People who use drugs (PWUD) in the U.S. often face barriers to accessing harm reduction, social, and medical services, including fragmented systems and limited access to locally relevant, usable information. A digital harm reduction support tool (DHRST) that identifies clients' needs and matches them to available community resources may help address these barriers. We examined the feasibility and acceptability of a DHRST among PWUD, as well as its potential role in supporting safer practices and improving engagement with services. We recruited a convenience sample of 37 clients from a community-based harm reduction organization to participate in semi-structured interviews. Participants were ≥ 18years old, English-speaking, and able to provide informed consent. Interviews explored perceptions of the feasibility, acceptability, and potential uses of a DHRST. Data were analyzed using thematic analysis. Four primary themes emerged from our data: (1) participants viewed a DHRST as a valuable tool for navigating fragmented and locally specific information about harm reduction, social, and healthcare services; (2) participants perceived the tool as a means of enhancing safety in an increasingly unpredictable drug supply through access to real-time, peer-generated information and alerts; (3) participants expressed concerns about privacy, surveillance, and the potential unintended consequences of sharing sensitive information; and (4) participants emphasized that feasibility would depend on accessibility, including device access, digital literacy, and the availability of multiple platforms for engagement. Overall, participants expressed strong enthusiasm for the potential value of a DHRST despite concerns regarding implementation and information security. Findings suggest that a DHRST is both acceptable and potentially valuable for supporting harm reduction among PWUD, particularly as a means of improving access to locally relevant information. However, its effectiveness will depend on careful attention to structural constraints, privacy and data governance, and the broader risk environment in which information-sharing occurs. These findings support continued development of DHRSTs while emphasizing the need for user-centered and context-sensitive design.

This study examined whether attendance at online digital health research appointments in the American Women Assessing Risk Epidemiologically (AWARE) study was associated with (1) participant age, (2) scheduling factors (time of day, day of week, month), (3) appointment confirmation, and (4) HIV behavioral risk factors. We analyzed scheduling and eligibility screening data from AWARE, a 24-month U.S.-based longitudinal digital cohort of cisgender women at elevated likelihood of HIV seroconversion. Participant demographic and behavioral data were merged with the study team's Outlook calendar. Chi-square tests and logistic regression models assessed associations between appointment attendance and participant characteristics and scheduling factors. Women aged ≥50 years had higher odds of missing baseline visits compared to those aged 20-29 years (44.7% vs 32.3%). Appointments scheduled at 2:00 pm (45.7%), 4:00 pm (45.2%), and 8:00 am (40.2%) had higher no-show rates than other times. No-show rates were lowest on Fridays (30.2%) and during March (27.7%) and June (25.2%). Confirming appointments 24 hours in advance significantly reduced no-shows compared to no confirmation (19.0% vs 51.6%). Histories of having been physically hurt (44.2% vs 32.1%), forced to have sexual activities (41.8% vs 34.1%) and incarcerated (39.3% vs 33.4%) were also associated with higher no-show rates. Similar patterns were observed for rescheduled visits. Attendance in digital research was influenced by age, scheduling, and structural vulnerabilities. Incorporating digital access support into study design and grant budgets may reduce disparities, improve retention, and enhance efficiency.

Efficacy and safety of a digital clinical decision support system using a C-reactive protein-based algorithm and evidence-based stopping rules to guide antibiotic therapy duration: A single-center, open-label randomized controlled trial in a tertiary care hospital.

Evolution of artificial intelligence at Hospital Italiano de Buenos Aires: A retrospective review of experience and lessons learned.

Evaluating the potential of applying artificial intelligence in the diagnosis of major depressive disorder: Neuroimaging and clinical behavioral markers.

