Artificial intelligence (AI) is rapidly expanding across the radiation oncology workflow, with applications spanning imaging, contouring, treatment planning, quality assurance, outcome prediction, workflow automation, and clinical decision support. Although technical progress has accelerated substantially, successful clinical translation remains inconsistent. Many of the challenges limiting implementation are not unique to radiation oncology and have previously emerged across healthcare and other high-stakes industries. In this narrative review, we examine radiation oncology AI through the broader lens of cross-industry AI development and deployment. We first summarize the current landscape of AI applications in radiation oncology and then analyze representative examples of successful and unsuccessful AI implementation from healthcare and other sectors. These experiences reveal recurring themes that strongly influence clinical AI success, including data representativeness, robust validation, workflow-centered design, human-AI collaboration, uncertainty management, bias mitigation, operational boundaries, and continuous performance monitoring. We discuss how these lessons apply directly to radiation oncology, where AI systems must function within complex clinical workflows involving imaging, planning, adaptive treatment, quality assurance, and longitudinal patient management. Emerging agentic and multimodal AI systems further amplify both opportunities and risks associated with deployment. Ultimately, the future impact of AI in radiation oncology will likely depend less on isolated algorithmic performance than on the development of trustworthy clinical AI ecosystems. Successful implementation will require rigorous validation, seamless workflow integration, human oversight, regulatory governance, and continuous adaptation. Lessons from healthcare and other industries suggest that the greatest and most durable clinical value may arise from AI systems that augment human expertise, cognitive workflows, and multidisciplinary decision-making rather than replace clinical decision-makers.
Heart rate variability (HRV) has remained a relatively finite and niche tool in cardiology despite decades of research supporting its physiological and clinical relevance. This limited adoption may resemble the early history of electrocardiography (ECG), which was initially regarded by many physicians as a laboratory instrument rather than a routine clinical tool. The delayed acceptance of ECG reflected technological limitations, cultural resistance and the need for clinicians to master unfamiliar concepts derived from physics and electrophysiology. HRV faces comparable barriers today. Although derived from ECG RR intervals, HRV requires interpretation of time-domain, frequency-domain, geometric and nonlinear indices that may appear mathematically complex and distant from conventional bedside reasoning. We argue that HRV should not be viewed as a replacement for ECG, but as an extension of ECG from electrical morphology to physiological dynamics. Lessons from ECG history were examined and compared with the current state of HRV adoption in clinical practice. The complementary diagnostic roles of ECG morphology and HRV analysis were considered, together with the potential contribution of wearable sensors, remote monitoring, artificial intelligence and large language models to facilitate HRV interpretation, education and clinical integration. Whereas conventional ECG morphology identifies arrhythmias, conduction disturbances, ischemic alterations and overt electrical abnormalities, HRV provides insight into autonomic modulation, cardiovascular adaptability and systemic physiological regulation. The emergence of wearable sensors, remote monitoring, artificial intelligence and large language models creates an opportunity to overcome barriers that have limited HRV adoption. Artificial intelligence may serve as an educational and interpretive bridge, translating complex HRV metrics into clinically meaningful concepts while supporting medical training, artefact awareness, case-based learning and workflow integration. HRV faces barriers comparable to those encountered during the early adoption of ECG, including technological limitations, educational challenges and resistance to incorporating unfamiliar physiological concepts into routine clinical practice. Lessons from ECG history suggest that HRV adoption will depend not only on evidence but also on standardization, education, clinical interpretation and cultural acceptance within cardiology.
Mpox, caused by the mpox virus, has evolved from isolated cases in endemic regions to widespread outbreaks affecting multiple countries in Africa. The Research and Innovation pillar of the Continental Incident Management Support Team (IMST) was established to generate evidence that supports response efforts, including analysing the efficiency and effectiveness of clinical trials and health research on mpox across Africa. This article describes the achievements, challenges faced and lessons learned from mpox research efforts. The contributions of research to the mpox response by the Africa Centres for Disease Control and Prevention (Africa CDC) are crucial to managing infectious disease outbreaks across the continent. Multiple research initiatives were coordinated across Member States, including socio-behavioural, epidemiological, diagnostic, vaccine and therapeutic studies. Key achievements included the establishment of a coordinated continental research platform, initiation of multi-country studies and mapping of ongoing mpox research activities across Africa. Challenges included bureaucratic procedures, delays in funding disbursement, ethical approval bottlenecks, coordination complexities and surveillance gaps that affected timely research implementation. Addressing these gaps has the potential to enhance evidence-based decision-making and provide valuable lessons for improving future epidemic preparedness and response in Africa. The mpox research demonstrated the vitality of collaborative research efforts, the need for continuous, systematic monitoring of its progress and the need for real-time dissemination of research findings to inform practices that ensure an effective response to mpox. Real-time dissemination of research findings, starting with early community engagement, is critical to ensure that research findings are translated into action.
