Tag: pubmed

A A Pract. 2026 Apr 15;20(4):e02183. doi: 10.1213/XAA.0000000000002183. eCollection 2026 Apr 1.

ABSTRACT

BACKGROUND: Preoperative chart review is time-consuming and prone to errors, particularly for cardiopulmonary conditions that impact anesthetic planning. We developed a guideline-aligned “clinical insight bot” that mines free-text documentation to surface perioperative cardiovascular risk signals relevant to the 2024 Mult Society perioperative guideline for noncardiac surgery.

METHODS: We analyzed 1000 de-identified medical cases from the PhysioNet MIMIC database. Medical terminology was extracted using regex-based NLP and categorized into 13 clinical specialties. Text features were encoded using TF-IDF vectorization and 1536-dimensional semantic embeddings stored in a PostgreSQL vector database (pgvector). Four machine learning models-Logistic Regression, Random Forest, Support Vector Machine (SVM), and Naive Bayes-were trained with stratified fivefold cross-validation to classify cases as “cardiopulmonary-only” versus “mixed/other.” Performance was evaluated using accuracy, precision, recall, and F1 score, with statistical comparison via McNemar’s test and bootstrap confidence intervals.

RESULTS: In a held-out test set of 200 notes (28 positive; 172 negatives; ~14% prevalence), a linear support vector machine achieved the best overall balance (F1 ≈ 0.71), with high precision (positive predictive value 0.94) and very low false positive rate (FPR) (1/172 ≈ 0.6%). False negatives were the dominant residual error class. The pipeline processed documents near-instantaneously and, when scaled to 1000 notes, replaced on the order of tens of clinician review hours (≈100× efficiency gain) while maintaining performance across common preoperative document types.

CONCLUSIONS: A lightweight, guideline-aligned insight bot can transform unstructured preoperative notes into concise, stepwise prompts that flag cardiovascular risk signals before the day of surgery. High precision with a very low FPR supports safe integration with anesthesiology workflows by minimizing paging noise, whereas time savings create operational and financial value. Future work should emphasize multicenter validation, structured data fusion (including labs, imaging, and vitals) to improve sensitivity, and prospective evaluation of downstream clinical and operational outcomes.

PMID:41985030 | DOI:10.1213/XAA.0000000000002183

Adv Sci (Weinh). 2026 Apr 15:e22070. doi: 10.1002/advs.202522070. Online ahead of print.

ABSTRACT

Ecosystem services (ES) link ecosystems and human societies, yet approaches to ecosystem service flow (ESF) are constrained by ambiguous definitions and limited process-oriented and scale-sensitive classifications. Here, we developed a “supply-demand-flow” framework distinguishing potential and actual supply and demand, and classifying ESF into in situ, interior, and exterior flows. Integrating multi-source datasets, biophysical models (InVEST, RUSLE, i-Tree), and socio-economic accounting based on population-consumption dynamics and sectoral statistics, we mapped nine ES across China from 2000 to 2020 at 1 km resolution. Results revealed pronounced ES supply and demand spatio-temporal heterogeneity. While the national ESF pattern remained stable, most services showed increasing exterior reliance, whereas water yield and tourism recreation became more locally sustained. Using flow balance and demand fulfillment as policy-proximal indicators, five management zones were delineated: local-sustained counties dominated southern China (∼30%); local-pressured types occurred in the Northeast, Qinghai-Tibet, and southwestern areas (∼15%); external-pressured types occurred in arid northwestern regions (1%-3%); southeastern coasts shifted toward external-sustained types (∼30%); and dynamic-transitional counties (∼20%) were scattered nationwide. By decomposing supply-demand relations into supply realization, spatial reallocation, and demand fulfillment, our framework helps align ecological functions with management priorities and offers insights for reconciling development and conservation in comparable socio-ecological contexts.

PMID:41984530 | DOI:10.1002/advs.202522070

JMIR Form Res. 2026 Apr 15;10:e88512. doi: 10.2196/88512.

ABSTRACT

BACKGROUND: The rapid evolution of digital technologies has transformed health, mental health, and social care, offering new modalities of digital care, assistance, and support through web-based platforms, mobile apps, extended reality, wearables, and artificial intelligence systems. Despite this proliferation, there is little consensus on what constitutes “high-quality” digital care. Challenges persist regarding data security, interoperability, accessibility, sustainability, and professional competence, whereas existing standards and regulations provide fragmented guidance.

