Number Of Trials Research Articles

Evaluation of a pediatric navigation program within primary care: a quantitative analysis guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework

BackgroundPediatric Support Services (PSS) is a Patient Navigation Program designed to address barriers from referral-to-service connection from primary care to health system and community-based services and resources. This study aimed to evaluate PSS’ implementation for mental health services along the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and identify factors throughout implementation to inform sustainability and delivery.MethodsThis study included descriptive analysis of all patients referred to PSS to assess reach, with a primary cohort analyses of a subset of patients referred specifically to mental health services. Data collection included triangulation of information extracted from electronic health records, direct contact with patients’ caregivers, and follow-up surveys completed by patients’ caregivers. Analyses were designed within each construct of the RE-AIM framework, and assessed for their tiered impact on the patient, provider, and system levels.ResultsFrom October 2019 to June 2023, 13,109 total referrals for 11,214 unique patients were triaged by PSS. The patient population overrepresented younger, Hispanic, female patients compared to the clinical population included in this health system’s service area. Of these patients, 3,929 were followed-up by trained navigators at two-weeks for mental health service connection, with 50.6% reported being connected to referred services and an additional 27.1% with pending appointments. There was a significant increase in referral connection rate as age increased and for Black patients, compared to other children. For patients considered connected to or pending services, a satisfaction survey found high satisfaction with PSS and the amount of navigator-patient contact (81.5 and 79.6%, respectively).ConclusionThese findings highlight potential program modifications to optimize quality of care and health for children and families, while enhancing capacity among providers, navigators, and clinics. Further adaptations, including electronic health record integration, patient/family feedback, and automated navigation processes, are suggested next steps for comprehensive navigation.Trial registrationThis study was approved by the Institutional Review Board for Prisma Health, trial number 1,852,794, with the most recent approval for expanded evaluation received on June 15, 2022 (original application approved in 2016).

Defining responders to altered running footwear based on measures of running economy

This study compared three different ways of defining a responder to a shoe intervention when assessing running economy (RE). Furthermore, we investigated the influence of multiple trials on the classification of responders. This was done using indirect calorimetry to measure RE in thirty-seven runners, in three different running shoes. Over two visits, each participant ran a total of four times in each shoe. Three responder definitions were used to classify participants into responders or non-responders. The strength of each definition was evaluated using a logistic regression analysis with a pseudo r2. The effect of multiple trials was analysed using number of trials defined as responders. Two definitions had similar high McFadden’s Pseudo r-squared (r2 = 0.89, r2 =0.86), being definitions that i) included a coefficient of variation (CV) derived from the literature and ii) a CV calculated by averaging all participants day-to-day CV from the present study. Inconsistent responders were present in 57% of the incidences, meaning that participant showed both responding and non-responding trials for the same shoe condition. For defining responders to a shoe intervention (RE specifically), it is recommended to use a cut-off value based on the literature which is easily available. Furthermore, conducting multiple trials is beneficial as this allows a separation between consistent- and inconsistent responders.

The use of dynamized high dilutions in a agriculture: a systematic literature review

The agricultural sector is looking for new ways to produce food sustainably, reducing the use of pesticides and still achieve good yields. The use of dynamized high dilutions (DHDs) in agriculture is an agroecological way to achieve this goal. In the last decade in particular, homeopathy has been increasingly used by farmers, both conventional and organic, with training opportunities and more research projects emerging. However, this field of research has not yet been systematically analysed. A systematic literature review will therefore be carried out using academic literature, grey literature and a comprehensive search strategy. The results will provide an overview of the research to date and also be available for processing into a handout for farmers and users. Methods: A panel of experts advises on the identification of suitable search terms in different languages and on the identification of suitable databases. The literature is then searched according to PRISMA guidelines, screened using the dual control principle, sorted according to quality features and then extracted in terms of content. The search strategy includes a systematic search for the combination of synonymous terms for "homeopathy", "Dynamized High Dilutions" and "agriculture*". Results: So far, eight literature databases have been searched and a total of 3300 references have been found using the search terms. The references are currently being screened by title and full text in accordance with the PRISMA guidelines. They will then be analysed according to specific quality features. The first results should be available by October 2024. Conclusion: A large number of trials evidenced the increasing the resilience of crops and plants and on pest resistance with the use of dynamized high dilutions (DHDs) have already been identified in the scientific literature. The use of homeopathy and DHDs can therefore make a contribution to the development of sustainability in agriculture.

