Healthcare leaders face sustained uncertainty: workforce volatility, financial pressure, and accelerating technology change. In 2024-2025, Ardent Health advanced an AI-enabled virtual care model from pilot to production across multiple markets. The model integrates virtual nursing, virtual attending physicians and providers, virtual sitting, and hospital-to-home remote patient monitoring (RPM) into routine care, with artificial intelligence (AI), providing earlier risk detection and workflow relief. Specifically, AI systems (1) analyze video streams to detect fall risks and unsafe behaviors, prompting earlier alerts to staff; (2) continuously evaluate vital sign trends from wearable sensors to identify clinical deterioration sooner; and (3) support ambient documentation with speech recognition and natural language processing (NLP) that improves note quality and coding accuracy.At Ardent's East Texas location, five months of virtual nursing contributed to reductions in contract labor, a decrease in voluntary RN turnover, and improvements in salaries, wages, and benefits (SWB) per patient day despite an increase in volume. Meanwhile, virtual attending physicians and providers increased virtual patient consultations resulting in patient retention and, generated bed-day capacity; AI-assisted vitals monitoring correlated with lower mortality and shorter length of stay; and the RPM program improved discharge continuity and avoided readmissions.This article presents a case study and playbook to help leaders manage risk, scale safely, and measure value. Readiness includes updating consent form language; data-use and retention policies; training staff to obtain patient consent; establishing algorithm oversight with internal data, analytics, and data science capabilities; and investing in network, data center, and hardware upgrades. We close with lessons learned and an organizational performance tracking accountability structure.
Henry Kipping (1726-1785) was an apothecary and surgeon in Brighton, England. Here we present a series of contemporary references to Kipping from newspaper, book, archive and web-based resources. Some relate to his medical practice (resuscitating a 'drowned' elderly physician and a fisherman, bleeding a member of parliament who had fallen from his horse and praising a nostrum for the 'gravel and stone'). Social references include a duel with an army officer whose sword Kipping confiscated. Kipping appears to have been popular, connected with members of Brighton's high society and passionate about traditional past times, e.g. swordsmanship, horse riding and hunting on the Sussex downs. Indeed, Kipping's horse ran in the earliest known horse race in Brighton (1770). He was consulted by notable local residents including the Thrale family of Brighton and Lady Wilhelmina Shelley (the latter evidenced by Kipping partaking in her funeral procession in 1772). Kipping lived and practised at 28 West street, a road most famous for its (now lost) George Inn where King Charles II stayed just prior to his escape to Normandy. Kipping comes across as a colourful and eccentric clinician.
Penicillin allergies are commonly reported in pregnancy, yet patients are rarely truly allergic. Identification of pregnant patients who would benefit from penicillin allergy testing is an important public health initiative to reduce alternative antibiotic usage and reduce associated adverse outcomes. This article reviews the epidemiology of penicillin allergy, the pathophysiology of allergy in general, in addition to penicillin allergy, the safety of penicillin allergy testing in pregnancy, the impact of penicillin allergy testing on maternal and neonatal outcomes, and considerations for quality improvement interventions. Original research articles, review articles, and professional society guidelines on penicillin allergy evaluation in pregnancy were reviewed. Penicillin allergy in pregnancy is associated with increased risks of adverse neonatal and maternal outcomes. The reviewed literature demonstrates that penicillin allergy testing in pregnancy is efficacious, with the majority of individuals undergoing penicillin allergy delabeling with low rates of allergy testing complications. In addition, penicillin allergy testing has been shown to be associated with a reduction in second-line antibiotic usage, although future studies are required to elucidate the full reduction in adverse outcomes associated with delabeling. Penicillin allergy in pregnancy is associated with increased risk of adverse outcomes. Given that the majority of individuals can be safely delabeled, efforts to explore opportunities for increased penicillin allergy assessment should be an ardent goal.
