17%, p-value 0.586), while the proportions of yellow (33.3% to 7%, p-value 0.288) and green category ICUs (66.6% to 36%, p-value 0.290) decreased. For P. aeruginosa, the proportions of red (12% to 27%, p-value 0.016) and green category ICUs (38% to 46%, p-value 0.358) increased, while the proportion of yellow category ICUs decreased (8% to 2%, p-value 0.043). For A. baumannii, the proportions of red (19% to 14%, p-value 0.649) and yellow category ICUs (5% to 1%, p-value 0.187) decreased, while the proportion of green category ICUs increased (19% to 72%, p-value <0.001). Conclusions Graph transformation allowed the observation of MDR Gram-negative bacterial infection trends in ICUs. Further studies should aim to confirm whether our arrow indicators are useful for infection control and in identifying factors for reducing infections.
Atomic-scale 3D structural dynamics and functional degradation of Pt alloy nanocatalysts during the oxygen reduction reaction
The critical effects of self-management strategies on predicting cancer survivors’ future quality of life and health status using machine learning techniques
Despite the significance of enhancing the quality of life (QoL) and overall health status (including physical, mental, social, and spiritual well-being) among individuals who have survived cancer, the existing prediction model for QoL and health status lacks sufficient interpretation. Our primary objectives were to develop and validate simple prediction models for QoL and secondary health statuses. Additionally, we aimed to interpret these prediction models using explainable artificial intelligence (XAI) methods, including extracting important features and creating dependence plots. Lastly, we sought to predict and interpret individual outcomes, visualizing the results using the XAI technique known as SHapley Additive explanation (SHAP). In this prospective cohort study, conducted through a web-based survey, we established prediction models for QoL and health statuses, comparing their performance with ensemble methods, including decision trees, random forest, gradient boosting, eXtreme Gradient Boost (XGBoost), and LightGBM. Following the model comparison, we selected the XGBoost model for further analysis. We identified crucial features associated with QoL and each health status separately and leveraged SHAP to extract individual prediction results from the XGBoost model. After preprocessing the data and selecting the appropriate model, our final dataset consisted of 256 cancer survivors with 42 predictive features. Repeated stratified K-fold validation demonstrated high performance of the XGBoost predictive model for QoL. Similarly, the XGBoost predictive model exhibited good performance for each health status, including mental, social, and spiritual well-being. The important features identified in these predictive models varied based on the specific health outcomes. This study represents the first endeavor to develop and validate predictive models for QoL and health status among cancer survivors while also providing interpretations of these models.
Charge-domain content addressable memory based on ferroelectric capacitive memory for reliable and energy-efficient one-shot learning
Caliban is a transcriptional target of p53 in response to DNA damage
Caliban, the Drosophila ortholog of human Nuclear export mediator factor (NEMF), is a recently identified regulator of the intrinsic apoptotic signaling pathway in response to DNA damage; however, the mechanism governing its expression after DNA damage remains unclear. In this study, we demonstrated that DNA damage upregulated caliban expression concomitant with p53 activation. Over-expression of p53 upregulated the mRNA and protein levels of caliban. We characterized the core region of the caliban promoter, which exhibited enhanced activity following DNA damage or p53 activation. Further analysis of the caliban promoter revealed a p53-binding site that directly interacts with p53 in response to DNA damage. Moreover, mutation of this p53-binding site or knock-down of p53 expression abolished the DNA damage-induced increase in caliban promoter activity, confirming p53’s critical role in regulating caliban expression. Taken together, our findings indicate that caliban is a direct transcriptional target of p53 in response to DNA damage.
