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A pilot randomized trial on the usability and acceptability of an app (MyIBDDiet) to improve the self-management of anti-inflammatory diet for individuals with inflammatory bowel disease: A protocol paper
The role of diet in the management of inflammatory bowel disease (IBD) is increasingly recognized with recent guidelines providing specific dietary recommendations. Although mobile health apps targeting diet and lifestyle habits in IBD are emerging, few are designed for self-management or have been formally evaluated for effectiveness. We have co-designed a diet guidance and tracking app (MyIBDDiet) with and for patients with IBD with the aim of improving overall diet profile. We will be conducting a 60-day single-centre pilot randomized trial of 40 IBD patients randomized in 1:1 ratio to MyIBDDiet app or usual care. Participants in the usual care group will crossover to the MyIBDDiet app group after 30 days. Primary outcome is usability assessed using a mixed method quantitative [Theoretical Framework of Acceptability (TFA), mHealth App Usability Questionnaire (MAUQ)], and qualitative approach (semi-structured interviews). Secondary outcomes include clinical efficacy evaluated by change in diet quality [Mini-EAT questionnaire, Automated Self-administered 24-Hour Dietary Assessment Tool (ASA-24), Healthy Eating Index (HEI), Mediterranean Diet Serving Score (MDSS)], changes in biomarkers of processed food intake (spot urine sodium and chloride), changes in IBD disease activity [Patient Reported Outcome (PRO2 and PRO3), C-reactive protein, fecal calprotectin], changes in quality of life [EuroQol-5 Dimension (EQ-5D), Short Inflammatory Bowel Disease Questionnaire (SIBDQ)] and safety. Exploratory outcomes include changes in fecal microbiome and serum and fecal metabolome. Additional quantitative data will be collected from the digital analytics of MyIBDDiet app. The pilot data generated will inform the design of an adequately powered randomized trial and future mobile app development and evaluation by providing a framework for evaluation of clinical effectiveness. Trial registration ClinicalTrials.gov Identifier: NCT06683105 . Registered on 8 November 2024.
G-PARC: Graph-Physics Aware Recurrent Convolutional neural networks for spatiotemporal dynamics on unstructured meshes
‘Student Geng’ ignites research-integrity scandal in China after calling out senior academics
Correction: Potential mechanisms and effects of AFB1-induced asthma: A comprehensive analysis based on network toxicology and molecular docking
Coati optimization algorithm to recover the secret key of the classical transposition cryptosystem
Abstract This study presents an enhanced approach for recovering the secret key of the standard classical transposition cryptosystem using a recently introduced metaheuristic, the coati optimization algorithm. To adapt the coati optimization algorithm for cryptanalysis, its core framework is specifically customized for the considered transposition cryptosystem. The performance of the tailored coati optimization algorithm is benchmarked against three established metaheuristics, namely genetic algorithm, cuckoo search and particle swarm optimization based on accuracy, effectiveness, and efficiency. Experimental results demonstrate that the proposed method performs competitively, often surpassing genetic algorithm, cuckoo search, and particle swarm optimization across all evaluation metrics. However, the current experimental evaluation is limited to English-language ciphertexts using English n -gram statistics; therefore, the applicability of the proposed framework to multilingual cryptanalysis remains a direction for future investigation.
Retrospective cohort study of Advanced HIV disease among children and adolescents in Uganda: Characteristics, clinical outcomes, and rate of mortality
Background People diagnosed with advanced HIV disease (AHD) are at high risk for mortality even after starting antiretroviral therapy (ART). We determined characteristics, clinical outcomes, and risks of mortality among children and adolescents diagnosed with AHD in western Uganda. Methods We conducted a retrospective cohort analysis of routinely collected program data of children and adolescents living with HIV (CALHIV) aged 0–19 years, from outpatient HIV clinic electronic medical records in 48 high-volume health facilities in two regions of western Uganda (Fort Portal and Hoima). Data for clients who initiated ART during January 2016—July 2023 were analysed. AHD was defined as a CD4 cell count <200 cells/μL, or WHO stage 3 or 4, or any child younger than 5 years of age living with HIV who had been on ART for more than 12 months and virally non-suppressed (≥1,000 copies). We used descriptive statistics (i.e., frequencies and percentages) to summarise characteristics and treatment outcomes. Kaplan-Meier curves were used to estimate survival overall and by clients’ characteristics; log-rank tests were used to compare survival functions. A gamma-shared frailty model was used to determine factors associated with the rate of mortality. Effect measures were summarized using adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (95%CI). Results A total of 5,143 CALHIV, including 3,067 (59.6%) females, with a median (interquartile range [IQR]) age of 10 (9) years were assessed. Overall, AHD was high (18.1%) and varied by age—0–4 years (68.4%), 5–9 years (12.6%), 10–14 years (13.2%), and lowest among adolescents, 15–19 years (7.7%). Just over half of the CALHIV with AHD were active in care (51.5% [480/932]), about a quarter (26.4% [264/932]) had transferred out, 13.8% (129/932) were lost to follow-up, and 8.3% (77/932) had died. Survival was significantly higher in CALHIV who were not malnourished compared to those with malnutrition (p = 0.001). Overall mortality rate per 100 person-years among CALHIV with AHD was 4.1 (95%CI:3.2–5.2) and was significantly higher among those who had been on ART for 3 months or less (27.3; 95%CI: 20.6–36.2) compared to 6 months or more (1.0; 95%CI: 0.6–1.7). Conclusion Advanced HIV Disease among CALHIV in western Uganda was consistent with what has been published elsewhere. Risk of death differed by nutrition status and was high among those on ART three months or less. Early screening and management of malnutrition, as well as early ART initiation and adherence initiatives, might improve outcomes and reduce AHD-related mortality among CALHIV.