Molecular and genomic tools are increasingly used in biosecurity to support early detection, diagnostics and reconstruction of invasion pathways. However, selecting an appropriate marker for the question being addressed is critical, and translating molecular evidence into operational decisions can be challenging. Over-interpretation of commonly used markers may lead to misleading conclusions about population structure, invasion history and management priorities. DNA barcoding remains valuable for species identification and initial haplotype assignment, but questions concerning invasion pathways, admixture and phenotypic variation require additional molecular and ecological evidence. Here, we use coconut rhinoceros beetle (Oryctes rhinoceros) incursions in the Pacific as a case study to highlight interpretive pitfalls and lessons for applying molecular and genomic tools in biosecurity and biological control. We synthesise evidence on the strengths and limitations of mitochondrial markers, particularly CoxI, for haplotyping and inference of population relationships, and show how incomplete sampling and simplified assays can obscure cryptic diversity and bias interpretation. We then examine factors that complicate interpretation of OrNV-based biocontrol outcomes, including diagnostic sensitivity, study design and environmental modulation of host-pathogen interactions. Overall, these examples show that molecular evidence is most informative when marker choice, biological validation and phenotypic data are aligned with the biosecurity question.
Healthcare providers contended with unique work challenges during the height of the COVID-19 pandemic by adapting to rapidly changing circumstances with limited knowledge and resources. One military treatment facility responded to these challenges by leveraging available technology to implement Operation Oasis, a communally developed and peer-led virtual resiliency program for healthcare providers. This paper aims to: (1) discuss the design and implementation of Operation Oasis, and (2) conduct a thematic analysis of 404 participant chat messages that participants voluntarily and anonymously provided across 2 years of a weekly Operation Oasis music-based offering, Human Jukebox. Key findings of the thematic analysis included that the "Music Appreciation" theme was in 43% of coded messages, making it the most common theme; "Positivity," "Gratitude," "Reminiscence/Nostalgia/Relating to Music," and "Social Connectedness" comprised the remaining top five themes. Participants' comments suggested they had experiences of positive emotions, personal reflection, and interpersonal connection, all of which are recognized as contributors to resilience and well-being. This paper offers workshop facilitators' reflections and lessons learned on the process of creating and implementing Operation Oasis, as well as a discussion of the potential need and impact of supporting similar programs in the future.
Cultural sensitivity is central to ethical and valid mental health research, yet we observed it is often insufficiently embedded in digital research tools. Drawing on qualitative work conducted during the co-development of the Core Mental Health Dataset (CMHDS), this commentary reflects on the practical challenges we encountered and the considerations which shaped our approach to culturally sensitive data collection in digital mental health research. We synthesise insights from a lived experience advisory group, recognising how our interpretations were informed through dialogue with participants, focusing on mental health terminology, perceptions of mental health and ethical considerations in research. This paper shares lessons learned from co-developing the CMHDS and advocates for culturally sensitive digital approaches to improve acceptability, inclusivity, and data quality. We emphasises the requirement of sustained co-production and ongoing reflexive design practices in addressing cultural sensitivity in digital mental health research.
In September, 2024, the UN General Assembly assigned the Quadripartite Joint Secretariat on Antimicrobial Resistance (AMR) the task of establishing an Independent Panel for Evidence for Action against AMR (IPEA). To promote stakeholder views and input around the constitution and functioning of this Panel, which could feed into the Quadripartite Joint Secretariat's consultation process, we independently commissioned seven papers to examine the lessons that could be learned from other high-level scientific panels. We then convened 85 stakeholders, primed with the background papers. The Workshop, held in Lagos, Nigeria in April, 2025, drew representation from around the world, particularly low-income or middle-income countries and Africa, and all One Health sectors. Stakeholder input and preferences on IPEA's structure and governance, science and content, and goals and outputs were collated in small-group roundtable discussions and plenary polling. The stakeholders pushed for a scientifically independent panel that is relevant to and respected by national governments. They also felt that the Panel-rather than third parties-should set its own agenda and establish its ways of working in detail, using open and transparent protocols. In this light, and to ensure that the evidence is presented clearly and forcefully to decision makers, effective communication will have to be a strength of this proposed Panel, along with the ability to parse and synthesise many evidence types from a range of sources. Stakeholder attendees were urged to contribute the Workshop's outputs, shared in plenaries and documented in this Personal View, to the Quadripartite Joint Secretariat's formal consultation.