OBJECTIVE: This study aimed to develop a contextualized, consensus-based quality assessment framework for digital care, assistance, and support in Flanders, Belgium. For this purpose, perspectives across technology, organizational processes, and professional competencies were integrated.

METHODS: The study used a multiphase design comprising (1) 10 expert interviews with Flemish government officials; (2) a narrative literature review of 303 peer-reviewed and gray literature sources; (3) a 3-round Delphi study with 50 experts across 5 domains (end users, facilitators, technology developers, deontology and ethics experts, and digital inclusion and media literacy experts); and (4) 4 complementary focus groups and 3 interviews with specialists in artificial intelligence, regulation, social work, mental health, and IT. The Delphi rounds gathered iterative feedback through open-ended elicitation, structured rating, and classification of quality criteria. Quantitative data were analyzed using descriptive statistics, whereas qualitative feedback was subjected to thematic analysis.

RESULTS: A total of 50 experts participated in round 1, a total of 40 (80%) participated in round 2, and 27 (54%) participated in round 3. Round 1 generated 577 unique quality criteria, consolidated into 26 clusters organized under 3 pillars: technology, organization, and professional competencies. The relative importance across pillars was balanced (mean score 37.29, SD 12.38 for technology; 33.33, SD 10.39 for professional competencies; and 29.80, SD 10.45 for organizations). Accessibility, reliability, and safety ranked highest for the technology; vision, quality monitoring, and infrastructure ranked highest for organization; and support, digital competencies, and ethics ranked highest for professional competencies. The finalized framework included 112 criteria, of which 35 (31.3%) were designated as optional and 77 (68.8%) were designated as minimum requirements. Focus groups and interviews validated the framework’s comprehensiveness and usability, emphasizing proportional implementation, user centrality, and alignment with European Union regulations. Stakeholders highlighted the need for tools, training, and governance mechanisms to ensure adoption and sustainability.

CONCLUSIONS: This study produced a codeveloped, context-sensitive quality assessment framework that balances technological robustness, organizational readiness, and professional competence in digital care, assistance, and support. The framework can serve both as a quality safeguard and a developmental road map. Accompanying self-assessment and governance tools enhance practical applicability. Implementation success will depend on governmental support, resource allocation, and structured feedback loops. Future research should pilot the framework in real-world settings, assess its impact, and establish mechanisms for continuous updates to maintain relevance in a rapidly evolving digital landscape.

PMID:41984529 | DOI:10.2196/88512

Orbit. 2026 Apr 15:1-5. doi: 10.1080/01676830.2026.2654185. Online ahead of print.

ABSTRACT

BACKGROUND: The purpose of this project was to determine whether conjunctiva-shortening posterior approach ptosis repair affects the complication rates of subsequent bleb-forming glaucoma filtering surgeries compared to conjunctiva-sparing anterior approaches.

METHODS: A retrospective cohort study was conducted at the Cleveland Clinic Cole Eye Institute, including patients who underwent ptosis repair followed by glaucoma filtering surgery between January 2010 and December 2024. Patients were divided into anterior approach (levator advancement) and posterior approach (Müllerectomy with or without tarsectomy) groups. Outcomes included rates of intraoperative complications and postoperative bleb-related complications. Fisher’s exact test was used for group comparisons, with p ≤ 0.05 considered significant.

RESULTS: Thirty-five eyes (34 patients) were included: 17 underwent anterior and 18 underwent posterior approach ptosis repair. Intraoperative complications occurred in one eye in each group. Postoperative bleb-related complications were reported in two eyes in the anterior group and one in the posterior group. Rates of bleb-related complications were not statistically different between groups. Anterior approach eyes were more likely to have had prior glaucoma surgery and require repeat ptosis repair.

CONCLUSION: Prior posterior approach ptosis repair does not significantly increase the risk of intraoperative or postoperative bleb-related complications in subsequent glaucoma filtering surgery. These findings support the safety of posterior approach ptosis repair, even in patients likely to require future filtering procedures.