Inequality in human exposure to future climate extremes
Identifying research priorities for pregnant South Asian immigrants in Canada: A James Lind Alliance approach
Background Pregnant South Asian immigrants (PSAI) make up a significant portion of immigrants to Canada and face a higher risk of adverse pregnancy outcomes compared to other ethnic groups. This disparity is largely due to cultural and linguistic barriers to maternity care, including language difficulties, limited cultural sensitivity in healthcare services, and a lack of awareness about culturally tailored educational resources. Despite the growing number of PSAI in Canada, there is limited understanding of how to best support their healthcare and well-being. To address this gap, we aim to conduct a priority-setting exercise to identify key research priorities and establish a patient-oriented research agenda that will drive long-term, impactful research and ultimately improve maternal health outcomes for PSAI in Canada. Methods This project follows the James Lind Alliance (JLA) priority-setting partnership (PSP) methodology, which includes forming a steering committee, identifying and verifying uncertainties, conducting an interim priority-setting phase, and holding a final workshop. Participants will include first-generation South Asian immigrant women from Bangladesh, India, Pakistan, and Sri Lanka, as well as clinicians, researchers, and community/professional organizations from Ontario, Alberta, and British Columbia. Data will be collected through Zoom-based recorded working group sessions and an online ranking survey. Qualitative data will be analyzed using an inductive content analysis approach supported by NVivo software. Subgroup diversity (e.g., ethnicity, gender, age, and geography) will be tracked across participant groups. Consensus on top research priorities will be achieved through a structured ranking process followed by a facilitated virtual workshop. The study began in May 2025 and is expected to conclude by January 2026, a timeline consistent with similar JLA PSP initiatives. Dissemination All findings will be shared through a peer-reviewed publication and conference presentations for the scientific community, a lay summary for community organizations, and a video and infographic for patient participants. Community and professional organizations will also support the dissemination of findings through their networks and social media channels.
100-kyr climate cycles caused by 2.4-Myr eccentricity-modulated carbon cycles
Incidence, risk factors and outcomes of preterm live births in a tertiary health facility in Ghana
Objectives Accurate measures of the burden of preterm live births are a challenge, particularly in low-and-middle income countries, due to factors including poor data quality and unreliable methods using last menstrual period (LMP) in determining gestational age of pregnancies. This study employed gestational age from first trimester ultrasound to determine incidence of preterm livebirths at Ho Teaching Hospital in Ghana, their risk factors and adverse outcomes. Methods This was a prospective study involving 666 pregnant women and their 680 live newborns from 1st October, 2019–31st March, 2020. Data was collected on socio-demographic characteristics such as age and for other variables including gestational age at delivery and birthweight. The primary outcome was overall preterm livebirth incidence. Logistic regression analysis was used to determine its predictors. Odds ratios were reported with 95% confidence intervals. Statistical significance was pegged at p-value <0.05. Results The mean age of the women was 29.0 years. About 93% (616/666) had formal education. Overall preterm livebirth incidence was 9.1% (62/680). Formal employment [AOR 6.84 (95% CI 1.63–28.73), p = 0.009], informal employment [AOR 4.98 (95% CI 1.39–17.85), p = 0.014] and hypertensive disorders in pregnancy (HDP) [AOR 6.43(95% CI 2.78–14.89); p < 0.001] increased the odds of preterm livebirth. Adequate antenatal clinic contacts (ANC) [AOR 0.14 (95% CI 0.05–0.37), p < 0.001] and doses of sulphadoxine-pyrimethamine for malaria prevention in pregnancy (IPTp) [AOR 0.21(0.10–0.45), p < 0.001] reduced the odds of preterm livebirth by 86% and 79% respectively. Conclusion Overall preterm livebirth incidence in the study compared favourably with global estimates. HDP and being employed were important risk factors and. suggest reducing workloads of pregnant women in formal employment may be beneficial. Targeted posting of specialists to aid adequate management of HDP at district hospitals and mitigating missed opportunities for IPTp need to be considered.
Charged peptides enriched in aromatic residues decelerate condensate ageing driven by cross-β-sheet formation
Abstract Biomolecular condensates play wide-ranging roles in cellular compartmentalization and biological processes. However, their transition from a functional liquid-like phase into a solid-like state—usually termed as condensate ageing—represents a hallmark associated with the onset of multiple neurodegenerative diseases. In this study, we design a computational pipeline to explore potential candidates, in the form of small peptides, to regulate ageing kinetics in biomolecular condensates. By combining equilibrium and non-equilibrium simulations of a sequence-dependent residue-resolution force field, we investigate the impact of peptide insertion—with different composition, patterning, and net charge—in the condensate phase diagram and ageing kinetics of archetypal proteins driving condensate ageing: TDP-43 and FUS. We reveal that small peptides composed of a specific balance of aromatic and charged residues can substantially decelerate ageing over an order of magnitude. The mechanism is controlled through condensate density reduction induced by peptide self-repulsive electrostatic interactions that specifically target protein regions prone to form cross- β -sheet fibrils. Our work proposes an efficient computational framework to rapidly scan the impact of small molecule insertion in condensate ageing and develop novel pathways for controlling phase transitions relevant to disease prevention.