Speciation of Malassezia and determination of sebum and hydration levels in secondary school students in Nigeria.

Pityriasis versicolor (PV) is a common skin condition associated with Malassezia species. Factors influencing PV development, such as sebum and skin hydration levels, are not fully understood, especially among adolescents. This study aimed to determine Malassezia speciation and assess sebum and hydration levels in secondary school students with PV in Ibadan, Nigeria. A cross-sectional study was conducted among secondary school students with PV and a control group. Sebum and hydration levels were measured using a sebumeter and corneometer, respectively. Malassezia speciation was determined through KOH microscopy and PCR-RFLP. Sebum levels were significantly higher in PV patients compared to controls. Skin hydration was lower in PV patients. Malassezia globosa was the predominant species, followed by Malassezia restricta and Malassezia sympodialis. No significant correlations were found between Malassezia species and clinical features. Increased sebum levels and decreased skin hydration are associated with PV in adolescents. Malassezia globosa is the primary species involved. Further research is needed to elucidate the complex relationship between these factors and PV pathogenesis. Clinical trial number Not applicable.

Imbalanced and Unchecked: The Role of Metal Dyshomeostasis in Driving COPD Progression.

Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterized by persistent inflammation and oxidative stress, which ultimately leads to progressive restriction of airflow. Extensive research findings have cogently suggested that the dysregulation of essential transition metal ions, notably iron, copper, and zinc, stands as a critical nexus in the perpetuation of inflammatory processes and oxidative damage within the lungs of COPD patients. Unraveling the intricate interplay between metal homeostasis, oxidative stress, and inflammatory signaling is of paramount importance in unraveling the intricacies of COPD pathogenesis. This comprehensive review aims to examine the current literature on the sources, regulation, and mechanisms by which metal dyshomeostasis contributes to COPD progression. We specifically focus on iron, copper, and zinc, given their well-characterized roles in orchestrating cytokine production, immune cell function, antioxidant depletion, and matrix remodeling. Despite the limited number of clinical trials investigating metal modulation in COPD, the advent of emerging methodologies tailored to monitor metal fluxes and gauge responses to chelation and supplementation hold great promise in unlocking the potential of metal-based interventions. We conclude that targeted restoration of metal homeostasis represents a promising frontier for ameliorating pathological processes driving COPD progression.

A randomized crossover study assessing critical errors, preferences, and ease of use of two multidose powder inhalers

ABSTRACT Background The effectiveness of inhaled medications in asthma and COPD is significantly impacted by inhalation errors. Feedback mechanisms, built into the design of the inhaler might reduce the number of critical errors. This study compares critical errors, preferences, and ease of use of two dry powder inhalers, the Nexthaler and the Turbuhaler. Research design and methods In this multi-center, prospective, randomized, open-label, cross-over study, the proportions of asthma and COPD patients making critical errors were compared between the Nexthaler and Turbuhaler after 4 weeks of clinical use, after having been trained in the correct use of both inhalers. Results 90 and 49 patients with asthma and COPD, respectively were assessed. No significant difference was found in the number of critical errors between the two inhalers (3 with Nexthaler and 5 with Turbuhaler). However, more patients preferred the Nexthaler (57.6%) over the Turbuhaler (34.5%) (p = 0.006), while 7.9% stated no preference. Conclusions The study found no significant differences in critical error rate between the Nexthaler and Turbuhaler but the Nexthaler was preferred over the Turbuhaler. This study highlights the importance of dedicating sufficient time to instructing patients in correct inhalation technique, which can lead to long-term retention of the inhalation technique. Trial Registration The trial is registered at International Clinical Trials Registry Platform. Trial number NL-OMON55778.

Countermarketing Versus Health Education Messages About Sugar-Sweetened Beverages: An Online Randomized Controlled Trial of US Adults.