The HIV Prevention Trials Network 094 INTEGRA study sought to fill the gap in implementation science literature by exploring the delivery of integrated prevention and care for HIV and opioid use dependence (OUD) through mobile units to people who inject drugs (PWID). Five U.S. INTEGRA sites with diverse implementation landscapes disproportionately affected by the HIV and opioid epidemics (New York, Philadelphia, Washington, DC, Houston, Los Angeles) . In-depth qualitative interviews from an embedded implementation science evaluation were conducted with 37 clinical and research INTEGRA staff delivering integrated care through mobile units. Pragmatic qualitative analysis was guided by the PRISM framework to identify key implementation needs, challenges, and solutions for delivering the INTEGRA intervention via mobile units in local neighborhoods. Staff described how mobile delivery of INTEGRA reduced key barriers that limit PWID access to HIV and OUD services. Yet, they also detailed complex implementation needs, including the proactive coordination among staff to ensure sustained access to INTEGRA services, navigating internal and external spaces to deliver services, maintenance-related demands to keep the mobile unit's infrastructure operational, and interdependent efforts that bridged the mobile unit's service delivery within the extant health systems and community landscapes. Findings demonstrated that mobile integrated care models can reduce access barriers for PWID but require tailored implementation strategies to address operational, spatial, infrastructural, and community-level demands. Results may help inform an implementation blueprint for similar communities working to respond to the intersecting HIV and opioid epidemics affecting PWID across U.S. settings.
Lung cancer is the leading cause of cancer death globally, and low-dose computed tomography (LDCT) screening reduces lung cancer mortality. The NHS England Lung Cancer Screening Programme is the largest national LDCT implementation to date, with over 2.5 million invitations issued, 7,193 cancers diagnosed and 63.1% detected at stage I in its first five-year evaluation. We describe the technical and workforce architecture supporting interpretation at scale and its transferability to other imaging-based screening. Three components have proved central. First, cloud-native, vendor-agnostic imaging information technology has overcome the fragmentation of NHS picture archiving and communication systems, supporting distributed acquisition, centralised expert interpretation and standardised structured reporting. Second, a virtual national specialist network of 180 consultant radiologists with thoracic subspecialty interest working within a single reporting environment, rather than a transactional teleradiology contract, has enabled subspecialist delivery, embedded peer review, discrepancy logging and named-consultant accountability. Third, vendor-agnostic integration of artificial-intelligence nodule detection/volumetry has supported network-level post-deployment monitoring for algorithm drift and population bias. This has supported over one million studies since 2020, currently exceeding 41,000 scans per month, with >99% returned within 72 hours. Established breast screening already exemplifies these principles: organised double reading, centralised quality assurance and, increasingly, integrated AI. With programme-specific adaptation, the same approach is relevant to screening with prostate MRI, CT colonography, and potentially cardiac CT in the future. Although these pathways differ in evidence base, invitation model and reading requirements and some applications remain investigational. Lung cancer screening may therefore represent an early archetype, rather than a special case, for imaging-based screening.
Digital technologies, including intraoral scanners, computer-aided design/computer-aided manufacturing (CAD/CAM), cone-beam computed tomography, artificial intelligence and additive manufacturing, are reshaping contemporary dental practise. Dental schools must therefore determine how digital competence should be defined and integrated into undergraduate curricula while preserving core clinical competencies. This perspective examines digital competence through the lens of prosthodontic education in Southeast Asia. It argues that digital competence extends beyond technical proficiency to encompass data literacy, critical appraisal, ethical decision-making and responsible use of digital technologies. Challenges to implementation include financial constraints, curriculum overload, faculty development, technical workforce readiness and unequal access to digital infrastructure. Drawing on reflections from curriculum implementation within a developing digital ecosystem, the article highlights that successful digital transformation depends more on institutional readiness than technology acquisition alone. A pragmatic three-phase framework is proposed to support the progressive integration of digital dentistry into undergraduate education while maintaining clinical reasoning, manual skills, professionalism and patient-centred care. Digital competence should be regarded as a core professional competency rather than a collection of technical skills. The goal of undergraduate education is not to produce technology experts, but graduates who can critically evaluate and appropriately integrate digital technologies into patient care. Sustainable curriculum transformation requires investment in faculty capability, organisational readiness and educational leadership alongside technological advancement.