An algorithm for nonlinear problems with variational inequality methods
The purpose of this paper is to introduce a mapping in the framework of a 2-uniformly smooth and uniformly convex Banach space and obtain a common solution for the fixed point set of finite families of βi-enriched non-expansive mappings and (Ψ,βi)-enriched strictly pseudocontractive mappings. Two solution sets of variational inequality problems are also given. Moreover, we prove several strong convergence theorems for the fixed point set of the finite family of (Ψ,βi)-enriched strictly pseudocontractive mappings and the solution set of variational inequality problems. By using the famous Mann-Halpern type iterative method we obtain some strong convergence theorems. Our results from this paper improve and generalize many well-known results in the existing literature.
Direct liquefying organic cages into porous liquid molecules for enhanced near-infrared photothermal conversion and catalysis
Exploring the risks of over-reliance on AI in diagnostic pathology. What lessons can be learned to support the training of young pathologists?
The integration of Artificial Intelligence (AI) algorithms into pathology practice presents both opportunities and challenges. Although it can improve accuracy and inter-rater reliability, it is not infallible and can produce erroneous diagnoses, hence the need for pathologists to always check predictions. This critical judgment is particularly important when algorithm errors could lead to high-impact negative clinical outcomes, such as missing an invasive carcinoma. However, the influence of AI tools on pathologists’ decision-making is not well explored. This study aims to evaluate the impact of a previously developed AI tool on the diagnostic accuracy and inter-rater reliability among pathologists, while assessing whether pathologists maintain independent judgment of AI predictions. Eight pathologists from different hospitals and with varying levels of experience, participated in the study. Each of them reviewed 115 slides of laryngeal biopsies, including benign epithelium, low-grade and high-grade dysplasia, and invasive squamous carcinomas. The study compared diagnostic outcomes with and without AI assistance. The reference labels were established by an expert’s double-blind review. Results show that assisted pathologists had a higher accuracy for high-grade dysplasia, invasive carcinoma and improved inter-rater reliability. However, cases of over-reliance on AI have been observed, resulting in the omission of correctly diagnosed invasive carcinomas during the unassisted examination. The false predictions on these carcinoma slides were labeled with a low confidence score, which was not considered by the less experienced pathologists, showing the risk that they would follow the AI prediction without enough critical judgment or expertise. Our study emphasizes the potential over-reliance of pathologists on AI models and the potential harmful consequences, even with the advancement of powerful algorithms. The integration of confidence scores and the education of pathologists to use this tool could help to optimize the safe integration of AI into pathology practice.