Computer-assisted design of arylethylbenzamides as predicted nanomolar inhibitors of papain-like cysteine protease of SARS-CoV-2
Why we seek to fly: Books in brief
Heart failure hospitalization in patients with and without type 2 diabetes: A population-based retrospective cohort study
Purpose Type 2 diabetes mellitus (T2DM) is a common comorbidity among patients with heart failure (HF). This study aims to describe how T2DM relates to HF hospitalization patterns across demographic groups and HF subtypes. Methods We conducted a population-based retrospective cohort study using 19 years of clinical data from Cerner Health Facts ® , a nationwide electronic health record (EHR) database. Adult patients hospitalized with HF were identified using ICD-9/ICD-10 diagnosis codes and HF-related medications and were stratified by T2DM status. Measures included HF-related hospitalization count, length of first HF hospitalization, and age at first HF hospitalization. Comparisons were examined across HF subtypes (historically termed systolic, diastolic, other). Additionally, sensitivity analyses were conducted using alternative inclusion criteria to assess the robustness of the findings. Results We identified 137,785 HF patients from the EHR database, among whom 29.5% had T2DM. Overall HF hospitalization was more common in men than in women; however, diastolic HF was more prevalent among women and presented at older ages whereas systolic HF was more prevalent among men. Compared with patients without T2DM, patients with T2DM experienced higher HF hospitalization count (mean: 2.81 vs. 2.42, p < 0.001), and both longer stay (mean: 7.03 vs. 6.85 days, p < 0.001) and earlier age (mean: 68.9 vs. 70.4 years, p < 0.001) of initial HF hospitalization. Across HF subtypes, T2DM was more prevalent among patients with diastolic HF (31.4% diastolic vs. 29.5% systolic vs. 28.7% other), and patients with T2DM were younger at first HF hospitalization than those without T2DM, with the largest difference observed for diastolic HF (mean: 70.4 vs. 73.1 years, p < 0.001). Conclusions In this large nationwide EHR cohort, T2DM was associated with more intensive HF hospitalization patterns and was more prevalent in the diastolic HF subtype. These findings highlight the relevance of diabetes status and HF subtype, in addition to demographic factors, in shaping HF-related healthcare utilization.
Aerial small object detection via dynamic convolution and hierarchical attention fusion for UAV imagery
Bottom-up synthesis of molecular nanodiamond from nanographene
Abstract Nanodiamonds hosting colour centres are promising building blocks for quantum technologies, enabling advances in quantum computation 1,2 , nanoscale NMR spectroscopy 3–6 , single-spin magnetometry 7,8 , wide-field quantum imaging 9 and single-photon sources 10,11 . However, the controlled bottom-up synthesis of ultrasmall and structurally uniform nanodiamonds has remained a challenge, with existing methods producing heterogeneous materials that vary in size, morphology, impurity content and defect quality. Here we show that well-defined, hydrogen-terminated molecular nanographenes serve as chemically confined precursors for high-pressure, high-temperature synthesis of ultrasmall (3–4 nm), monodisperse and highly crystalline molecular nanodiamonds with only a single sp 2 surface reconstruction and produced on a milligram scale. The same bottom-up platform also enables a two-component strategy for incorporating silicon- and germanium-based colour centres during synthesis, yielding SiV − and GeV − emitters without ion implantation, irradiation or post-treatment. Because the nanographene precursor defines both the confined carbon framework and the hydrogen content, this approach provides intrinsic, precursor-level control over nanodiamond size and composition, particularly in the low-nanometre regime relevant for biological and quantum sensing. Molecular nanographenes, ultralarge polycyclic aromatic hydrocarbons, therefore, establish a scalable and modular route to high-quality molecular and fluorescent nanodiamonds and offer a general design principle for tailored quantum materials and nanoscale devices.