Objectives. To test whether countermarketing messages for sugary drinks lead to lower intentions to consume sugary drinks and less perceived weight stigma than health education messages. Methods. In August 2023, we conducted an online randomized controlled trial with US adults (n = 2169). We assessed the effect of countermarketing messages, health education messages, and neutral control messages on intentions to consume sugary drinks and perceived weight stigma. Results. Both countermarketing messages (Cohen d = -0.20) and health education messages (d = -0.35) led to lower intentions to consume sugary drinks than control messages (Ps < .001). However, both types of messages elicited more perceived weight stigma than control messages (ds = 0.87 and 1.29, respectively; Ps < .001). Countermarketing messages were less effective than health education messages at lowering intentions to consume sugary drinks (d for countermarketing vs health education = 0.14) but also elicited less perceived weight stigma than health education messages (d = -0.39; Ps < .01). Conclusions. Countermarketing messages show promise for reducing sugary drink consumption while eliciting less weight stigma than health education messages, though they may need to be refined further to minimize weight stigma and maximize effectiveness. Clinical Trial Number. ClinicalTrials.gov NCT05953194. (Am J Public Health. 2024;114(12):1354-1364. https://doi.org/10.2105/AJPH.2024.307853).

Immunological impact of intraperitoneal and intravenous chemotherapy in ovarian cancer, translational analyses of the Phase 3 iPocc trial

BackgroundThe iPocc trial, a randomized, global phase 3 study that compared intraperitoneal (IP) and intravenous (IV) carboplatin with dose-dense paclitaxel chemotherapy in epithelial ovarian cancer (EOC) patients, demonstrated improved progression-free survival in patients who received IP chemotherapy. The present study aimed to investigate the role of preexisting tumor immunity in the clinical outcomes of patients receiving IP chemotherapy. MethodsThis study involved analyzing patient data from the iPocc trial, selectively of those whose tumor specimens were preserved at the time of primary surgery. A total of 116 cases ((IP; n = 59), (IV; n = 57)) were subjected to microarray analysis. Single-sample gene set enrichment analyses were performed to evaluate the tumor immune microenvironment. ResultsPatients with enhanced tumor infiltration of T cells, natural killer (NK) cells, and cytotoxic lymphocytes in the IP group had a longer overall survival (OS) than those in the IV group, but not in the group with low infiltration. IP therapy improved the OS of patients with high expression of immune-related genes such as CD8A and FOXP3. In patients' subdivided into “immune Hot” and “immune Cold” groups based on hierarchical clustering analysis using four parameters representing “Innate immunity,” “T cells,” “IFNG response” and “Inhibitory molecules,” IP therapy significantly improved prognosis in the “immune Hot” group, but not in the “immune Cold” group compared to that of IV therapy. ConclusionsIP chemotherapy enhances the survival rates of patients with EOC with an immune-Hot phenotype in the tumor microenvironment prior to treatment.(Japan Registry of Clinical Trials number, jRCTs031180141.)

Optimizing laser cutting of stainless steel using latin hypercube sampling and neural networks

Optimizing cutting parameters in fiber laser cutting of austenitic stainless steel is challenging due to the complex interplay of multiple variables and quality metrics. To solve this problem, Latin hypercube sampling was used to ensure a comprehensive and efficient exploration of the parameter space with a smaller number of trials (185), coupled with feedforward neural networks for predictive modeling. The networks were trained with a leave-one-out cross-validation strategy to mitigate overfitting. Different configurations of hidden layers, neurons, and training functions were used. The approach was focused on minimizing dross and roughness on both the top and bottom areas of the cut surfaces. During the testing phase, an average MSE of 0.063 and an average MAPE of 4.68% were achieved by the models. Additionally, an experimental test was performed on the best parameter settings predicted by the models. Initial modelling was conducted for each quality metric individually, resulting in an average percentage difference of 1.37% between predicted and actual results. Grid search was also performed to determine an optimal input parameter set for all outputs, with predictions achieving an average accuracy of 98.34%. Experimental validation confirmed the accuracy and robustness of the model predictions, demonstrating the effectiveness of the methodology in optimizing multiple parameters of complex laser cutting processes.

The effects of soy protein and soy isoflavones intake on chronic kidney disease: a systematic review and meta-analysis.

