Patient callbacks after discharge from the emergency department are critical for communicating diagnostic test results, especially for sexually transmitted infections such as gonorrhea and chlamydia. Although these callbacks are essential for timely treatment and patient education, they can be time consuming and administratively burdensome. This quality improvement initiative evaluates the volume, success rate, and primary reasons for emergency department callbacks over 6 years, focusing on patient notification, education, and treatment during their emergency department visit. A retrospective analysis was conducted using an administrative data set of 3615 visits that required a callback to patients treated at an urban community emergency department in southeast Washington, DC, between March 2018 and June 2024. Data on callback attempts, reasons for callbacks, and patient follow-ups were extracted and analyzed. Descriptive statistics characterized the frequency and outcomes of these callbacks. Of the 3615 visits with at least 1 callback attempt, 21.2% of initial attempts failed to reach patients. Chlamydia and gonorrhea were the primary reasons for callbacks, accounting for 46.4% and 45.1% of ED cases requiring a callback, respectively. A notable 9.5% of visits requiring a callback required at least 3 attempts to reach the patient. In addition to gonorrhea and chlamydia, reasons for callbacks included positive results for herpes simplex virus, Trichomonas vaginalis, and various cultures. Limitations included missing data and free-text entries. The high volume of callbacks and the failure rate of initial attempts highlight inefficiencies in the current system. These findings suggest a need for improved technology and workflows to enhance timely treatment and reduce the burden on nursing and physician staff. Future studies should examine the impact of such interventions on treatment outcomes and workflow efficiencies. Improving callback systems and incorporating rapid sexually transmitted infection testing could streamline ED operations, ensure timely patient treatment, and mitigate the spread of sexually transmitted infections. Further research is needed to validate these approaches and explore their broader implications for public health and clinical practice.
Emergency departments (ED) present unique challenges for elderly patients who often experience higher revisit rates, increased number of complications, and worse health outcomes. This study examines the impact of implementing a combined automated screening callback and Geriatric Emergency Nurse Initiative Expert (GENIE)-led callback system on reducing ED revisit rates among elderly patients. We conducted a retrospective analysis that compared revisit rates before and after the implementation of a GENIE callback system in the ED of a large, Level 1 trauma academic center. The study cohort included 23,664 patients, and the primary outcome was revisits at three, seven, and 30 days post-discharge from the ED. Data were adjusted for the Emergency Severity Index (ESI), age group, and sex. The cost of this initiative came from a three-year grant of $650,000 from the Gary and Mary West Foundation, which included the salary for a GENIE nurse. Revisit ratios in the pre-intervention period were 4.8%, 8.9%, and 17.2% at three, seven, and 30 days after discharge, respectively. Following implementation of the callback system, those ratios decreased to 3.9%, 7.6%, and 15.2% at the corresponding time points. All reductions were statistically significant (P < .001) and remained significant after adjusting for ESI, age group, and sex. The GENIE callback system effectively reduced ED revisits among elderly patients, highlighting the importance of structured follow-up communication and care. These findings support the expansion of such programs to improve patient outcomes and reduce healthcare costs.
Black adults are underrepresented in cardiovascular disease clinical trials. Individual and social circumstances may limit when they are available to complete trial prescreening requirements. Characterizing preferences related to callback times and the impact of calling during preferred times could inform strategies to improve the recruitment of Black adults into clinical research. Our objectives were to characterize prescreening call preferences and successfully reaching a potential participant among adults inquiring about participation in two trials for Black residents of Boston. The GoFreshRx and GoFresh trials examine the effect of a home-delivered Dietary Approaches to Stop Hypertension (DASH)-patterned grocery intervention on blood pressure among Black adults with or without hypertension treatment in Boston. With the exception of the study population, both trials were identical and used the same recruitment apparatus for outreach. Interested persons completed a common online form for both trials and indicated their preferred callback time. Staff call attempts and participant screening status were logged prospectively. Gender was estimated based on first name, using a published algorithm. Odds ratios (OR) were determined via logistic regression models with adjustment for estimated gender, recruitment source, method of inquiry, and first call during preferred callback time. Of 2870 inquiries (September 2022-July 2023), 1740 participants were called and 1286 were reached. Out of the 1740 participants, 25% preferred to be called before noon and 22% after 4 pm, yet only 10% of the latter were called after 4 pm. Calling during preferred times significantly increased the odds of reaching participants (OR: 1.44; 95% CI: 1.12, 1.85) and completing a prescreening interview (OR: 1.39; 95% CI: 1.14, 1.71). Staff outreach 8-12 weeks (vs 0-4 weeks) after inquiry submission was significantly associated with lower odds of completing a prescreening interview (OR: 0.41; 95% CI: 0.23, 0.73). Participants who made inquiries via return mail were significantly less likely to be reached outside work hours (OR: 0.49; 95% CI: 0.27, 0.90) and in the afternoon (OR: 0.51; 95% CI: 0.30, 0.88). Participants recruited through community events were more likely to be reached in the afternoon (OR: 2.71; 95% CI: 1.06, 6.97). Contacting participants during their preferred callback time was associated with reaching them and completing a prescreening interview. These data highlight the importance of study teams' flexibility in outreach time to enhance the recruitment of Black adults into cardiovascular clinical trials.