Recovery support services (RSS) are an evidence-based approach to support recovery from substance use disorders, most often composed of peer-to-peer support, referrals to housing, job training, and other forms of prosocial engagement and activities. During the COVID-19 pandemic, RSS providers quickly converted in-person services to digital delivery to avoid disruption. It is unclear if this rapid conversion impacted the delivery of services or if this delivery model could enhance RSS reach and uptake more generally by extending the reach of RSS providers and offering an alternative delivery method and access point. The goal of this study was to identify how RSS providers in Texas adapted their services for digital delivery and to what extent, if at all, technology limitations (eg, lack of digital infrastructure) were present. We conducted an electronic survey of 85 RSS providers, assessing their current capacity and methods for the digital recovery support service (D-RSS), followed by semistructured online interviews with a subset of 20 respondents. Most survey respondents (74/85, 87.1%) used D-RSS, though they used many dated technologies, devices, and platforms for service delivery. Many respondents indicated that they use Zoom (Zoom Video Communications) videoconferencing to communicate with participants; however, providers also indicated that they must use several different technology platforms to accomplish their service delivery goals. Four main themes emerged from the interviews: (1) the impact of the COVID-19 pandemic on RSS, (2) barriers and facilitators to technology-delivered D-RSS, (3) awareness and expectations regarding the use of D-RSS, and (4) training needs to deliver D-RSS. RSS organizations have access to technology for D-RSS; however, the technology is often outdated. Because the pandemic required a rapid and unexpected shift to D-RSS to maintain and potentially expand access during a public health emergency, providers desire guidance for training staff and participants on how to best use technology. A subset of providers endorsed the potential of a unified platform for D-RSS delivery, especially for data capture. Most barriers to D-RSS identified by our respondents may be addressable through the streamlined deployment of technology resources, rigorous training and onboarding programs in best practices for providers and participants, and tailored implementation strategies for varying local contexts.

Electronic prescribing systems like Saudi Arabia's Wasfaty service are central to digital healthcare transformation, aiming to improve safety, efficiency, and patient experience. While nationally implemented, assessing local user satisfaction is critical for optimizing the service. The objective of the study was to evaluate patient experience and satisfaction with the Wasfaty electronic prescription service and to examine associations with sociodemographic and health-related factors. A cross-sectional survey was conducted among 407 Wasfaty users in Bisha, Saudi Arabia. Data were collected via a structured questionnaire using a 5-point Likert scale. Satisfaction scores were calculated as composite means and categorized as low, moderate, or high. Associations were analyzed using Pearson's Chi-square and exact probability tests. Overall satisfaction was high across all domains (mean scores: pharmacy environment 3.9 ± 1.0; pharmacists 4.1 ± 1.1; Wasfaty system 4.1 ± 0.9). The majority of participants reported high satisfaction (pharmacy: 66.1%; pharmacists: 74.1%; Wasfaty: 71.7%). Female gender and younger age (18-30 years) were significantly associated with higher satisfaction in most domains (P < 0.05). Educational level, chronic disease status, and frequency of Wasfaty use were not significantly associated with satisfaction levels. Users in Bisha are highly satisfied with the Wasfaty service, particularly with pharmacist interaction and system usability. The significant disparities by age and gender highlight the need for tailored interventions, such as improved digital support for older adults and more targeted patient engagement strategies for male users, to ensure equitable service quality and support the ongoing success of Saudi Arabia's e-prescribing initiative.

Effectiveness of a blended care intervention in physiotherapy with exercise and education for patients with hip or knee osteoarthritis (SmArt-E): a multicentre pragmatic randomized controlled trial.

Post-bariatric hypoglycaemia (PBH) is an increasingly recognised complication of bariatric and metabolic surgery, that can markedly impair quality of life and jeopardise the long-term benefits of surgery. This review summarises the current evidence on the epidemiology, pathophysiology and management of PBH, with a particular focus on mechanism-based treatment strategies. We first point out the limitations of existing epidemiological data and then outline a practical diagnostic framework. We next review the evolving understanding of PBH as a heterogeneous, pathophysiology driven syndrome arising from rapid nutrient delivery, exaggerated incretin responses, excessive insulin secretion, impaired glucagon secretion and emerging contributors such as post-prandial serotonin hypersecretion, bile acid signalling and microbiome change. On this basis, we review therapeutic options by mechanistic target, covering dietary and lifestyle interventions, acarbose, SGLT inhibition, somatostatin analogues, GLP-1 receptor antagonists, diazoxide, glucagon-based approaches and experimental serotonin receptor antagonism, and briefly discuss agents with limited supportive evidence. Finally, we explore key knowledge gaps and future directions, including the need for long-term prospective data, precision medicine approaches, rational combination therapy and greater integration of continuous glucose monitoring and digital decision support. Mechanism-based, multidisciplinary care from bariatric physicians, dietitians and surgeons, offers the best prospect of managing PBH, preserving quality of life and safeguarding the metabolic benefits of bariatric surgery.