Explainable machine learning for predicting activities of daily living at discharge in stroke patients: A retrospective study using SHAP interpretability
Purpose We aimed to develop a machine learning model to predict activities of daily living (ADL) at discharge in stroke patients and identify key predictors to guide rehabilitation decisions. Materials and methods Data of 589 stroke inpatients (2019–2024) were split into good (BI ≥ 60) and poor (BI < 60) ADL groups. Continuous variables were processed using Z-score normalization, followed by preliminary univariate regression screening (P < 0.05) and final feature selection via LASSO regression (lambda.1se = 0.0488). The screened features were used to train and validate ten machine learning algorithms; 30% of the dataset (n = 177) was allocated as an independent test set for model evaluation, and SHAP analysis was performed to interpret the optimal model. Results Six of 41 features were retained. Random forest achieved the best performance (AUC = 0.958; accuracy = 0.936; sensitivity = 0.934; specificity = 0.950). SHAP identified the top drivers: admission Barthel Index, standing balance, Brunnstrom stages (upper and lower limb), dressing, and grooming abilities. Conclusion The ADL risk prediction model constructed using machine learning, particularly the random forest model, shows excellent predictive performance and clinical interpretability, making it valuable for individualized risk assessment of daily living skills in stroke patients at discharge.
Relative age effects in competitive wrestling: variations by age group and gender
Abstract This study examined the presence of the relative age effect (RAE) in wrestling and its association with competitive success across age groups, styles, and gender. Data were drawn from 6,631 wrestlers (5,678 males and 953 females) competing in freestyle, Greco-Roman, and women’s categories at the 2025 Turkish Wrestling Championships, spanning ages 10–14 and the senior level. Birthdates were grouped into quartiles, and competitive outcomes were classified as medalists, quarterfinalists, others. Chi-square goodness-of-fit tests and chi-square tests of independence were conducted to examine the distribution of birth quarters and their association with tournament success outcomes. Analyses showed that there were no differences between birth quartiles in male freestyle and Greco-Roman wrestlers aged 10–13, as well as in all age categories among female wrestlers ( p > 0.05); however, athletes born in the early months of the year were statistically significantly overrepresented in the male 14 years and senior categories ( p < 0.05). In both styles, for males and in all categories for females, athletes born earlier in the year were found to have a higher likelihood of achieving higher tournament rankings across all youth categories ( p < 0.05), whereas this relationship was not observed at the senior level ( p > 0.05). Overall, the findings suggest that relative age advantages are most pronounced during developmental stages and diminish at the elite adult level, highlighting the potential value of considering relative-age-related performance differences when designing youth talent identification and development systems.
Evaluating the impact of the EU Medical Device Regulation (MDR) on mortality and device availability in Germany
Introduction The EU Medical Device Regulation (MDR), effective since May 25, 2017, aims to enhance the safety and quality of medical devices within the EU. This study models the potential net mortality implications of the MDR in Germany under explicit assumptions about safety improvements, market withdrawals, and certification delays. Methods A combined top-down and bottom-up approach was employed to evaluate the impact of the EU MDR on mortality in Germany. The top-down approach estimated avoided deaths using the Keyfitz–Vaupel life-table elasticity, while the bottom-up approach quantified mortality reductions attributable to individual MDR-regulated medical devices. Based on the results of both approaches, the analysis also estimated the number of deaths potentially resulting from market withdrawals and certification delays. Results Official German reports attribute an average of 17 device-related deaths annually, whereas international estimates suggest the true figure may reach up to 2,500 per year. Market withdrawals and certification delays associated with MDR implementation were modelled as potentially contributing an estimated 163–1,884 additional annual deaths and a one-time mortality burden of 700–4,200 deaths. Conclusion Under central assumptions, the MDR is consistent with long-term reductions in device-related mortality, but transition-period certification bottlenecks and withdrawals—especially for niche/pediatric devices—can offset gains in the short to medium term. Targeted mitigation is warranted to secure benefits and limit unintended harms.
