Mechanistic insights and therapeutic innovation in immune-related adverse events.

The tumor microenvironment (TME) plays a pivotal role in immuno-oncology, influencing cancer progression and treatment outcomes. Among its components, stromal tumor-infiltrating lymphocytes (sTILs) represent important prognostic and predictive biomarkers in breast cancer. However, visual assessment of sTILs is complex, time-consuming, and subject to inter-observer variability. To address these challenges, we propose an AI-based framework for sTILs quantification in hematoxylin and eosin (H&E)-stained breast cancer histopathological images across different molecular subtypes, in accordance with the recommendations of the International Immuno-Oncology Biomarker Working Group (IIOBWG). The framework integrates two parallel and explainable segmentation models trained on multi-center data: an attention-based model for TILs detection and a stroma segmentation model designed to identify both tumoral and infiltrated stromal regions as a unified clinically relevant compartment. The resulting segmentation outputs are combined through a scanner resolution-aware quantification algorithm, enabling robust sTILs scoring across data acquired from different scanners and institutions. The proposed framework was externally validated on two independent private datasets comprising 60 and 112 whole-slide images with expert-annotated Region Of Interests (ROIs). Strong agreement with expert pathologist scoring was achieved (Pearson correlation up to 0.73; Concordance Correlation Coefficient (CCC) up to 0.72), and the framework consistently outperformed state-of-the-art approaches when evaluated on the same data. These results demonstrate that the proposed framework provides a reliable, efficient, and scalable solution for standardized sTILs quantification, supporting its potential utility in both clinical practice and translational research.

Defining diagnostic disclosure in the acute care setting: A concept analysis.

Do somatic symptoms bias depression screening? Reliability and equivalence of PHQ-8 in those with and without chronic pain: A nationally representative study of U.S. adults.

High-quality data selection-driven instruction tuning for biomedical large language models.

Return-to-school protocols in pediatric concussion care.

Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care. To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research. This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included. The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care. Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families. The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.

Investigating the rates of change in depressive symptoms for adults in individual, couple, and family therapy.

Artificial intelligence in diagnostic software: validation, safety, and lifecycle challenges in Europe.

Evidence on the health needs of UK veterans accessing primary care is limited. Electronic health records (EHRs) offer an opportunity to address this evidence gap if veterans are correctly identified. This study validated the identification of veterans in the Clinical Practice Research Datalink (CPRD) and assessed its feasibility for examining their health compared with non-veterans. We conducted a matched cohort study in CPRD, the largest primary care database in the UK, identifying veterans using military-related codes in patients' EHRs. Each veteran was matched to one or two non-veterans on age, gender, practice, and index date. Validation was undertaken through general practitioner confirmation of veteran status. We compared demographics, risk factors and recorded health conditions using descriptive statistics. Poisson regressions assessed the association between veteran status and various physical and mental health conditions. 122,484 veterans and 244,573 matched non-veterans were identified. 95% were captured using definite military terms, and validation showed substantial agreement with GP records. Veterans had higher recorded prevalence across all conditions. The largest differences were observed for PTSD (adjusted prevalence ratio [aPR] 16.43, 95% CI 14.89-18.13), followed by Alzheimer's disease (aPR 2.74, 95% CI 2.56-2.92), alcohol use disorder (aPR 2.23, 95% CI 2.09-2.39), hearing loss (aPR 2.09, 95% CI 2.02-2.15), and osteoarthritis (aPR 1.98, 95% CI 1.93-2.03). Recorded prevalence was also higher among veterans for COPD (aPR 1.83, 95% CI 1.77-1.89), depression (aPR 1.83, 95% CI 1.79-1.87), prostate cancer (aPR 1.83, 95% CI 1.73-1.94), coronary heart disease (aPR 1.78, 95% CI 1.72-1.84), lower back pain (aPR 1.73, 95% CI 1.70-1.77), and myocardial infarction (aPR 1.65, 95% CI 1.56-1.75). Differences for anxiety and breast cancer were modest. This study establishes a foundation for UK veterans' health research using primary care data. Provided that identification and recording of veteran status improve in NHS records, CPRD offers considerable potential to monitor veteran health trends, identify needs, and evaluate interventions at scale.