The study objectives were to identify the frequency and risk factors for intensive care unit (ICU) admission and mortality associated with respiratory syncytial virus (RSV), influenza, and human metapneumovirus (HMPV) pneumonia hospitalizations and to compare these rates with patients admitted with other acute respiratory infections (ARIs) caused by these viruses. This study identified hospitalization encounters of adults aged 50-88 years with RSV, influenza, and HMPV pneumonia between 2016 and 2023 in the Colorado Hospital Association database. Multivariate logistic regression was used to estimate the odds of ICU admission and mortality. Of 2210 hospitalized patients with RSV pneumonia, 780 (35%) were admitted to ICU and 205 (9.3%) died. Similar proportions were observed for HMPV pneumonia (27.5% and 5.9%) and influenza pneumonia (32.5% and 7.6%) ICU admissions and mortality, respectively. Dementia had the highest odds for ICU admission in patients with RSV pneumonia (adjusted odds ratio [aOR], 4.2 [95% confidence interval {CI}, 1.34-13.18]); chronic pulmonary disease (CPD) for influenza pneumonia (aOR, 2.99 [95% CI, 2.45-3.66]), and chronic obstructive pulmonary disease (COPD) without asthma for HMPV pneumonia (aOR, 5.04 [95% CI, 2.92-8.7]). Increasing age was associated with increased mortality for RSV and influenza. CPD and COPD had >2-fold greater odds of mortality in patients with pneumonia for all 3 viruses. Increasing numbers of comorbidities significantly increased ICU admission and mortality in all 3 groups. Pneumonia is a severe manifestation of ARI with RSV, influenza, and HMPV, with differing risk factors for ICU admission and mortality.
Positive health outcomes are realized when individuals receive interprofessional care, which also includes collaboration with family and care providers. We used social network analysis to explore interprofessional care networks and experiences of independent, community-dwelling older adults and how they perceive collaboration between different medical and non-medical network members. Twenty-three participants were interviewed and asked to name individuals contributing to their health and well-being (network of care) and position them in a concentric circle to reflect the relative strength of relationships. The average network size was 11. Closest relationships were with spouses, children, and family physicians. Relationship strength with network members was marked by frequency, accessibility, longevity, and impact of interactions. Participants were ardent self-advocates for their care, but reported few apparent episodes of collaboration between network members. Our study highlights that coordinated and collaborative care for independent community-dwelling older adults is lacking and does not routinely engage non-medical network members.
Gynecological cancers, including cervical, endometrial, ovarian, and vulvovaginal cancer, have increasing incidence and mortality globally over the last three decades. In that time, there have been advances in medical therapies and paradigm shifts in surgical treatment which have resulted in a greater quality of life for patients. Clinicians have also refocused efforts to preventing gynecologic cancer. The state of screening and prevention is varied in each of the cancer types. The most comprehensive screening program and only preventable gynecological cancer is cervical cancer, which has been heavily studied since the 1900s. Cervical cytology, primary high-risk human papillomavirus (HPV) testing only, and co-testing are all effective in detecting cervical dysplasia and touted by the major medical. An additional arsenal is prevention through vaccination which has been shown to decrease cervical cancer. Unfortunately, the other gynecological cancers do not have effective screening strategies. The high rates of symptoms in endometrial cancer facilitate detection at an early stage but thus far, asymptomatic screening is only advocated in very high-risk population due to the invasive nature. Novel non-invasive mechanisms are currently under study though none have translated into clinical practice as of yet. Ovarian cancer remains the most innocuous with vague symptoms at onset resulting in late-stage diagnosis. Recommendations for prophylactic oophorectomy only apply to subsets of the population with predisposing genetic mutations. This has led to an ardent push for creative strategies such as opportunistic salpingectomy and a national genetic screening program. These efforts are in addition to the investigations underway researching radiologic, liquid biopsy, and genetic marker screening modalities for all gynecologic cancer. This review article discusses the state of screening, prevention, and recent advancements and pilot studies for each gynecological cancer.