Extensive literature probes labor market discrimination through correspondence studies in which researchers send pairs of resumes to employers, which are closely matched except for social signals such as gender or ethnicity. Upon perceiving these signals, individuals quickly activate associated stereotypes. The Stereotype Content Model (SCM; Fiske 2002) categorizes these stereotypes into two dimensions: warmth and competence. Our research integrates findings from correspondence studies with theories of social psychology, asking: Can discrimination between social groups, measured through employer callback disparities, be predicted by warmth and competence perceptions of social signals? We collect callback rates from 21 published correspondence studies, varying for 592 social signals. On those social signals, we collected warmth and competence perceptions from an independent group of online raters. We found that social perception predicts callback disparities for studies varying race and gender, which are indirectly signaled by names on these resumes. Yet, for studies adjusting other categories like sexuality and disability, the influence of social perception on callbacks is inconsistent. For instance, a more favorable perception of signals like parenthood does not consistently lead to increased callbacks, underscoring the necessity for further research. Our research offers pivotal strategies to address labor market discrimination in practice. Leveraging the warmth and competence framework allows for the predictive identification of bias against specific groups without extensive correspondence studies. By distilling hiring discrimination into these two dimensions, we not only facilitate the development of decision support systems for hiring managers but also equip computer scientists with a foundational framework for debiasing Large Language Models and other methods that are increasingly employed in hiring processes.
The need for discharge prescription clarification can lead to delays in patient care and possibly medication nonadherence, which can then lead to repeat emergency department (ED) visits and an increased strain on the healthcare system. This study aims to categorize and quantify the reasons pharmacies request prescription clarification from ED providers. This is a retrospective analysis of a quality improvement (QI) database containing prescription clarification request data at an urban, 61-bed academic ED in a Level I trauma center with 18 beds dedicated to pediatric patients. The database included de-identified information regarding prescription clarification callbacks populated from prescription clarification forms completed by ED unit clerks. Clarification types were reviewed and classified. Descriptive statistics were used to present the classification types. Total 2714 clarifications were collected. Of all available clarifications, 63.4% were classified as potentially preventable. The most common preventable clarification was clarification of directions for use (899, 33.1%), followed by a clarification of medication (333, 12.3%), dose (313, 11.5%), concern over a patient allergy or adverse event (135, 5.0%), and duplicate prescriptions (41, 1.5%). Of the nonpreventable clarifications, the most common were insurance issues (397, 14.6%), followed by medication availability (379, 14.0%), delayed patient presentation/lost prescriptions (131, 4.8%), and lastly, patient requests to resend prescriptions to a different pharmacy (86, 3.2%). Preventable medication clarifications account for the majority of clarification calls, with clarifications for the directions for use accounting for the highest percentage of preventable clarifications, followed by medication clarifications, dosing clarifications, patient allergy or adverse event concerns, and duplicate prescriptions.