Existing literatures on the potential impact of soy protein consumption on kidney function present conflicting findings. In this study, a meta-analysis has been conducted to assess the impact of soy protein consumption in comparison to animal protein consumption among individuals with chronic kidney disease (CKD). A structured electronic search was conducted on Medline, EMBASE, and Cochrane Library for randomized controlled trials published up to March 2024. The outcome measures were serum creatinine (SCR), triglyceride (TG), total cholesterol (TC), calcium (Ca), C-reactive protein, proteinuria, high-density lipoprotein (HDL), low-density lipoprotein (LDL), uric acid (UA) and phosphorus concentrations. Mean differences were calculated for net changes using random-effects models. Eighteen trials with a total of 522 participants were included in this systematic review. The results showed that consumption of soy protein led to a significant decrease in total cholesterol, LDL, and proteinuria levels. The average reduction was - 20.55mg/dL (95% CI - 38.25, - 2.85mg/dL) for total cholesterol (P = 0.02), - 8.26mg/dL (95% CI - 13.35, - 3.17mg/dL; P = 0.001) for LDL and - 140.53 (95% CI - 205.83, - 75.23mg/day) for proteinuria. No statistically significant impact was observed on serum creatinine, triglycerides, calcium, C-reactive protein, HDL, uric acid, or phosphorus levels. The findings of the meta-analysis showed a potential protective impact of soy protein intake on hyperlipidemia and proteinuria inCKD patients. It is important to note that the evidence presented may be of limited accuracy due to relatively small number of trials and participants.

Fractional Doses of Pneumococcal Conjugate Vaccine — A Noninferiority Trial

BackgroundPneumococcal conjugate vaccines are an expensive component of the routine immunization schedule. Fractional-dose regimens may be one option to increase the sustainability of the vaccine program.MethodsWe assessed whether the immunogenicity of fractional doses of the 10-valent and 13-valent pneumococcal conjugate vaccines (PCV10 [GSK] and PCV13 [Pfizer], respectively) would be noninferior to that of the full doses and analyzed the prevalence of vaccine-serotype carriage. We randomly assigned healthy infants in Kenya to one of seven equal-sized trial groups. Participants in groups A through F were assigned to receive either a fractional or full dose of PCV10 or PCV13, administered as two primary doses plus one booster dose. In group A, participants received a full dose of PCV13; group B, a 40% dose of PCV13; group C, a 20% dose of PCV13; group D, a full dose of PCV10; group E, a 40% dose of PCV10; and group F, a 20% dose of PCV10. Participants in the seventh group (group G) received a full dose of PCV10 as three primary doses without a booster. Immunogenicity was assessed 4 weeks after the primary series of doses and 4 weeks after the booster dose. Noninferiority could be declared 4 weeks after the primary series if the difference in the percentage of participants with a threshold response was not more than 10% and 4 weeks after administration of the booster if the ratio of the geometric mean concentration (GMC) of IgG was more than 0.5. A vaccine dose was prespecified as noninferior if it met the noninferiority criterion for at least 8 of the 10 vaccine types in the PCV10 groups or at least 10 of the 13 vaccine types in the PCV13 groups. Carriage was assessed when participants were 9 months and 18 months of age.ResultsIn the per-protocol analysis, 40% of a full dose of PCV13 met the noninferiority criterion for 12 of 13 serotypes after the primary series and for 13 of 13 serotypes after the booster. The immunogenicity of the 20% dose of PCV13 and of the 40% and 20% doses of PCV10 was not noninferior to that of the full doses. The prevalence of vaccine-serotype carriage was similar across the PCV13 groups at 9 months and 18 months of age.ConclusionsIn a three-dose schedule (two primary doses and a booster), 40% doses of PCV13 were noninferior to full doses for all included serotypes. Lower doses of PCV13 and PCV10 did not meet the criteria for noninferiority. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov number, NCT03489018; Pan African Clinical Trial Registry number, PACTR202104717648755.)

Multivariate analysis for agronomic, physiological, macro, and micronutrient traits of exotic vegetable amaranth genotypes

The genus amaranth is comprised of 60–70 species. This climate hardy plant is grown as a vegetable as well as cereal crop in many areas of the world. Current study multivariate analysis was used to characterize the exotic vegetable amaranth genotypes. The experiment was conducted in the research area of Muhammad Nawaz Shareef University of Agriculture, Multan under RCBD design with three replications of 50 exotic amaranth genotype. 22 different variables were investigated for the principal component and cluster analysis using different software packages in R studio. According to the results of principal component analysis the first five PCs had eigenvalues greater than one and they explained the 84.59% diversity in exotic vegetable amaranth accessions. First two principal components explained 57.31% of variation. Traits that loaded highly for first PC include moisture (-0.892), carbohydrates (0.938), energy (0.920), stomatal conductance (0.803), net photosynthesis (0.795) and dry weight (0.770). The traits which impacted the second PC highly include protein (0.692), fat (-0.571), nitrogen (0.692), calcium (0.545), phosphorus (0.908), zinc (0.960), iron (0.826) and potassium (0.872). For future breeding program the selection based on these results will be effective for crop enhancement drive in exotic vegetable amaranth genotypes. Hierarchical clustering was done and dendrogram split the 50 genotypes into 5 groups using silhouette method. The pairwise clustering revealed that intra cluster distance is smaller than inter cluster distance. The maximum inter cluster distance was observed between cluster I and II (9.88); between cluster I and III (9.47); between cluster II and IV (9.27).Clinical trial number Clinical trial number not applicable.