Maternal nutritional exposures during pregnancy are critical determinants of maternal and neonatal outcomes, yet remain inadequately characterized in many African settings, including Cameroon. The CAMELIA (Cameroon Maternal and Early Life Assessment) cohort aims to evaluate maternal nutritional status early in pregnancy, implement a structured nutritional intervention, and assess its impact on maternal, neonatal, and long-term metabolic outcomes. CAMELIA is a prospective, longitudinal interventional cohort enrolling 1,200 pregnant women at less than 22 weeks' gestation in an urban primary healthcare facility in Cameroon (Hôpital Monseigneur Jean Zoa, Yaoundé). Participants are recruited at the first antenatal visit and followed through delivery and up to 42 days postpartum. Data and biological samples are collected across four visits: at enrolment (< 22 weeks), between 24 and 32 weeks of gestation, at delivery, and at 42 days postpartum. A structured multi-modal nutritional intervention (SUN-APP program) is initiated at enrolment, delivered through individual counselling, group education, monthly interactive workshops, and digital health support via weekly WhatsApp and SMS messages. Gestational hyperglycaemia is screened using fasting capillary blood glucose at V1 and V2, applying a threshold of ≥ 92mg/dL. Primary outcomes are feasibility and acceptability of the intervention. Secondary outcomes include prevalence of gestational hyperglycaemia, hypertensive disorders, anaemia, low birth weight, and preterm birth. The study holds ethical approval from the Cameroon National Ethics Committee (CNERSH; approval no. 2025/04/1790/CE/CNERSH/SP) and is registered in the ISRCTN registry (ISRCTN13961105). The CAMELIA study provides a scalable and replicable framework for embedding structured nutritional risk screening and targeted interventions into routine antenatal care in a low-resource African setting. Findings will inform strategies for the prevention of gestational metabolic disorders and adverse perinatal outcomes across generations. ISRCTN13961105. Registered 14 August 2025.

This study aims to analyze the deep learning approach in the context of Islamic Religious Education (PAI) in the digital era. Deep learning, as part of the 21st-century educational paradigm, emphasizes the active involvement of students in building meaningful understanding, critical thinking, and transferring knowledge into real-life contexts. This study used a systematic literature review (SLR) method on 28 national journal articles published between 2016 and 2026. The results show that the deep learning approach can significantly improve the quality of PAI learning, including: (1) increasing the holistic understanding of religious concepts, (2) developing students' character and morals, (3) integrating Islamic values ​​in solving contextual problems, and (4) increasing student motivation and engagement. The findings also identify factors inhibiting implementation, including the limited pedagogical competence of PAI teachers and the minimal digital infrastructure support in Islamic-based schools. This study concludes that the integration of deep learning in PAI requires curriculum reorientation, increased teacher capacity, and consistent policy support from educational stakeholders.

Public libraries are increasingly understood not merely as information-service institutions but as community-based infrastructures that support civic life, social connection, digital inclusion and everyday wellbeing. This article offers an integrative review of scholarship on the community roles of public libraries across five major strands: public sphere and democracy, social capital and trust, place and community engagement, digital inclusion and administrative access, and wellbeing, welfare and social integration. The review argues that the literature has moved decisively beyond narrow service-centred conceptions of the public library, yet remains fragmented across thematic domains and often under-specifies the mechanisms through which libraries generate community effects. The article’s central contribution is to reconceptualise the public library as a form of social infrastructure that links informational access, relational encounter, civic participation and low-threshold support. Four recurring mechanisms—accessible infrastructure, relational encounter, mediated capability-building and institutional buffering—are identified as the analytical bridge between institutional presence and community effects. The article concludes by outlining a research agenda that prioritises conceptual clarity, mechanism specification and stronger comparative evidence, and by drawing out practical implications for how public libraries can position themselves within local systems of digital, civic and social support.