Family care partners of persons living with dementia (PLWD) have limited support and resources and experience high levels of stress and burden. Prior research has demonstrated that one call to the Alzheimer's Association's Helpline benefitted 80% of callers following a single call. However, some care partners need more support than a single call. The aim of this study was to evaluate the efficacy of offering up to two additional Helpline care consultations after an initial call to the Helpline. 2503 study participants were Helpline callers who received one, two, or three care consultations at the callers' request. The PROMIS measure of self-efficacy in managing emotions was assessed among participants over time (baseline to two weeks after each care consultation), and differences were assessed between caller groups. No statistical differences were noted in demographics between those who received a single call versus two or three calls. Baseline self-efficacy scores were significantly lower in those who requested more than one call (p < 0.01). Self-efficacy scores improved over time in all three groups of callers, and the improvement was significant in those who received one and two care consultations (p < 0.01). Further research is indicated to understand the specific support needs of care partners that can benefit from more than one call to a telesupport helpline.
This mixed-methods study investigated themes and factors associated with recent dog adopters declining free over-the-phone support for dog behaviors of concern. At least one behavior of concern (potentially aggressive behavior [PAB], separation-related behavior [SRB], or other behavior of concern [OB]) was reported across 6,317 post-adoption support (PAS) calls made to 3,782 adopters at 2-days, 2-weeks, and 4-months post-adoption. However, for 68.8% of calls, the behavior support offered was declined. Generalized linear mixed-effects modeling and Tukey post-hoc testing showed declining support was significantly more likely at 2-weeks post-adoption compared to 2-days and when reporting behaviors of concern in the following combinations: PAB or SRB individually > PAB and SRB simultaneously > only OB > OB with PAB +/SRB. Inductive thematic analysis produced four themes from adopters' responses around declining help: "Awareness but no action yet", "managing behaviour", "feels support not needed", and "belief of cause". Findings offer insights into adopter attitudes around dog behavior, support needs, and behavioral management. Future research should explore whether declining this support is associated with using other support types and whether uptake impacts overall adoption.
Digital wound monitoring has become increasingly feasible with the widespread use of smartphones and mobile messaging platforms. Although most previous studies have focused on chronic wounds and demonstrated the clinical benefits of remote monitoring, little is known about how patients with acute wounds perceive and report wound-related changes after discharge; these factors may affect the accuracy and reliability of patient-facing digital health systems. This study aimed to evaluate the diagnostic performance of patient-reported infection symptoms in predicting clinician-initiated callbacks within a chatbot-based wound monitoring platform. A secondary objective was to identify wound features most strongly associated with patient-reported infection and examine differences between acute and chronic wound populations. This retrospective observational study was conducted at a tertiary medical center in Taipei, Taiwan, between June 30, 2022, and March 1, 2023, as part of an institutional digital health initiative. Within this program, adults with acute or chronic wounds voluntarily joined a chatbot-based monitoring system deployed through the Line messaging app using a bring-your-own-device model. Participants submitted daily symptom reports and wound photographs through the chatbot interface. For each submission, patient self-report of infection served as the primary predictor variable, while an independent review by a senior plastic surgeon determined the reference standard (callback vs no callback). Logistic regression and generalized estimating equation models were applied to account for within-subject correlation, with covariates including age, sex, and wound type. Analyses were performed separately for acute and chronic wounds. This study included 159 patients; 88 (55.3%) had acute wounds and 71 (44.7%) had chronic wounds. Across the study period, 4764 wound photographs were submitted, with a median of 5 (IQR 2-18) photographs per patient. Diagnostic performance differed by wound type. For acute wounds, the area under the receiver operating characteristic curve was 0.702, with 52.6% sensitivity (95% CI 31.7-72.7) and 87.8% specificity (95% CI 84.7-90.3). For chronic wounds, the area under the receiver operating characteristic curve was 0.907, with 94.9% sensitivity (95% CI 93.3-96.2) and 86.4% specificity (95% CI 85.2-87.5). In symptom correlation analyses, redness was significantly associated with patient-reported infection in the acute wound subgroup (odds ratio [OR] 3.94, 95% CI 1.97-7.90; P<.001), whereas in the chronic wound subgroup, both redness (OR 86.35, 95% CI 57.11-130.56; P<.001) and skin darkening (OR 358.55, 95% CI 244.79-525.16; P<.001) showed significant associations (all P<.001). This study highlights the differences in how patients perceive and report infection-related symptoms between populations with acute and chronic wounds. Lower diagnostic accuracy for acute wounds underscores the influence of limited experience and contextual constraints on patient self-assessment. These findings suggest that patient-facing digital wound monitoring systems should be tailored according to wound chronicity and patient experience, incorporating adaptive feedback and artificial intelligence-assisted screening to enhance patient-reported symptom interpretation.