High-flux and anti-fouling membrane distillation membrane with VOC capture ability enabled by ZIF-8
Evaluation of continuous arrhythmia monitoring using an implantable loop recorder in heart failure patients with a reduced ejection fraction: The LINQ2-HF trial rationale and protocol
Introduction Heart failure with a reduced ejection fraction (HFrEF) is a common and serious condition often associated with atrial fibrillation (AF) and ventricular arrhythmias, leading to poor outcomes such as rehospitalizations and death. Detecting asymptomatic arrhythmias remains challenging, as traditional monitoring methods like 12-lead electrocardiograms (ECGs) or Holter ECGs are insufficient for continuous surveillance. This study aims to evaluate the utility of continuous arrhythmia monitoring using an implantable loop recorder (ILR) to detect asymptomatic arrhythmias in HFrEF patients, particularly for AF and ventricular tachycardia (VT). Methods and analysis This is a single-center, non-randomized exploratory study. Thirty-five patients with HFrEF (LVEF ≤ 40%) and no history of AF will receive ILR implants. Primary endpoints include the detection of new-onset AF lasting at least 6 minutes and sustained or non-sustained VT. Secondary endpoints include the identification of bradycardia, pauses, and other arrhythmias, along with cardiovascular outcomes such as death and hospitalization. Additionally, secondary endpoints will include arrhythmia treatments, including anticoagulation therapy, catheter ablation, and implant of therapy devices. Data will be collected via remote monitoring through the Medtronic CareLink system, with event rates estimated using Kaplan-Meier methods. Data collection will span three years, with analyses conducted in the first and third years. Conclusion The LINQ2-HF trial is designed to detect new-onset AF and VT in HFrEF patients using ILR, with the aim of informing future strategies for arrhythmia management in this population. Name of the registry Japan Registry of Clinical Trials (jRCT). Trial registry number jRCTs032240593 Registration data https://jrct.niph.go.jp/en-latest-detail/jRCTs032240593
A comparative analysis of heterogeneity in lung cancer screening effectiveness in two randomised controlled trials
Abstract Clinical trials demonstrate that screening can reduce lung cancer mortality by over 20%. However, lung cancer screening effectiveness (reduction in lung cancer specific mortality) may vary by personal risk-factors. Here we evaluate heterogeneity in lung cancer screening effectiveness through traditional sub-group analyses, predictive modelling approaches and machine-learning in individual-level data from the Dutch-Belgian lung cancer screening trial (NELSON; 14,808 participants, 12,429 men, 2377 women, 2 persons with an unknown sex) and the National Lung Screening Trial (NLST; 53,405 participants, 31,501 men, 21,904 women). We find that screening effectiveness varies by pack-years (screening effectiveness ranges across trials: lowest groups = 26.8-50.9%, highest groups = 5.5-9.5%), smoking status (screening effectiveness ranges across trials: former smokers = 37.8-39.1%, current smokers = 16.1-22.7%) and sex (screening effectiveness ranges across trials: women = 24.6-25.3%; men = 8.3-24.9%). Furthermore, screening effectiveness varies by histology (screening effectiveness ranges across trials: adenocarcinoma = 17.8-23.0%, other lung cancers = 24.5-35.5%, small-cell carcinoma = 9.7%-11.3%). Screening is ineffective for squamous-cell carcinoma in NLST (screening effectiveness = 27.9% (95% confidence interval: 69.8% increase to 4.5% decrease) mortality increase) but effective in NELSON (screening effectiveness = 52.2% (95% confidence interval: 25.7-69.1% decrease) mortality reduction). We find that variations in screening effectiveness across pack-years, smoking status, and sex are primarily explained by a greater prevalence of histologies with favourable screening effectiveness in these groups. Our study shows that heterogeneity in lung screening effectiveness is primarily driven by histology and that relaxing smoking-related screening eligibility criteria may enhance screening effectiveness.
How do patients and health care professionals perceive de-implementation of routine follow-ups after total hip or knee arthroplasty? Protocol for a nested qualitative study within a hybrid effectiveness de-implementation trial
Background Total hip and knee arthroplasties significantly improve the quality of life for patients with severe osteoarthritis. However, some patients experience complications that require follow-up care. Amid rising demand for these arthroplasties, debates have emerged around the value of routinely scheduled follow-ups (RFUs). This qualitative study, nested within a hybrid effectiveness de-implementation trial that assesses quantitative differences between RFU and check-ups on-demand (COD), will explore and compare the patients’ and health care professionals’ (HCPs) experiences with, and perceptions about, RFU and COD at 1 and 10 years after total hip and knee arthroplasty. Materials and methods First, a pre-study reference panel will be organised to prepare a focus groups topics guide. Subsequently, 2 methods of data collection will be used: 8 focus groups with total of 80 participants from the main trial and 10 in-depth interviews with different HCPs. Thematic analysis using a deductive approach will be performed on anonymised transcripts to identify key themes. For this, the comparative case study framework and the Theoretical Framework of Acceptability will be used. Findings will be used to inform the transition from RFU to COD if deemed acceptable by patients and HCPs.