Growing availability of laboratory test result information in large healthcare databases presents opportunities to improve confounding control. Whilst information on the ordering of tests and the resulting continuous test values are available, their optimal integration into data-driven confounding control strategies like the high-dimensional propensity score (HDPS) remains unclear. We propose methods to incorporate test-related data into HDPS, addressing key concerns around data quality and missing data. We illustrate these approaches using UK Clinical Practice Research Datalink GOLD data comparing COPD-specific mortality in new-users of proton pump inhibitors (PPIs) and H2-receptor antagonists (H2RAs). Hazard ratios (HRs) were estimated using Cox models weighted by inverse HDPS. Integration of 35 blood-test values was achieved via biologically informed cut-offs and using a missing-indicator approach for continuous data. Results were benchmarked against a HDPS model derived from clinical, referral, and prescription data dimensions. Among 733,885 new PPI and 124,410 H2RA users, the adjusted HR for PPI use and COPD mortality was 1.36 (95% CI: 1.14-1.64) in the primary HDPS analysis. Incorporating test-requested data and continuous blood test values attenuated estimates towards the expected null association (HR 1.24; 95% CI: 1.02-1.56). Of the 500 HDPS covariates selected in the final model, 46% were derived from test-related data. We empirically evaluated methods for incorporating laboratory test results into the HDPS framework, demonstrating their potential to reduce residual confounding in UK EHR studies. We propose principled approaches for incorporating laboratory test result data into data-driven confounding control strategies. Results from our case study highlight the potential for these data to reduce residual confounding in UK EHR studies. When available, test information should be considered within HDPS.

Autistic people often experience mental and physical health challenges that require high-quality healthcare. However, several barriers hinder their access to healthcare, including difficulties communicating in healthcare settings. Communication-related barriers might differ between countries but have been mainly investigated in high income countries. Less is, therefore, known about the barriers to access to healthcare in middle-income countries such as Georgia. In this study, we investigated challenges in communication between autistic people, parents and non-autistic healthcare professionals for the first time in Georgia. We report qualitative data from three focus groups comprising seven autistic participants (aged 13-29 years), two healthcare specialists (a child psychiatrist and a paediatrician), and four mothers. The findings revealed that autistic people and parents of autistic individuals often experience communication breakdowns in healthcare settings and beyond. Limited knowledge of autism among professionals, as well as the lack of services and support remain a big problem, affecting the lives of autistic people. These findings have implications for healthcare practice and future research and policy in Georgia and other countries with similar socio-political characteristics.

ABSTRACT Although research emphasizes strategy and technology concerns in organizational digitalization, we have limited understanding of how digital initiatives interrelate these concerns over time. Against this backdrop, we conducted a clinical inquiry into the Connected Restroom Initiative at Georgia-Pacific with its trajectory through four stages: idea-focused initiation, technology-focused experimentation, customer-focused commercialization, and process-focused consolidation. Empirically, we offer a detailed account of how the initiative iteratively orchestrated strategy moves of competitive positioning, resource reconfiguration, and organizational renewal together with architecture moves of event sensing, trace analysis, and platform co-creation within and across its stages. Conceptually, we draw on these insights and extant literature to develop a grounded model of how the initiative dynamically interrelated strategy and architecture moves as a structured, incremental response to the dynamic business landscapes in which it unfolded. We conclude with a discussion of implications for theory, practice, and clinical IS research.

ABSTRACT This study examines how artificial intelligence (AI) is reshaping educational policies in the United States, with a focus on California, Texas, Florida, and New York. Drawing on policy diffusion theory and institutional isomorphism, this study examines state-level policy approaches to AI integration, equity, and ethics in K–12 education within the broader federal policy context. Data were drawn from policy briefs, executive orders, task force reports, guidance documents, and policy updates issued between January 2023 and January 2026. Using structured juxtaposition, the analysis examines cross-state variation in policy approaches and the extent to which federal guidance, equity, and ethical concerns are reflected in state-level responses. Findings reveal emerging patterns of convergence and divergence between federal guidance and state legislation shaped by political support, institutional capacity, and policy priorities. This study contributes to the literature by identifying emerging patterns of AI governance across states, clarifying the role of federal guidance as a normative reference point, and advancing understanding of how equity and ethical considerations are embedded in state AI education policies. This study also highlights implications for educational policy, practice, and future research to ensure AI in K-12 education is adopted in ethical and equitable ways within a decentralized federal system.