Coronary artery disease (CAD) polygenic risk scores (PRS) may identify individuals at elevated genetic risk "flying under the radar" in contemporary practice. The aims of the PROACT (Polygenic Risk Based Detection and Treatment of Subclinical Coronary Atherosclerosis) trials are to prospectively identify these individuals, quantify subclinical coronary plaque, and slow its progression with pharmacologic interventions. The aim of this study is to report interim feasibility and implementation findings from PROACT, a genotype-first, biobank-enabled trial, characterizing eligibility yield, callback engagement, and subclinical coronary atherosclerosis on coronary computed tomographic angiography among individuals with high CAD PRS. Within a hospital-based biobank, adults 40 to 75 years of age with high CAD PRS, without cardiovascular disease, and not on lipid-lowering therapy were invited. The authors characterize 2,495 eligible individuals with high CAD PRS, report on the feasibility and early operational outcomes of a genotype-first callback strategy for a clinical trial in the first 1,314 invited, and describe plaque prevalence by age and sex in the first 204 participants using coronary computed tomographic angiography. Among 64,092 genotyped participants, 2,495 (3.9%) were eligible and had high CAD PRS despite low clinical risk (median 10-year pooled cohort equations risk for atherosclerotic cardiovascular disease 3%; Q1-Q3: 1%-8%). Recruitment showed high engagement: among 1,314 invited individuals, 283 (21.5%) opted in, and 204 (15.5%) completed baseline imaging. Compared with participants who did not opt in, those who opted in had higher specialty care engagement and lived closer to the study site. Analysis of the first 204 participants enrolled by January 31, 2025 (mean age 56.3 ± 8.5 years, 69% women), showed that despite the low clinical risk and favorable cardiovascular health (mean Life's Essential 8 score 73.3 ± 11.5 vs the U.S. average of ∼65), one-half the participants (102 of 204) had subclinical plaque. Subclinical plaque prevalence was 76.2% in men and 38.3% in women and was high across age groups. These exploratory findings highlight the feasibility of implementing genotype-first recruitment for prevention trials and reveal a large proportion of "silent" high-genetic risk individuals with subclinical plaque for whom pharmacotherapy could be beneficial but who remain undetected by standard clinical assessments. (Polygenic Risk Based Detection of Subclinical Coronary Atherosclerosis and Change in Cardiovascular Health [PROACT 1], NCT05819814; Polygenic Risk Based Detection of Subclinical Coronary Atherosclerosis and Intervention With Statin and Colchicine [PROACT 2], NCT05850091).
Pediatric cardiologists (PCs) and pediatric cardiac surgeons (PedCSs) in Korea face growing workforce shortages due to declining birth rates, decreasing interest among trainees, and increasing burnout. This study investigated the working conditions, job satisfaction, and burnout levels among Korean PCs and PedCSs. In June 2023, the Korean Pediatric Heart Society distributed a structured questionnaire via email to 149 members actively practicing pediatric cardiac care (115 PCs, 34 PedCSs). Responses from 122 members were analyzed. Descriptive statistics and regression analyses were performed to identify the factors associated with burnout (P<0.05). A total of 122 physicians (96 PCs, 26 PedCSs) completed the survey (response rates: overall, 81.9%; PCs, 83.5%; PedCSs, 76.5%). Among the PCs, 79.2% worked more than 51 hr/wk, 57.3% worked night shifts, and 70.8% experienced emergency callbacks at least once per month. PedCSs reported comparably heavy burdens, with 80.8% working >51 hr/wk and 88.5% experiencing monthly emergency callbacks. Regional disparities were notable: 48.2% of PCs in the Seoul metropolitan area (SMA) performed >51 catheterizations annually versus 7.1% in other regions, while 62.5% of PedCSs in the SMA performed >30 surgeries annually versus 20% elsewhere. Litigation, reported by 66.7% of PCs versus 84.6% of PedCSs, contributed to dissatisfaction and burnout. The key drivers included limited research time, legal risks, and nonspecialized duties. Overall, 64.0% of the PCs and 61.6% of the PedCSs reported experiencing burnout. In the multivariable analysis, answering ≥6 emergency callbacks/mo (adjusted odds ratio [aOR], 7.91; 95% confidence interval [CI], 1.28-48.79), occupational dissatisfaction (aOR, 2.57; 95% CI, 1.09-6.04), and work environment dissatisfaction (aOR, 2.74; 95% CI, 1.16-7.14) independently predicted burnout, whereas the working >51 hr/wk variable did not remain significant postadjustment. Excessive workload, frequent emergency callbacks, regional maldistribution of case volumes, litigation pressure, and occupational dissatisfaction drive high burnout among Korean pediatric cardiac specialists. These findings highlight persistent workforce challenges in Korea's pediatric cardiac system. Regular surveys and ongoing research are essential to ensuring sustainable pediatric cardiac care.