Magnetic poly(phages) encoded probes-based dual-mode assay for rapid determination of live Escherichia coli and Hafnia paralvei based on microfluidic chip and ATP bioluminescence meter.

Adual-mode assay was developedfor screening and detecting live Escherichia coli (E. coli) and Hafnia paralvei (H. paralvei) (as two typical pathogens in aquatic environments) based on magnetic poly(phages) encoded probes (MPEP). The probes were prepared by grafting a large number of phages targeting different target bacteria on a long-chain DNA structure, respectively. They could specifically capture and enrich E. coli and H. paralvei by magnetic separation. Then, different DNA signal tags with different lengths conjugate with the corresponding MPEP-bacteria complex and form two kinds of sandwich structures, respectively. After that, the captured E. coli and H. paralvei were lysed to release both adenosine triphosphate (ATP) and DNA signal tags. The measurement includes two steps. Firstly, a portable ATP bioluminescence meter was employed to rapidly screen the positive samples that contain either of the two target bacteria. Secondly, only positive samples were injected into the microfluidic chip which could detect various DNA signal tags for accurate quantification of the target bacteria. The assay demonstrated high sensitivity (3 CFU/mL for E. coli and 5 CFU/mL for H. paralvei), high specificity (strain identification), signal amplification (20-fold), and short time (≤ 35 min). It can be applied to detect other pathogens solelyby changing the relative phage in MPEP. Furthermore, the proposed dual-mode assay provides a wide prospect for rapid screening and accurate determination of live foodborne pathogens. Clinical Trial Number: nbdxms-20240322.

Excitation of the bottom-up pathways has no effect on remote muscle fatigue in healthy participants.

The aim of this study is to investigate the effect of induced excitation of the bottom-up pathways at the lateral elbow muscles on local muscle fatigue in the neck region in healthy participants. Eligible participants (n:55) were randomly allocated to an intervention group (n:28) or a control group (n:27). The fatigue of bilateral neck flexor(sternocleidomastoid) and extensor (upper trapezius) muscles was evaluated using surface electromyography, at baseline and immediately post-intervention during a neck flexor and extensor endurance test respectively. Excitation of the bottom-up pathways was performed at multiple lateral elbow muscles in the intervention group by using a temporal summation protocol of mechanical pain, and the pressure pain threshold was determined once in each of the multiple lateral elbow muscles in the control group. Linear mixed model analyses were performed for each outcome measure to evaluate changes over time and within- and between-group differences. No significant "group X time" interaction effects were detected for any of the outcome measures. Significant main effects for time was found for "amplitude over time" of the left upper trapezius (p:0.003) and right sternocleidomastoid muscle (p: 0.013), and for "amplitude changes" of the left upper trapezius muscle (p:0.021). Significant within-group changes were identified in some outcomes in the control group: increased "amplitude over time" of the right sternocleidomastoid muscle (p:0.024) and decreased "amplitude changes" of the left upper trapezius muscle (p:0.024), decreased "normalized median frequency slope over time" of the left UT (p: 0.013). There were no significant within-group changes in the intervention group. No significant between-group differences for any of the outcome measures were found. This study shows no effect of the induction of excitation of the bottom-up pathways at the lateral elbow muscles on the neck muscles' fatigue characteristics compared to a control intervention. Clinical Trial Number: NCT05146960. Date of Registration: December 7, 2021.