With the ardent use of artificially intelligent robots, broadband motion detection and recognition (BMDR) technology with simultaneous perception-memory-computation functions is becoming essentially important. However, the existing state-of-the-art all-in-one BMDR remains insufficient. Herein, we demonstrate an InSe ferroelectric field-effect transistor exhibiting broadband responsivity from 450 to 973 nm, attributed to the moderate band gap of approximately 1.3 eV in InSe. The InSe device displays memory functionality derived from the ferroelectric properties of Pb(Zr0.2Ti0.8)O3 (PZT) and computational capability enabled by its progressive nonvolatile modulation of conductance, which facilitates artificial synapse-weight updating. Hence, the InSe ferroelectric field-effect transistor has a broadband perception-memory-computation functionality. Importantly, by integrating bias-based nonvolatile positive-direction/negative-direction photoconductive mechanisms with interframe differencing computations, the proposed InSe ferroelectric field-effect transistor achieves efficient motion detection and recognition (MDR) of a moving rabbit. The detected moving-rabbit images are subsequently fed into a neural network built on conductance mapping principles for classification, achieving 100% accuracy after only 40 training epochs, outperforming comparable results. The proposed work enables the development of the next-generation all-in-one BMDR technology based on two-dimensional devices.
Off-the-shelf CAR T cells need to reliably escape allogeneic immune responses to become universal medicines. The primary T cell product SC291 was engineered with a CD19 CAR, T cell receptor alpha constant (TRAC) knockout, and the hypoimmune (HIP) edits of HLA depletion and CD47 overexpression. Here, we report exploratory immune analyses from the ARDENT (NCT05878184) and GLEAM (NCT06294236) trials with HIP-edited CD19 CAR T cells. Although there was an alloimmune response against HLA-replete subpopulations of SC291, we observed no de novo immune response against fully edited HIP CAR T cells in all patients, irrespective of the dose or the patient's disease. The lack of antibodies against the HLA-replete CAR T cells was identified as a marker for deep tissue CD19 cell depletion, and all patients without such antibodies for 60 days showed concomitant B cell depletion in peripheral blood. The immune data presented support the reliability of the HIP concept to evade allorejection.
This study aimed to evaluate the association between high-density lipoprotein (HDL) subfractions and long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients with acute myocardial infarction (AMI). A total of 1,240 AMI patients admitted to Beijing Tsinghua Changgung Hospital between 2017 and 2023 were included. HDL subfractions, including HDL-2b and HDL-3, were quantified using microfluidic chip electrophoresis. Patients were stratified into tertiles according to HDL-3 levels. The primary endpoint was the occurrence of MACCEs. Kaplan-Meier analysis, Cox proportional hazards models, restricted cubic spline (RCS), and mediation analyses were performed to evaluate the associations between HDL subfractions and MACCEs. During a median follow-up of 52.4 months, 132 MACCEs (10.7%) occurred. Patients in the highest HDL-3 tertile had a lower MACCEs incidence than those in the lowest tertile (6.7% vs. 16.4%, p < 0.001). Higher HDL-3 levels were associated with improved event-free survival (HR = 0.58, 95% CI: 0.37-0.91) and demonstrated discriminative ability for MACCE risk (AUC = 0.62; 95% CI: 0.57-0.67), whereas HDL-C and HDL-2b were not significant. RCS analysis revealed a linear inverse association between HDL-3 and MACCEs (p for non-linearity = 0.356). The Gensini score partially mediated this relationship, accounting for 11.8% of the total effect. Lower HDL-3 levels were independently associated with a higher long-term risk of MACCEs in AMI patients. HDL-3 may represent a potential biomarker for residual cardiovascular risk stratification and a potential therapeutic target for improving post-infarction outcomes.
Preparing new smart receptors and materials through controlling foldamer assemblies constitutes an appealing strategy. In this context, the use of a redox input appears as a relevant tool to monitor the self-assembly process, provided a careful design of well-chosen electroactive units. Our research group previously showed how the single-to-double helix equilibrium of foldamers can be shifted thanks to redox processes. Aiming at generalizing this strategy and rationalizing our findings, we designed a long oligopyridine dicarboxamide strand bearing tetrathiafulvalene (TTF) units, which are connected on the periphery through short amide linkers. This design proved to have a dramatic impact on the supramolecular behavior of the foldamer, preventing the formation of double helices in the neutral state. Using a combination of electrochemical and spectroscopic measurements, we show that duplex formation can be triggered by oxidizing a foldamer that does not form double helices in the neutral state.