Rare disease patients, who collectively number over 400 million worldwide, remain systematically underserved within existing universal health coverage frameworks. Orphan drug market exclusivity is a widely adopted regulatory incentive designed to stimulate pharmaceutical innovation for rare diseases. Recent regulatory reforms in China, the United States, and the European Union have introduced conditional mechanisms, signaling a shift from static proprietary protection toward a conditional regulatory governance model. Japan, while not undertaking legislative reform in 2026, offers a distinct reference point through its re-examination system. To date, no study has systematically integrated these latest legislative reforms into a comparative regulatory analysis or examined how the institutional design of orphan drug exclusivity can be calibrated to balance innovation incentives with equitable patient access. This study employs an integrated multi-method approach combining comparative legal analysis, doctrinal interpretation, evidence-based policy evaluation, and case analysis. A structured analytical framework is constructed around four key regulatory dimensions-eligibility criteria, exclusivity duration, scope of protection, and exception mechanisms. Using this framework, the study compares the orphan drug exclusivity regimes of the United States, the European Union, and Japan, and assesses the institutional risks embedded in China's newly enacted legislation. This article proposes a novel theoretical model that reconceptualizes orphan drug market exclusivity as a conditional public-law entitlement whose legitimacy is premised on the continuing fulfillment of public health objectives. Applying this framework, the study identifies four core structural deficiencies in China's current regime and, drawing on mature comparative practices, develops targeted institutional design proposals for each regulatory dimension. Reconceiving orphan drug market exclusivity as a conditional public-law entitlement, rather than as an intellectual property right, offers a sustainable governance pathway for reconciling innovation incentives with the equity and financial protection goals of universal health coverage. Embedding conditional constraints into pharmaceutical exclusivity rules ensures that regulatory incentives serve long-term public health objectives and carries implications for addressing market failures and access challenges in other areas of global public health.
暂无摘要（点击查看详情）
暂无摘要（点击查看详情）
Frontal lobe epilepsy (FLE) surgery often requires complex presurgical evaluations and intraoperative monitoring, which may not be readily available in resource-limited settings. We report our experience establishing FLE surgical services in Indonesia to develop strategies for a simple but reliable service in low- and middle-income countries. We included patients who underwent FLE surgery between 2003 and 2023 in Semarang, Indonesia. These patients underwent surgery with at least 12 months of follow-up. Univariate and multivariate Firth penalized logistic regression analyses were performed to identify factors associated with surgical outcome, stratified by follow-up duration. Kaplan-Meier survival analysis and log-rank tests were performed to assess time-to-seizure recurrence across subgroups. 87 FLE surgeries were performed over a period of 20 years. Approximately 60% of the patients were pediatric. Most patients (63.2%) showed visible focal cortical dysplasia on imaging. At the ≥5-year follow-up group, 56.8% of the patients had Engel Class I disease, with 79.3% have favorable (productive) functional outcomes. Among factors associated with postoperative outcomes, the number of anti-seizure medicines ≥3 was a significant seizure-free predictor at ≥5-year follow-up (odds ratio 0.18, 95% confidence interval 0.04-0.87, p = 0.033). The median seizure-free survival was 10.0 years for the overall cohort. Despite several limitations, this research suggests that establishing routine FLE services in countries with limited resources is feasible. To maintain a simple but reliable service, a streamlined surgery pathway should be introduced, together with strengthening national capacity and adopting cost-efficient technology.
Human psychoneuroimmunology research has demonstrated that stress, depression, and close relationships reliably shape immune and endocrine function in ways that matter for health. Across studies of examination stress, laboratory stressors, marital discord, cancer survivorship, and dementia caregiving, psychosocial adversity predicts more infections, weaker vaccine responses and faster erosion of vaccine protection, slower wound healing, heightened inflammation, and accelerated cellular aging. Depression also sensitizes immune function, producing larger inflammatory responses when individuals encounter stressors. Loneliness, low support, and distressed relationships can amplify stress reactivity and are linked to greater inflammatory and metabolic vulnerability, including postprandial inflammatory and endothelial responses. More recent work has extended these pathways to the gut microbiome and intestinal permeability (leaky gut), integrating microbial, neuroendocrine, and immune mechanisms. Collectively, the evidence supports a biobehavioral model in which social stress accelerates immune aging and increases risk for inflammation-related disease, while behavioral and nutritional interventions can modify these trajectories.