Autofluorescence spectroscopy and multispectral autofluorescence microscopy for characterization of lupus nephritis in renal tissues
Abstract The study investigates lupus nephritis in label-free mode using simultaneous autofluorescence spectroscopy and multispectral autofluorescence microscopy. Lupus nephritis (LN) is an autoimmune disease with proteinuria as the most typical symptom and indicator of renal damage and disease activity. This study includes the development and application of a micro-spectro-endoscope on the renal tissues of murine LN, covering three stages, advanced end-stage (proteinuric), early onset disease (antibody-positive), and healthy with no disease manifestations (young). The micro-spectro-endoscope exploits the autofluorescence (AF) at two excitation wavelengths, 365 and 405 nm, to probe endogenous autofluorescence activity. Multispectral autofluorescence microscopy performed using a 365 nm light emitting diode (LED) collected information from three spectral bands, 440–490 nm, 500–560 nm, and 600–650 nm, respectively. Three regions, medulla, medulla-cortex, and cortex, were investigated using autofluorescence microscopy, and the maximum autofluorescence was recorded in the cortex region. Acquiring simultaneous AF spectroscopy and AF microscopy provided molecular and morphological information from the same tissue location. Simultaneous autofluorescence microscopy and spectra of kidney tissues from proteinuric, antibody-positive, and young mice were recorded with a micro-spectro-endoscope by exciting at 405 nm LED. A significant change in the peak of the autofluorescence spectrum for proteinuric, antibody-positive, and young mice was observed, with peaks around ~ 480 nm, ~ 493 nm, and ~ 532 nm, respectively. The alternation in the autofluorescence peak is likely due to the variations of nicotinamide adenine dinucleotide and flavin adenine nucleotide fluorophores during the progression of the disease. An additional peak around ~ 616 nm is also observed in antibody-positive tissue, showing the presence of lipofuscin, which is absent in young and proteinuric tissues, indicating the possibility of increasing lysosomal activity and oxidative stress.
“Shining a light on chronic pain”: A qualitative study of stakeholder views towards chronic pain at work and the Pain-at-Work Toolkit
Purpose The study explored the views of organisational stakeholders who participated in the feasibility trial of the Pain-at-Work Toolkit towards the implementation of the toolkit in ‘real-world’ workplace settings. This digital toolkit was co-created with healthcare professionals, employers, and people with chronic pain and aimed to inform and enable individuals to self-manage their chronic pain at work. Design/methodology/approach A qualitative study using semi-structured interviews with 15 stakeholders from 12 organisations that participated in a feasibility trial of the Pain-at-Work Toolkit. Purposive sampling was used to ensure the inclusion of stakeholders with management or supportive roles who have responsibility for the health and wellbeing of employees. Findings The findings illuminate three key themes: not all disabilities are visible; not all line managers are equal; and who has control? These surmise that invisible disabilities such as chronic pain are underestimated, poorly understood, and inconsistently provisioned for in organisational policies. It highlights the key role that line managers play in employee disclosure and access to support but demonstrates that line managers vary in their delivery of support to employees. Lastly, it explores stakeholder perceptions of the roles of the employer relative to the employee with chronic pain. It confirms the need for additional resources to plug organisational gaps and give workers tools to self-manage their pain at work. Originality This study indicates the need for resources / supports to upskill line managers so they can intervene to proactively support employees with chronic pain to reduce sickness absence and presenteeism (working when unwell). The research demonstrates organisational stakeholders’ interest in a multi-faceted approach to help employees self-manage chronic pain in all types at work, such as that provided by the Pain-at-Work Toolkit. In addition, it clearly identifies the potential for complementary resources to educate and facilitate line managers to better support their staff.
Hybrid steel and carbon fiber reinforcement enhances mechanical performance and sustainability of cementitious composites
Path loss characterization of a compact dual-band mmWave antenna in urban microenvironments
This work presents a compact dual-band millimeter wave (mmWave) antenna that operates at 17–27 GHz and 36–43 GHz, with resonance frequencies centred at 21.1 GHz and 38.3 GHz, respectively. The multiple embedded arc-shaped mmWave antenna geometry provides compact, effective dual-band operation. The concentric arcs of the antenna structure are effectively optimized to produce a dual band of operation with good impedance matching. The resulting antenna has gain of 4.8 dBi at 26 GHz and 6.1 dBi at 37 GHz frequencies. The developed antenna is intended for widespread usage in satellite and 5G networks. Despite providing significant bandwidth for 5G and other next-generation communication systems, mmWave frequencies are susceptible to path loss, particularly in congested urban areas. This study further investigates the performance of the designed dual-band mmWave antennas in various urban environments. Both Line-of-Sight (LOS) and Non-Line-of-Sight (NLOS) scenarios are considered to capture realistic deployment conditions. To accurately model propagation behaviour, the analysis incorporates the ABG and CI path-loss models, which comprehensively account for environmental factors such as shadowing, diffraction, and precipitation.