Abstract Purpose The Open Researcher and Contributor Identifier (ORCID) is becoming the de facto standard for researcher identification in scholarly communication, providing a persistent unique identifier and a registry that functions as a digital CV. The purpose of this study is to analyse the ORCID profiles of a selected group of leading researchers to analyse creation, completion, and updating of their records, with particular attention to the Works section. Design/methodology/approach We focus on the 357 grants awarded by the European Research Council (ERC) to researchers with a Spanish host institution between 2014 and 2020, for whom a high degree of ORCID adoption has been reported. Data included in their ORCID records were downloaded and the completion and dynamics of Personal Information and Activities sections are studied. Differences by domain and researcher career stage are explored. Findings All ERC researchers have an ORCID iD, and in most cases, their records are publicly available. ORCID profile completion is quite high in the Activities sections, particularly Works and Employment, and lower in the Personal Information sections. Most of the profiles were created by the users themselves and had been updated recently (75 % in the last three months). Sections that allow for automatic input tend to show higher completion rates and are more recently updated. Although ORCID accepts all kind of research outputs, journal articles form the majority (84 %) in our study. Works are added to profiles mainly by commercial entities (especially Elsevier and Clarivate), with non-profit organisations (e.g., Crossref) a distant second. Only 10 % of works are included by researchers themselves. Research limitations As the study examines a particular group of elite researchers, their practices regarding profile completion and updating cannot be generalized to other researcher populations. Practical implications ERC-funded researchers show quite high engagement with the ORCID system, but there is uneven completion of record sections and data quality issues that need to be addressed to improve the system and consolidate identifier use. Originality/value ORCID record completion, work collection and updating behaviour have been insufficiently explored to date. The study of a population of leading researchers helps reveal ORCID record completion practices, as well as data quality issues and controversial approaches to work collection.

The fast adoption of Generative AI in corporate sustainability communication has inevitably created a new paradox in modern-day green marketing: on one hand, brands can use AI to create highly personalized and emotionally engaging ecological messaging on scale, and on the other hand, there is an increased suspicion among consumers regarding the accuracy of AI-generated environmental claims. Descriptive research is used to investigate the nature and distribution of consumer's reactions (trust and skepticism towards the Greenwashing) in the context of the communication of green marketing with the help of AI in urban consumers in India. The study has been conducted across four big urban cities of India with the use of structured questionnaire, which is administered to 400 respondents across four cities; in this way, the prevalence of such responses has been mapped across the four different segments of respondents, the co-occurrence of such responses has been mapped and the mediating role of brand transparency and message credibility, as perceived by these respondents, has been documented. The findings indicate that the combined effect of curiosity and suspicion arises when meeting green content generated with AI, that the greenwashing skepticism is much higher among the respondents with a higher degree of digital literacy and previous experience with greenwashing, and that the disclosure of the use of AI has a significant influence on the audience's perception of the content as being trustworthy. The paper concludes with a descriptive framework that can take into account the dual response dynamics of consumer communication on sustainability issues when the media is shaped by AI and offers proposals for practice and future causal research.

Previous work has highlighted that children and adolescents with migraine are underdiagnosed and undertreated in primary care. To characterise diagnosis and treatment patterns among children and adolescents with migraine in primary care. A retrospective cohort study using the Clinical Practice Research Datalink Aurum. The study cohort included patients aged 6-17 years presenting to primary care practices with headache/migraine in England between September 2012 to May 2023 ("index" event). Prescribed medications, primary care consultation and referral rates 12 months after index were investigated. Medication overprescription was defined as per the ICHD-3 definition of medication overuse headache. 246 744 children (6-12 years) and adolescents (13-17 years) were observed attending primary care with headache/migraine. The majority of headache was unclassified (67.6%), particularly in children compared to adolescents (77.6% v 57.9%). Primary headache disorders accounted for 31.3% of headache presentations, higher in adolescents compared to children (40.9% v 21.4%). Migraine was the most common primary headache disorder (N=67,059, 86.9%), constituting the final sample for subsequent analyses.Acute medication was prescribed to 28,478 (45.7%), and preventive medication for 17,153 (27.5%). Paediatric clinics referral rates were 14 referrals per 100-person-years. Medication overprescription was observed in 26.0% of triptan users. Most headache cases presenting to primary care in England remain unclassified, particularly in children (6-12 years). Compared to previous research, more children and adolescents were prescribed medication for migraine in primary care and fewer were referred to secondary care. Evidence of suboptimal medication use was still observed in this study.