Multiomics approaches disclose very-early molecular and cellular switches during insect-venom allergen-specific immunotherapy: an observational study

Allergen-specific immunotherapy (AIT) induces immune tolerance, showing the highest success rate (>95%) for insect venom while a much lower chance for pollen allergy. However, the molecular switches leading to successful durable tolerance restoration remain elusive. The primary outcome of this observational study is the comprehensive immunological cellular characterization during the AIT initiation phase, whereas the secondary outcomes are the serological and Th2-cell-type-specific transcriptomic analyses. Here we apply a multilayer-omics approach to reveal dynamic peripheral immune landscapes during the AIT-initiation phase in venom allergy patients (VAP) versus pollen-allergic and healthy controls. Already at baseline, VAP exhibit altered abundances of several cell types, including classical monocytes (cMono), CD4+ hybrid type 1-type 17 cells (Th1-Th17 or Th1/17) and CD8+ counterparts (Tc1-Tc17 or Tc1/17). At 8-24 h following AIT launch in VAP, we identify a uniform AIT-elicited pulse of late-transitional/IL-10-producing B cells, IL-6 signaling within Th2 cells and non-inflammatory serum-IL-6 levels. Sequential induction of activation and survival protein markers also immediately occur. A disequilibrium between serum IL-6 and cMono in VAP baseline is restored at day seven following AIT launch. Our longitudinal analysis discovers molecular switches during initiation-phase insect-venom AIT that secure long-term outcomes. Trial number: NCT02931955.

Association between stress hyperglycemia ratio and mortality in acute myocardial infarction patients with and without atrial fibrillation: a retrospective cohort study from the MIMIC-IV database

BackgroundThe stress hyperglycemia ratio (SHR) potently predicts adverse outcomes in patients with acute myocardial infarction (AMI), and previous studies reported U-shaped relationships between SHR and adverse prognosis. However, the relationship between SHR and mortality risk in AMI patients with or without atrial fibrillation (AF) remained unknown, and which factors affect the mortality in lower SHR patients were unclear. This study aims to research the relationship between SHR and mortality risk in AMI patients with or without AF, and whether AF affects the mortality in lower SHR patients.MethodsWe conducted a cohort study using data from 3233 patients with a first diagnosis of AMI from the MIMIC-IV (version 2.2) database. Patients were divided into two groups based on AF. The study outcome was 1-year all-cause mortality. SHR was defined as the index calculated by the formula: SHR = (admission glucose) (mmol/L) / (1.59 * HbA1c [%] – 2.59).ResultsU-shaped association between SHR and all-cause mortality was found only in AMI patients with AF, not in AMI patients without AF. For AMI patients with AF, the inflection point for the curve was found to be a SHR of 1.09, either lower (OR, 0.30; 95%CI, 0.10, 0.94) or higher (OR, 3.28; 95%CI, 2.01, 5.34) SHR is associated with increased mortality. However, a linear relationship was found in patients without AF, higher (OR, 1.95; 95%CI, 1.52, 2.51) SHR is associated with increased mortality. For patients with SHR ≤ 1.09, AF increased the risk of all-cause mortality(OR, 1.50; 95%CI, 1.10, 2.05), while this effect was not found in patients with SHR > 1.09.ConclusionThe association between SHR and mortality in AMI patients with or without AF is different: U-shaped association between SHR and all-cause mortality only in AMI patients with AF, not in AMI patients without AF. AF is a factor that make the difference by increasing the risk of mortality in AMI patients with low SHR. Lower SHR may increase mortality through the onset of AF. This study emphasizes avoiding “relative hypoglycemia”, SHR = 1.09 is the moderately tight glycemic control, which means glucose level is about (1.59 * HbA1c [%] – 2.59) * 1.09 mmol/L.Trial registrationClinical trial number: not applicable.

Enhancing Lignin‐Carbohydrate Complexes Production and Properties with Machine Learning

Lignin‐carbohydrate complexes (LCCs) present a unique opportunity for harnessing the synergy between lignin and carbohydrates for high‐value product development. However, producing LCCs in high yields remains a significant challenge. In this study, we address this challenge with a novel approach for the targeted production of LCCs. We optimized the AquaSolv Omni (AqSO) biorefinery for the synthesis of LCCs with high carbohydrate content (up to 60/100 Ar) and high yields (up to 15 wt%) by employing machine learning (ML). Our method significantly improves the yield of LCCs compared to conventional procedures, such as ball milling and enzymatic hydrolysis. The ML approach was pivotal in tuning the biorefinery to achieve the best performance with a limited number of experimental trials. Through Pareto front analysis, we identified optimal trade‐offs between LCC yield and carbohydrate content, discovering extensive regions that produce LCCs with yields of 8‐15 wt% and carbohydrate contents ranging from 10‐40/100 Ar. We measured the glass transition temperature (Tg), surface tension, and antioxidant activity of the LCCs. Notably, we found that LCCs with high carbohydrate content generally exhibit low Tg and surface tension. Our biorefinery concept, augmented by ML‐guided optimization, represents a significant step toward scalable production of LCCs with tailored properties.