Naungan Kasih (NK) is a hybrid positive parenting program for parents and caregivers of preschool-aged children that blends digital, in-person, and remote support to strengthen parenting skills and promote children's healthy development. This paper documents the development, evaluation, and scaling pathways in which academic institutions, Malaysian government agencies, and international organizations collaborated as a consortium to translate evidence-based parenting principles into a locally feasible, culturally responsive delivery model. NK progressed through a three-phase implementation journey. It began by strengthening and standardizing in-person parenting support in response to a government request, then shifted to digital delivery during COVID-19 through ParentText and ParentChat, and is currently focused on embedding hybrid NK within the government preschool platform to support scalable, sustainable delivery. The development process involved formative assessment, co-design, and pilot testing of the program. NK is being tested through a cluster-randomized controlled trial with effectiveness outcomes including caregiver parenting practices, mental health, and relationship quality, as well as child developmental and behavioral outcomes, alongside process measures of reach and engagement. The scaling pathway leverages evaluation outputs by building a train-the-trainer system, supervision and quality-assurance mechanisms, standardized monitoring for continuous improvement, a technology-transfer process, and modular materials that can be adapted across local contexts without diluting core components. The NK collaboration framework demonstrates how a multi-stakeholder partnership can produce an evidence-informed, implementation-ready intervention, while simultaneously establishing the operational infrastructure required for rigorous evaluation and scalable delivery within government agencies.

Mobile health (mHealth) interventions offer opportunities to improve access to safe, evidence-informed support for people affected by eating disorders (EDs). However, challenges remain around sustained engagement, inclusivity, and integration with care. The co-produced Eating Disorder Support App, developed by the Eating Disorder Health Integration Team (EDHIT) from Bristol Health Partners in the UK, aims to provide trusted, accessible information for individuals with lived experience, supporters, and healthcare professionals. This study examined user engagement, acceptability, and the perceived impact of the app on knowledge, confidence and support-seeking, while identifying opportunities for refinement. A mixed-methods evaluation was conducted using an online survey and follow-up semi-structured interviews. Sixteen participants (people with lived experience, supporters, and healthcare professionals) completed a survey assessing app use, usability, satisfaction, and perceived impact; four took part in qualitative interviews exploring experiences in depth. Quantitative data were analysed descriptively, and qualitative data were analysed using conventional qualitative content analysis. Within this sample, participants reported high satisfaction with the app's accessibility, clarity, and non-judgemental tone, with the majority (93.8%) rating its overall quality as good or excellent. Survey findings indicated perceived improvements in knowledge, confidence, and intentions to seek or support help-seeking. Qualitative content analysis produced four overarching categories, with ten subcategories, providing further insight into how the app functioned as a trusted, accessible adjunct to care, supporting understanding, reassurance, and emotional safety. Participants also highlighted areas for improvement, including the need for greater personalisation, expanded multimedia content, and clearer navigation to manage initial information load. Overall, findings highlighted the app's perceived value, while identifying opportunities to enhance engagement and inclusivity. This evaluation suggests that the Eating Disorder Support App may be an acceptable and useful digital resource that complements clinical care and supports self-management. Future evaluations should include larger and more diverse samples, longitudinal follow-up, and assessment of clinical outcomes to strengthen the understanding of impact. Continued co-production and lived-experience involvement are likely to enhance inclusivity, relevance, and sustained engagement in digital ED support tools.