Helical foldamers constitute particularly relevant targets in the field of host-guest chemistry, be that as hosts or substrates. In this context, the strategies reported so far to control the dimensions and shape of foldamers mainly involve modifications of the skeleton through covalent synthesis. Herein, we prepared an oligopyridine dicarboxamide foldamer substituted by photo-active tetraphenylethylene units (TPE). We demonstrate that it is possible to toggle the length of a helical foldamer by two means. First, the elongation of foldamers can be tuned by adjusting the concentration, as demonstrated by DOSY NMR spectroscopy and X-ray diffraction analyses on both the single and the double helix structures. Secondly, and in a more original manner, a photo-induced protonation process triggered by TPE units promotes a novel pathway to unfold helical foldamers, leading to dramatic conformational and spectroscopic changes.
The passing of Sunil K Pandya (SKP) on December 17, 2024, evoked memories of his remarkable life both as an individual and a medical professional in many physicians, patients and colleagues. In her tribute, Lopa Mehta has described him as "Medical Ethics personified, an astute clinician, a dexterous neurosurgeon, an ardent historian, a philosopher who stood high above worldly gains and fame" [1]. Early in January 2025, we published an anthology of SKP's select articles in IJME as a tribute to his contribution to bioethics and to the journal. The reminiscences of his friends and colleagues in that tribute issue are vivid reflections of his genuine, multifaceted and virtuous personality [2].
Chronic kidney disease (CKD) is a major health concern globally, with more than 850 million people suffering from it. Several studies have been carried out to reduce inflammation in CKD patients; and to study the relationship between gut microbiota and inflammation. The effect of herbal formulations to improve the gut flora and reduce inflammation has not been studied earlier. The study aims to evaluate effect of herbal formulation combined with standard of care (SOC) treatment compared to SOC. A prospective, randomized, parallel group clinical trial was planned on 90 patients split equally into standard of care (SOC) with herbal treatment (IP) and only SOC groups. The change in the abdominal pain score, percent change in the pathogenic and non-pathogenic microbiome were the key endpoints of interest. The safety assessment was in terms of adverse events, changes in hematological and biochemical parameters. The demographic and other patient characteristics showed statistically non-significant differences between two groups. On day 90, the median abdominal score in SOC + IP group (2.00) was significantly lower than that of SOC group (3.00) (p = 0.002). The quality of life score improved significantly in SOC + IP group (p < 0.001), unlike SOC group. There was significant reduction in pathogenic microbes in SOC + IP group; however, the reduction in non-pathogenic microbes was non-significant in this group. The adverse events (AEs) were in mild form, and the proportion of patients with AEs differed non-significantly between two groups. The IP supplementation along with SOC significantly improved the GUT micro flora, and improved the overall quality of life of CKD patients. This treatment combination can be practiced for effective patient management.
Among older adults, respiratory syncytial virus (RSV) infection is a known cause of hospitalization, intensive care unit (ICU) admission, and mortality risk. The severity of the disease burden of human metapneumovirus (HMPV) among older adults is less well recognized. The objective of this study was to better understand risk factors for hospitalization with and outcomes in adults ≥50 years of age infected with HMPV and to compare these with RSV risk factors and outcomes. This was a retrospective cohort analysis of adults 50-88 years of age in 93 medical facilities in the Colorado Hospital Association database between 2016 and 2023. RSV and HMPV, other respiratory infections, and comorbidities were identified using International Classification of Diseases, Tenth Revision codes and grouped by increasing numbers of comorbidities. Multivariate logistic regression was performed to estimate the risk of the various predictors on ICU admission, and mortality for both HMPV and RSV infection, adjusted for sex, age, and comorbidity. The highest risk for ICU admission was chronic obstructive pulmonary disease (COPD) (RSV: adjusted odds ratio [aOR], 2.24 [95% confidence interval {CI}, 1.81-2.77], P < .001; HMPV: aOR, 2.99 [95% CI, 2.13-4.19], P < .001), and those with neuromuscular disease without dementia (RSV: aOR, 2.33 [95% CI, 1.98-2.75], P < .001; HMPV: aOR, 2.22 [95% CI, 1.75-2.80], P < .001). Age significantly increased the odds of mortality among RSV-infected but not HMPV-infected patients. Neurological disorders with dementia were the highest comorbid risk factor for RSV mortality (aOR, 4.16 [95% CI, 3.01-5.77]; P < .001), in contrast to COPD for HMPV mortality (aOR, 12.44 [95% CI, 3.02-51.17]; P < .001). HMPV infection poses a unique disease burden with specific high-risk comorbidities among the older adult population distinct from that of RSV and warrants further study.