From 2020 to 2023, Madagascar experienced an outbreak of circulating vaccine-derived poliovirus type 1 (cVDPV1) that notably affected adults and was associated with high mortality among paralytic cases. This atypical epidemiological pattern required adapted surveillance approaches and tailored outbreak response strategies, including vaccination campaigns targeting adult populations. We conducted a descriptive analysis of the cVDPV1 outbreak in Madagascar between September 2020 and September 2023. Epidemiological data on confirmed and polio-compatible cases were reviewed, including age distribution, clinical presentation, and outcomes. We also documented outbreak response strategies, particularly vaccination campaigns and operational innovations implemented to reach adult populations. A total of 54 confirmed cases of paralytic polio caused by cVDPV1 were reported during the study period, including two adults presenting with fever and paralysis. Between February 2022 and March 2023, 15 adult acute flaccid paralysis cases were classified as polio-compatible by the National Polio Eradication Committee due to missing (86%) or negative laboratory specimens. Mortality among these compatible adult cases was 56%. In response, Madagascar conducted vaccination campaigns using bivalent oral polio vaccine, targeting the entire population in four regions and children under 15 years in the rest of the country. Critical role of country leadership, strategic mobilization, and effective communication in driving success and influencing risk perception during the 2023 campaigns helped achieve high coverage among adults. The cVDPV1 outbreak in Madagascar demonstrated the potential for significant adult involvement and high mortality in polio outbreaks. High vaccination coverage combined with targeted innovations and strong community engagement contributed to successful outbreak control. These findings highlight the importance of inclusive vaccination strategies and tailored approaches in similar settings.
Nurse scientists are increasingly expected to lead research applying artificial intelligence (AI) to advance health equity. However, there is little published guidance on how to structure and lead the multidisciplinary teams required to meet such work demands. To describe a replicable team science model for nurse-led AI research, derived from a completed three-year project using AI text analysis to detect stigmatizing language in obstetric electronic health records and its associations with maternal health outcomes. We present a case-based analysis of a multidisciplinary project (2022-2025) integrating nursing, data science, epidemiology, obstetrics, and informatics. We describe team structure, workflow, and decision-making across five methodological phases. Four principles for effective nurse-led AI team science emerged: deliberate role design positioning nurse scientists as intellectual leaders; investment in cross-disciplinary translation infrastructure; operationalization of equity at every stage; and realistic resource and timeline planning. This blueprint offers practical guidance for nurse scientists seeking to lead technically complex, equity-focused AI research, arguing that team structure, not technical sophistication, is the most critical determinant of success.
When the COVID-19 pandemic emerged, pregnant women were quickly identified as a high-risk group. It became a priority to clarify any risks associated with COVID-19 infection, and later vaccination, to pregnant women and their offspring. The Nordic registries constituted unique resources to quickly answer these questions. Our findings from the Nordic registries demonstrated that pregnant women with COVID-19 face a higher risk of hospitalization compared to non-pregnant women of reproductive age, and a higher risk of venous thromboembolism and stillbirth. However, the majority of studies proved no COVID-19 associated risks of adverse pregnancy outcomes. We also provided reassuring evidence indicating no increased risk of miscarriage, stillbirth, congenital malformations, preterm birth, or other adverse neonatal outcomes in children born to mothers vaccinated against COVID-19 during pregnancy. In this commentary, we highlight both opportunities and methodological challenges when using the Scandinavian health registries during an ongoing pandemic crisis.
Sodium-glucose cotransporter 2 inhibitors (SGLT2i) are cornerstones in the treatment of Type 2 diabetes (T2D), but their use is associated with diabetic ketoacidosis (DKA), a potentially life-threatening complication in the critical care setting. We present two cases of male patients with T2D who developed SGLT2i-associated ketoacidosis under different stressors: the first following coronary artery bypass graft (CABG) surgery and the second after the addition of semaglutide to his therapeutic regimen. Both patients presented with high anion gap metabolic acidosis, ketonuria, and plasma glucose levels < 200 mg/dL. Management required intravenous insulin protocols and glucose supplementation to reverse ketosis. This report emphasizes the need for preoperative suspension protocols and close monitoring of changes in combination therapy to avoid diagnostic delays in the intensive care unit.
暂无摘要（点击查看详情）