Chronic illness disrupts everyday routines, social roles, and sense of self, particularly among young individuals undergoing identity formation. With the expansion of digital media, social platforms have become key sites where patients narrate illness experiences, negotiate stigma, and seek support. However, such processes remain underexplored in non-Western, collectivist contexts. This study examines how young Chinese individuals with diabetes construct illness narratives and negotiate identity in digital environments. This study uses a narrative analysis approach, combining inductive thematic coding with culturally and critically informed interpretation. A total of 303 narrative posts were collected from RedNote, a Chinese social media platform characterized by diary-like user-generated content. The dataset includes both text-based and video-based posts, capturing longitudinal and first-person accounts of living with diabetes. In total, 4 distinct narrative types were identified. The chaos narrative captures experiences of cognitive dissonance, emotional breakdown, and disruption of daily routines following diagnosis, often accompanied by guilt toward family members and anxiety over future uncertainty. The stigma narrative reflects social withdrawal, concealment of illness, and perceived discrimination in intimate relationships and employment contexts, highlighting the role of externally imposed social judgment. The resilience narrative illustrates processes of self-acceptance, disciplined self-management, and the integration of illness into everyday life through routinized practices such as blood glucose monitoring and dietary regulation. The solidarity narrative emphasizes the importance of familial care and digitally mediated peer support, where users exchange practical knowledge, emotional encouragement, and collective identity markers, transforming isolation into shared experience. Across these narratives, illness is not only experienced as disruption but also actively reinterpreted through culturally embedded values such as familial responsibility and collective belonging. This study advances illness narrative research by demonstrating how digital platforms mediate culturally specific forms of meaning-making among young patients with chronic illness. It extends the concept of biographical disruption by conceptualizing it as a dynamic and relational process shaped by digital storytelling, familial expectations, and peer interaction. The findings highlight the importance of culturally sensitive and platform-aware approaches to health communication and digital patient support.

Integrating an ethic of care into the design of digital bereavement services: a care-oriented approach

The global burden of infertility and its associated psychological distress is substantial, yet many individuals face barriers to accessing psychological support. A scalable, low-cost online intervention presents a promising solution. A randomized controlled trial (RCT) was conducted (experimental vs. waitlist control group) to evaluate the efficacy of a fully automated cognitive behavioral therapy (CBT) program in reducing infertility-related stress among women attempting to conceive. Data were analyzed using linear mixed models on an intention-to-treat basis. The study enrolled 63 Icelandic women experiencing infertility-related stress. The intervention, Overcome Fertility Stress, is an online program designed to identify and modify maladaptive behaviors and thought patterns contributing to infertility-related distress. It delivers personalized treatment through prewritten text, audio, and video responses based on user input. Infertility-related stress was measured using the 46-item Fertility Problem Inventory (FPI), which assesses a global stress score and five domains of infertility-related stress. Participants in the experimental group demonstrated a significant reduction in infertility-related stress (mean reduction score = 22.85, p < 0.05), whereas the control group showed no significant changes (p > 0.05). The within-group effect was large, but controlled between-group effects and confidence intervals should be prioritized when interpreting treatment benefit. These findings provide preliminary controlled evidence that a fully automated CBT program may reduce infertility-related stress, although the underpowered sample and low adherence require cautious interpretation. This RCT, alongside prior feasibility studies, suggests that Overcome Fertility Stress may be a promising low-intensity intervention for infertility-related stress. No significant effects were observed on secondary outcomes measuring depression, anxiety, stress, or worry, suggesting the program is specific to infertility-related stress rather than a broader intervention for emotional disorder symptoms. Larger, adequately powered trials with stronger engagement strategies are needed. Future research should focus on expanding access and integrating digital psychological support into standard fertility care.

ABSTRACT Online peer e-mentoring can foster academic success, career readiness and well-being in undergraduate programs. Using a mixed method design that combines the Critical Incident Technique with automated text analytics, we coded 209 surveys and 149 reflective narratives from mentors and mentees enrolled in a sector specific Bachelor of Commerce degree program in Canada. Mentors highlighted leadership growth, psychological and emotional support, and role modeling, yet noted persistent engagement hurdles. Mentees shifted from seeking academic and career guidance to prioritizing emotional reassurance, while scheduling and technical issues were common challenges. These patterns refine peer mentorship frameworks for virtual contexts, indicating that targeted mentor training, precise goal alignment, and digital support may improve transition, retention, and inclusion for business students. The study advances peer mentoring research by linking quantitative incident metrics with automated text analytics in a sector specific, marketing related setting. The findings suggest that with guidance and adaptation, a transition to online peer-mentoring has the potential to be as effective as in-person mentoring.

Early economic assessment of a standardized ICU rounding bundle: Pre-modelling and budget impact analysis.

Strategic governance of integrated nuclear medicine, diagnostic radiology, and radiation therapy in comprehensive cancer centres: A balanced scorecard framework.