Depression, performance status, and discontinued treatment mediate an association of curability belief with prognosis in advanced cancer patients

Individuals diagnosed with advanced cancer often experience stress and depression, factors linked to worse survival. Curability belief—defined as the hope and expectation of cure through treatment, based on affective forecasting—may differ from the patient’s actual life expectancy (i.e., likelihood estimation) and has shown variable associations with cancer survival. In this study, multivariate Cox regression analyses were used to examine the effect of curability belief and depression on 1-year survival after adjustment for physical factors. Additionally, regularized partial correlations among physical and psychological factors were assessed using mixed graphical models to elucidate their roles in mediating the relationship between curability belief and 1-year survival. This multi-center cohort study, conducted across 13 tertiary hospitals (including four ranked among the ‘World’s Best Specialized Hospitals 2025’ in oncology), involved 382 adults with stage IV advanced cancer and an oncologist-estimated survival of more than 6 months. Baseline data included demographics, primary tumor site, number of metastatic sites, symptom burdens (EORTC QLQ-C15-PAL), performance status (ECOG-PS), depression levels (PHQ-9), anti-cancer treatment type, patient’s life expectancy estimation, and curability belief. Follow-up data included 1-year survival and end-of-life care (place of death) for deceased patients. Multivariate Cox proportional hazards models were used to assess adjusted hazard ratios (aHRs) for curability belief, depression, and their interaction on 1-year survival, adjusting for significant demographic and clinical factors from univariate Cox regressions. The Kaplan–Meier method was used to plot survival probability by curability belief and depression interaction. Mixed graphical models estimated regularized partial correlations among 1-year survival, curability belief, patient’s life expectancy, depression, primary tumor site, anti-cancer treatment type, performance status, and symptom burden. In terms of healthcare utilization, patients with curability belief were more likely to receive standard or advanced anti-cancer therapy, while those without curability belief tended to suspend or discontinue therapy (P < 0.001). Among patients who did not survive the 1-year follow-up (N = 161), end-of-life care settings differed significantly between those with curability belief (predominantly nursing homes and home settings) and those without (primarily hospice and tertiary/secondary hospitals; P = 0.036). In multivariate Cox regression, curability belief (P = 0.003), depression (PHQ-9 score ≥ 10; P = 0.003), and their interaction (P = 0.040) were significantly associated with 1-year survival, after adjusting for sex, residential area, primary tumor site, performance status, anti-cancer treatment type, and symptom burdens (fatigue and appetite loss). The relationship between curability belief and 1-year survival was significant only in patients without depression [PHQ-9 score < 10; aHR (95% CI) = 2.20 (1.31–3.70); P = 0.003]. In the mixed graphical model, node predictability values for curability belief, depression, and 1-year survival were 0.68, 0.50, and 0.70, respectively, with curability belief showing partial correlations with depression (r = 0.30) and patients’ life expectancy (r = 0.20); depression correlated with fatigue (r = 0.53), anorexia (r = 0.16), life expectancy (r = 0.24), performance status (r = 0.23), and curability belief; and 1-year survival correlated with suspended/stopped anti-cancer treatment (r = 0.45), primary tumor site (r = 0.24), and performance status (r = 0.15). Partial correlations of performance status with depression and discontinued treatment mediated the association between curability belief and 1-year survival. Curability belief among stage IV advanced cancer patients with an oncologist-estimated survival of over 6 months was associated with depression levels and patients’ perceived life expectancy estimations. Performance status, depression, and anti-cancer treatment status mediate the relationship between curability belief and improved 1-year survival in patients without depression. Further research using longitudinal modeling of depression, performance status, and healthcare utilization, with curability belief and primary tumor site as covariates, is warranted.Trial registration: Clinical Trial Number (ClinicalTrials.gov): NCT03222258; Study Registration Dates (First submitted: 2017-06-05; First submitted following the QC criteria: 2017-07-16; First posted: 2017-07-19).