The present study aimed to identify the impact of various periodisation approaches used in training athletes and to identify the effect size of the periodisation technique in improving athletes' peak performance before the main event. Inclusion criteria comprised recruitment of all those studies in which the effects of periodisation training were identified on athletes' peak performance. Various databases such as Google Scholar, Pedro, MEDLINE, Cochrane Library, EMBASE, and Web of Science were searched by independent reviewers using the MeSH terms including 'interval training', 'aerobic exercise', 'periodisation,' 'peak performance', and 'athletes'. A sample size of n = 121 participants included in six studies were analysed in which the effects of periodisation methods of training among athletes were estimated for improving their peak performance by assessing jump height and speed, pool effects in the form of random, and fixed effect model were provided to depict cumulative results of all the included studies. In achieving optimisation in athletes' peak performance, inculcating the concept of periodisation is a practical approach. While incorporating periodisation in training, models of training principles must be given ardent importance. Key Words: Exercise training, Sports, Athletes, Periodisation, Peak performance.
Carbapenem-resistant Klebsiella pneumoniae (CRKP) infections continue to impose high morbidity threats to hospitalized patients worldwide, limiting therapeutic options to last-resort antibiotics like colistin. However, the dynamic genomic landscape of colistin-resistant K. pneumoniae (COLR-Kp) invoked ardent exploration of underlying molecular signatures for therapeutic propositions/designs. We unveiled the structural impact of the widespread and emerging PmrB mutations involved in colistin resistance (COLR) in K. pneumoniae. In the present study, clinical isolates of K. pneumoniae expressed variable susceptibilities to colistin (>0.5 μg/mL for resistant and ≤0.25 μg/mL for susceptible) despite mutations such as T157P, G207D and T246A. The protein sequences extracted from in-house sequenced genomes were used to model mutant PmrB proteins and analyze the underlying structural alterations. The mutations were contrasted based on molecular dynamics simulation trajectories, free-energy landscapes and structural flexibility profiles. The altered backbone flexibilities can be an essential factor for mutant selection by COLR K. pneumoniae and can provide clues to deal with emerging mutants. Furthermore, PmrB having high druggability confidence (>0.99), was explored as a potential target for 1396 virtually screened FDA-approved drug candidates. Among the top-10 compounds (scores >70), amphotericin B was found to be potential candidate with high affinity (Binding energy <-8 kcal/mol) and stable interactions (RMSF <0.7 Å) against PmrB druggable pockets, despite the mutations, which encourages future adjunct therapeutic research against COLR-Kp.
The Canadian pianist Glenn Gould, referred to as a "concert dropout," is known for his recorded performances that are applauded even during current times. Gould identified with Sōseki's concept of "Hi-ninzyo (Inhumanity)" and was an ardent admirer of Sōseki Natsume's well-known novel, "The Three-Cornered World." In this paper, I rediscuss my previous work that describes neuropsychologically the brain mechanisms underlying intelligence, emotions, and will that form the basis of "Hi-ninzyo (Inhumanity)" as the cognition and attitudes of life that Gould and Sōseki shared.
The Dutch painter Piet Mondrian, famous for his geometric grid paintings, was an ardent jazz fan. In the late stage of his career, he became intrigued with boogie-woogie music, which inspired him to paint his masterpiece Broadway Boogie Woogie. While boogie-woogie and science operate in different domains, both share the characteristics of experimentation, improvisation, and pushing boundaries—whether it is creating new piano rhythms and melodies or creating new ways to discover innovative solutions to problems in art and science.