PMID:41984516 | DOI:10.1080/01676830.2026.2654185

J Vet Emerg Crit Care (San Antonio). 2026 Apr 15. doi: 10.1111/vec.70099. Online ahead of print.

ABSTRACT

OBJECTIVE: To determine if the administration of 20% intravenous lipid emulsion (ILE) to healthy dogs at the standard antidotal dose induces a hypocoagulable state.

DESIGN: Prospective, nonblinded, crossover study.

SETTING: University teaching hospital.

ANIMALS: Twelve adult, purpose-bred Beagles with no history of recent illness or underlying endocrine disease.

INTERVENTIONS: Treated dogs received 20% ILE using a standard protocol for management of intoxications: 2 mL/kg bolus over 2 min, followed by 0.25 mL/kg/min for 60 min. Control dogs received lactated Ringer’s solution (LRS) using the same dosing scheme. Dogs were randomly assigned to receive ILE or LRS, then received the alternate treatment after a 1-week washout period.

MEASUREMENTS AND MAIN RESULTS: Viscoelastic coagulation monitoring parameters using a benchtop viscoelastic coagulation monitor, prothrombin time (PT), activated partial thromboplastic time, and platelet count were measured 5 min before and 5 min after interventions. Compared with LRS administration, there was an increase in clot formation time after ILE administration and a decrease in the alpha angle, amplitude at 10 min, and amplitude at 20 min. There was an increase in PT after LRS infusion. Otherwise, no differences were noted in PT, activated partial thromboplastic time, platelet counts, or remaining viscoelastic coagulation monitoring parameters for either group.

CONCLUSIONS: Viscoelastic findings were suggestive of a relative hypocoagulability after ILE administration. Although statistically significant, most of these values were still within the provided reference intervals, so the magnitude of change may not be clinically important. The increase in PT after LRS solution, while statistically significant, was clinically irrelevant. ILE was well tolerated at the antidotal dose and did not have a clinically relevant effect on coagulation in otherwise healthy dogs in this study.

PMID:41984515 | DOI:10.1111/vec.70099

Adv Sci (Weinh). 2026 Apr 15:e20580. doi: 10.1002/advs.202520580. Online ahead of print.

ABSTRACT

Glomerular pathology is central to the diagnosis and prognosis of renal diseases, yet the heterogeneity of glomerular morphology and fine-grained lesion patterns remain challenging for current AI approaches. We present GloPath, an entity-centric foundation model trained on over one million glomeruli extracted from 14 049 renal biopsy specimens using multi-scale and multi-view self-supervised learning. GloPath addresses two major challenges in nephropathology: glomerular lesion assessment and clinicopathological insights discovery. For lesion assessment, GloPath was benchmarked across three independent cohorts on 52 tasks-including lesion recognition, grading, few-shot classification, and cross-modality diagnosis-outperforming state-of-the-art methods in 42 tasks (80.8%). In the large-scale real-world study, it achieved an ROC-AUC of 91.51% for lesion recognition, demonstrating strong robustness in routine clinical settings. For clinicopathological insights, GloPath systematically revealed statistically significant associations between glomerular morphological parameters and clinical indicators across 224 morphology-clinical variable pairs, demonstrating its capacity to connect tissue-level pathology with patient-level outcomes. Together, these results position GloPath as a scalable and interpretable platform for glomerular lesion assessment and clinicopathological discovery, representing a step toward clinically translatable AI in renal pathology.

PMID:41984508 | DOI:10.1002/advs.202520580

J Alzheimers Dis. 2026 Apr 15:13872877261440972. doi: 10.1177/13872877261440972. Online ahead of print.