Clinical characteristics and outcomes of patients on haemodialysis at Jimma medical center, Ethiopia: a 7-Year review

BackgroundHaemodialysis is the primary kidney replacement therapy modality in Africa. In Ethiopia, the number of patients undergoing Haemodialysis is increasing, yet data on their outcomes is scarce. This study assesses the clinical characteristics and outcomes of Haemodialysis patients at Jimma Medical Center.MethodsA retrospective cross-sectional study was conducted from April 08 to 12, 2024, involving patients who underwent Haemodialysis at Jimma Medical Center from June 2017 to March 2024. The data were coded and entered into EpiData version 3.1, then exported to the Statistical Package for Social Sciences version 26.0 for analysis. Descriptive statistics summarized the patients’ clinical characteristics and outcomes, and Kaplan-Meier curves were used to assess survival status.ResultsDuring the seven-year study period, 68 patients underwent Haemodialysis at Jimma Medical Center, with a predominance of males (69.1%). The average age of patients was 42.7 (± 12.8) years with 69.1% (95% CI: 57.5–79.1%) diagnosed with chronic kidney disease, while 30.9% (95% CI: 20.9–42.5%) had acute kidney injury. Among chronic kidney disease patients, common clinical features included nausea and vomiting (100%), proteinuria (95.7%), and body swelling (82.9%), while acute kidney injury patients frequently presented with oliguria (100%), nausea and vomiting (90.5%), and hematuria (52.4%). Hypertensive nephropathy was the leading cause of chronic kidney disease (40.4%), and acute glomerulonephritis (38.1%) and severe malaria (33.3%) were the predominant causes of acute kidney injury. Mortality was observed at 47.6% (95% CI: 27.7–68.6%) in acute kidney injury patients and 40.4% (95% CI: 27.3–54.7%) in chronic kidney disease patients. Emergency vascular access was required in 95.7% of chronic kidney disease and 100% of acute kidney injury patients.ConclusionThis study highlights the substantial burden of chronic kidney disease and acute kidney injury among hemodialysis patients at Jimma Medical Center, revealing distinct clinical profiles and outcomes. Although acute kidney injury patients exhibited a longer median survival time, the significant mortality risk within the first year underscores the urgent need for improved treatment access and resource allocation. Enhancing early intervention and ensuring the availability of critical medications, such as erythropoietin, are essential for optimizing patient outcomes for both chronic kidney disease and acute kidney injury groups.Clinical trial number:Not applicable

The effectiveness of online educational interventions on impostor syndrome and burnout among medical trainees: a systematic review

BackgroundImpostor syndrome and burnout are highly prevalent among medical students and trainees, significantly impacting their mental health and professional development. The advent of online educational interventions provides a promising solution, offering accessibility and flexibility to tackle these issues. This systematic review aims to evaluate the effectiveness of online educational interventions in alleviating impostor syndrome and burnout among medical learners.MethodsA comprehensive literature search was conducted across PubMed, Cochrane Library, Embase, Scopus and PsycInfo, identifying relevant studies published up to March 2024. Studies focusing on online interventions targeting impostor syndrome and burnout among medical students, residents, and fellows were included, and their quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).ResultsAmong the screened studies, six met our inclusion criteria, comprising four randomized controlled trials, one qualitative study, and one mixed-methods study. Their mean MERSQI score was 14.67 (SD 1.23), indicating a high methodological quality. The interventions adopted in these studies varied, including group coaching sessions, workshops, and provision of educational resources. Notably, two randomized trials demonstrated significant reductions in impostor syndrome symptoms after online interventions, compared with the control groups. On the other hand, results for burnout outcomes were equivocal, with some studies reporting improved emotional exhaustion scores and decreased burnout risk, while others found no significant differences.ConclusionsCurrent evidence suggests that structured online educational interventions, particularly those incorporating coaching and cognitive reframing strategies, can effectively reduce impostor syndrome among medical trainees. However, the impact on burnout remains inconclusive. Further research is needed to optimize online program components and implementation strategies to comprehensively address both impostor syndrome and burnout in this population.Clinical trial numberAs this is a systematic review rather than a clinical trial, no clinical trial number is applicable. Nonetheless, this systematic review has been prospectively registered with PROSPERO (registration number: CRD42024541034), in line with best practice recommendations for systematic reviews.