To examine primary care contacts among individuals with eating disorders (EDs) and assess differences across diagnoses and ethnic backgrounds. Matched cohort study using retrospective primary care data. Primary care electronic health records from the Clinical Practice Research Datalink (CPRD) and linked Hospital Episode Statistics (HES) covering 1 January 2010 to 31 December 2023. 46 473 individuals aged 18-65 years, with a recorded ED diagnosis or a referral to ED services, matched by age, sex and practice location (ratio 1:3) to 145 286 individuals without an ED. The primary outcome was the number of primary care contacts in 24 months prior to ED diagnosis or referral to ED specialist service. Secondary outcomes examined whether ethnicity impacted likelihood of referral to specialist ED services. Most individuals had a diagnosis of anorexia nervosa (43.0%), followed by bulimia nervosa (13.8%) and other specified feeding and ED (6.6%). 40.6% were aged 18-25 years, 79.5% were female and ethnicity was predominantly White (83.7%), with smaller proportions Asian (6.3%) and Black (3.4%). Compared with non-ED controls, cases had approximately double the rate of primary care contacts (incidence rate ratio (IRR)=1.96, 95% CI 1.94 to 1.98). Elevated contact rates were observed across all ED diagnostic groups, with IRRs ranging from 1.78 (95% CI 1.75 to 1.82) for anorexia nervosa to 2.45 (95% CI 2.09 to 2.88) for avoidant/restrictive food intake disorder (all p<0.001). Contact rates were significantly lower across all minoritised ethnic groups compared with White individuals. Referral odds were significantly lower among Asian (OR=0.78, 95% CI 0.65 to 0.94) and Black patients (OR=0.56, 95% CI 0.41 to 0.79). There is a need to increase ED awareness within minoritised communities, alongside culturally inclusive primary care adaptations to support help-seeking for EDs. Targeted education for clinicians and patients in primary care may also improve screening and recognition of EDs across diverse presentations and communities, facilitating access to timely, evidence-based care. The dataset from this study is held securely at the Medicines and Healthcare products Regulatory Agency. Access may be granted on completing a data request. The CPRD Ethnicity Record sources underlying data from HES and primary care data copyright 2025, re-used with the permission of The Health & Social Care Information Centre.

Efficient preventive management of acute exacerbation of chronic obstructive pulmonary disease (COPD) is predicated on accurate risk stratification. We compared the performance of exacerbation history (current standard of care) versus a revised version of a multivariable risk scoring tool (Acute COPD Exacerbation Prediction Tool (ACCEPT)) using primary-care UK data. We used validated case definitions to identify diagnosed patients with COPD ≥40 years old from the UK Clinical Practice Research Datalink Aurum (2004-2020). For each patient, a single annual COPD visit was randomly selected as the index date. The outcome was the occurrence of ≥1 moderate/severe exacerbation(s) within a year of the index date. We conducted time-to-event analyses of the latest version of ACCEPT (ACCEPT 2.0) and developed a recalibrated version (ACCEPT 3.0-UK). Model performance was evaluated using discrimination (time-dependent area under the receiver operating characteristic curve (AUC)), calibration and net benefit. The final cohort included 158 384 patients (55.0% male; mean age 71.5 years). ACCEPT 2.0 achieved an AUC of 0.77 for predicting moderate/severe exacerbations, outperforming both any and frequent exacerbator categories (AUC: 0.69 and 0.67, respectively). However, it overpredicted exacerbation events (observed-to-expected (O/E) ratio: 0.81 (95% CI 0.80 to 0.81)). Recalibration resolved this overprediction, yielding O/E ratio of 1.00 (95% CI 0.99 to 1.00), while maintaining discrimination (AUC: 0.77). ACCEPT 3.0-UK was net beneficial and superior to exacerbation history across a wide range of risk thresholds. ACCEPT 3.0-UK has substantially higher performance than exacerbation history, quantifies predicted risks for shared decision-making and is likely to confer clinical utility for risk stratification in primary care.

This systematic review examined associations between interoceptive processes and psychotherapeutic outcomes-including interoception as a pre-therapy client factor, as a pre-post change measure and as a therapeutic outcome in itself-and identified intervention protocols promoting interoceptive abilities, while evaluating how interoception is defined and measured within psychotherapy. Following PRISMA 2020 guidelines and PROSPERO registration, searches were conducted in PubMed, PsycINFO, CINAHL, Web of Science and Scopus. Eligible studies involved adults undergoing psychotherapy, assessed interoception using validated self-report or physiological measures, and reported therapeutic outcomes. Twenty-one studies were synthesized using thematic analysis and the PICO framework. Improvements in interoceptive functioning, particularly interoceptive awareness, bodily trust and self-regulation, were associated with reductions in psychological symptoms, including eating disorder pathology, depression, anxiety and distress. Interoception emerged as a transdiagnostic process across diagnostic groups. Interoception is clinically relevant in psychotherapy, yet evidence is shaped by predominantly top-down conceptualizations. Integrating behavioural and psychophysiological measures may clarify bottom-up mechanisms of therapeutic change. This integration can inform assessment strategies and support more embodied, process-oriented psychotherapeutic research in practice.