ABSTRACT

BackgroundArgyrophilic grain disease (AGD) is a common tauopathy in the elderly, but its neuroimaging features remain less well characterized compared with Alzheimer’s disease (AD). Notably, structural covariance network (SCN) analysis has not previously been applied to AGD.ObjectiveThis study aimed to investigate SCN alterations in pathologically confirmed AGD and AD and to characterize disease-specific patterns of network disruption.MethodsWe examined 12 AGD, 13 AD, and 18 healthy controls (HC). Individualized structural covariance matrices were constructed from regional gray matter volumes, and global and nodal graph-theoretical metrics were computed for each participant. Group differences were assessed using analysis of covariance adjusting for age and sex, and partial correlations were performed to examine associations between global metrics and Mini-Mental State Examination (MMSE) scores.ResultsGlobal SCN metrics showed a graded pattern, with strength, clustering coefficient, and efficiency lowest in AD, highest in HC, and intermediate in AGD. All global metrics except modularity were significantly correlated with MMSE. Nodal analyses revealed widespread reductions in closeness centrality in AD, with more limited decreases in AGD. Betweenness centrality showed an AD > AGD > HC pattern, whereas closeness centrality showed the opposite trend. Eigenvector centrality also suggested a graded trend (AD < AGD < HC), despite regional variability.ConclusionsSCN-derived metrics were consistent with disease-related volume patterns and revealed that AGD exhibits an intermediate network profile between AD and healthy aging. These findings suggest that SCN-based measures offer complementary insights into disease-related patterns of network disruption.

PMID:41984506 | DOI:10.1177/13872877261440972

J Alzheimers Dis. 2026 Apr 15:13872877261441603. doi: 10.1177/13872877261441603. Online ahead of print.

ABSTRACT

BackgroundAlzheimer’s disease (AD) is a complex, multifactorial neurodegenerative disorder involving dysfunction across multiple brain regions. While accumulating evidence has implicated the roles of diverse cell types, including neurons, glia, and vascular cells in AD pathogenesis, it is still poorly understood how cell type interactions drive or respond to the disease progression and severity.ObjectiveThis study aimed to systematically characterize cell-type-specific alterations and intercellular communication changes associated with AD progression.MethodsWe leveraged the transcriptome profiling and a previously established statistical framework to present a comprehensive mapping of the cellular interaction landscape in the human brain of AD.ResultsWe identified a wide array of AD-associated cell-cell interactions (CCIs), including not only between the non-neuronal and neuron cells, but also among different neuron subtypes. These patterns were further supported by cell-type signature scoring. Moreover, due to the flexibility of the framework, we further examined CCIs associated with clinical dementia rating across multiple cortical regions. Our findings revealed that the temporal and frontal cortices showed a stronger correlation with dementia severity. However, the subregions of the temporal area show specific dementia-associated CCIs, especially between the inferior and middle temporal gyrus.ConclusionsOur work advances our understanding of the cellular microenvironment in AD, offering novel insights into how intercellular interactions shape disease trajectory and cognitive outcomes.

PMID:41984490 | DOI:10.1177/13872877261441603

JAMA Netw Open. 2026 Apr 1;9(4):e264881. doi: 10.1001/jamanetworkopen.2026.4881.

ABSTRACT

IMPORTANCE: Computer-aided detection (CAD) systems can enhance adenoma detection, but their effectiveness in high-performance settings and among patients with positive fecal immunochemical test (FIT) results remains uncertain.

OBJECTIVE: To evaluate the impact of CAD on adenoma detection in routine practice, focusing on patients with positive FIT results.

DESIGN, SETTING, AND PARTICIPANTS: This multicenter, open-label, randomized clinical trial was conducted at 4 tertiary hospitals in Taiwan from February 23, 2022, to November 27, 2024. Adults aged 40 to 79 years who were scheduled for a colonoscopy owing to FIT positivity, symptoms, screening, or surveillance were randomized 1:1 to CAD-assisted or standard colonoscopy. Data were analyzed from December 1, 2024, to February 28, 2025.

EXPOSURES: Colonoscopy performed with a real-time CAD system or standard high-definition colonoscopy.

MAIN OUTCOMES AND MEASURES: The primary outcome was adenoma detection rate (ADR), defined as the proportion of patients with at least 1 histologically confirmed adenoma. Secondary outcomes included adenomas per colonoscopy (APC), sessile serrated lesion detection rate (SSLDR), and postpolypectomy surveillance intervals according to the US Multi-Society Task Force (USMSTF) and European Society of Gastrointestinal Endoscopy criteria.

RESULTS: Of 1356 randomized participants (mean [SD] age, 60.0 [9.4] years; 678 [50.0%] female and 678 [50.0%] male), CAD-assisted colonoscopy met noninferiority criteria for ADR compared with standard colonoscopy (395 of 675 [58.5%] vs 363 of 681 [53.3%]; absolute difference, 5.2 percentage points [95% CI, -0.1 to 10.5 percentage points]). Superiority was not statistically significant. CAD significantly increased mean (SD) APC (1.41 [1.95] vs 1.20 [1.88]; P = .01), driven mainly by detection of diminutive adenomas. In exploratory analyses of 864 patients with FIT-positive findings, CAD significantly increased ADR (288 of 441 [65.3%] vs 243 of 423 [57.4%]; P = .02; adjusted odds ratio [AOR], 1.39 [95% CI, 1.05-1.86]) and APC (mean [SD], 1.64 [2.08] vs 1.39 [2.09]; P = .01). SSLDR did not differ between groups. Consequently, CAD led to more intensive surveillance recommendations under USMSTF criteria, particularly in patients with FIT-positive findings (58 of 441 [13.2%] vs 31 of 423 [7.3%]; AOR, 1.94 [95% CI, 1.22-3.09]).

CONCLUSIONS AND RELEVANCE: In this randomized clinical trial, CAD-assisted colonoscopy met noninferiority criteria for adenoma detection. Superiority was not statistically significant overall, with significant improvements limited to the exploratory FIT-positive subgroup, driven largely by diminutive adenomas. CAD also increased intensive surveillance assignments. The incremental benefit of CAD in reducing interval cancer risk requires further investigation.

TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03842059.

PMID:41984482 | DOI:10.1001/jamanetworkopen.2026.4881

JAMA Netw Open. 2026 Apr 1;9(4):e267242. doi: 10.1001/jamanetworkopen.2026.7242.

ABSTRACT

IMPORTANCE: American Indian and Alaska Native people have higher hepatitis C virus (HCV) incidence and mortality rates compared with other racial and ethnic groups. With the point-of-care HCV RNA diagnostic test recently approved for use in the US, the Cherokee Nation integrated diagnostic testing within existing community-based screening efforts to reach underserved community members.

OBJECTIVE: To describe the lessons learned from implementing community-based point-of-care HCV RNA testing, including same-day HCV treatment uptake, in a tribal health setting.

DESIGN, SETTING, AND PARTICIPANTS: This quality improvement study, conducted on the Cherokee Nation reservation in northeastern Oklahoma, collected quantitative data through paper-based surveys and electronic medical records from Cherokee Nation’s Infectious Disease Department and harm reduction site, as well as qualitative data from staff meetings. Eligible participants included people aged 22 years or older who visited participating sites from October 30, 2024, to May 28, 2025, and provided informed consent.

EXPOSURE: The Cherokee Nation Hepatitis C Engagement and Linkage Program.

MAIN OUTCOME AND MEASURES: Test acceptance, completion, validity, and results; HCV treatment uptake; and implementation lessons learned.

RESULTS: Of the 400 participants (mean [SD] age, 42.5 [12.6] years; 209 [52%] women), 247 of 377 (66%) had a high school degree or less, 309 of 374 (83%) had an annual income of $15 000 or less, and 149 of 385 (39%) reported ever injecting drugs. There were 405 point-of-care HCV RNA tests offered, and 348 (86%) accepted. Of these, 23 (7%) were not performed due to insufficient sample volume. An additional 51 samples (15%) tested were invalid. Of the 274 valid tests, 26 (10%) detected HCV. Of the samples with HCV, 12 (46%) were from American Indian and Alaska Native participants and 14 (54%) were not. Nine participants (35%) with detectable HCV initiated treatment, 6 (67%) the same day, and all who initiated treatment were American Indian and Alaska Native. Most invalid tests occurred within 2 months of implementation. Test validity increased after introducing techniques to improve volume collection.

CONCLUSIONS AND RELEVANCE: In this quality improvement study conducted in a tribal clinic and harm reduction site, point-of-care HCV RNA testing was feasible and effective, with high acceptance and same-day treatment among American Indian and Alaska Native participants. Staff training, addressing logistical barriers, and broadening the population reached supported equitable access to testing. This study supports expanding point-of-care HCV RNA testing and integrated treatment to advance HCV elimination.

PMID:41984476 | DOI:10.1001/jamanetworkopen.2026.7242