This small group session is intended for emergency medicine residents, medical students, and faculty. Improvisational techniques offer a novel and effective approach to teaching relationship-centered communication (RCC) and enhancing learner feedback in emergency medicine (EM).1 Improvisational theater (improv) is a form of spontaneous performance where all things or most things are made up on the spot. The "yes, and" principle-accepting a partner's idea ("yes") and building upon it ("and")-reflects core improv values such as affirmation, spontaneity, active listening, and empathy, all of which contribute to psychologically safe learning environments.1 It is an engaging practice that can foster creativity, build confidence, and enhance communication and social skills. Improv helps participants become more adaptable, attuned to emotional tone, and comfortable with uncertainty. These are critical elements of high-quality interpersonal feedback.2,3,4In the fast-paced EM setting, where teaching and supervision often occur in real time, the ability to deliver concise, respectful, and actionable feedback is essential. Improv-based learning provides a low-stakes space to explore tone, content, and delivery without fear of error. Prior studies demonstrate that improv improves communication performance, team collaboration, and confidence in difficult conversations.5,6 This module builds on that foundation by integrating structured feedback models and core RCC principles with improvisational exercises, allowing participants to refine skills through play, reflection, and peer interaction. As EM continues to emphasize communication and professionalism milestones, improv offers a compelling adjunct to traditional faculty or resident development by combining emotional literacy, interpersonal skills, and educational theory in a single interactive format. By the end of this session, learners will be able to improve relationship-centered communication (RCC): 1) define "yes, and" and its role in RCC, and 2) demonstrate active listening and responsiveness using improvisational techniques such as "yes, and," gift-giving, establishing scene, and callbacks. They will also be able to improve learner feedback: 1) define "yes, and" and its role in learner feedback, 2) review three evidence-based feedback models through a "yes, and" lens, and 3) practice improv techniques and deliver structured feedback in real-time peer scenarios using improvisational techniques such as "yes, and," gift-giving, establishing scenes, and callbacks. Using Kern's six-step approach, this curriculum was designed to address gaps in relationship-centered communication (RCC) and feedback skills among emergency medicine residents.7,8,9,10 The first two workshops focused on RCC, linking improvisational principles to patient communication through the Three-Function Model, which emphasizes building relationships, understanding the patient's perspective, and collaborating on care decisions. Sessions incorporated facilitator discussions, a video clip from Whose Line Is It Anyway? and small-group improv exercises. The third workshop targeted feedback skills for Graduate Medical Education (GME) leadership, introducing concepts such as "yes, and," credible feedback, and evidence-based models, and included interactive activities like the "Red Ball" exercise and improv-based learner scenarios to reinforce effective communication and feedback practices. A post-intervention survey with a 5-point Likert scale was administered immediately after all three sessions via Google Forms. Participants were asked about the structure of the activity, length, engagement, relevance to practice, and the facilitator's skill. Open-response questions included: "Describe a specific moment during the improv session that stood out to you." "How did it impact your understanding or approach to feedback or communication?" "How do you see the skills learned today translating to your future clinical practice?" "How likely are you to use "yes, and" in your communication with colleagues and patients?" "What challenges did you encounter when applying improv techniques during this session?" Thematic analysis of reflective prompts was performed. Fifty-two learners participated and responded to the post-intervention survey. This included a 5-point Likert scale and open-response questions administered for all three sessions. Respondents rated highly (4 or 5 on Likert scale) the activity structure (96.1%), length (84.3%), engagement (100%), relevance to practice (92.3%), and facilitator skill (88.5%). Thematic analysis of free-text answers revealed themes of "enjoyment/engagement," "connection to patient care," "applying improv to feedback," and "openness to future application." This applied improvisation curriculum provided an effective modality to practice RCC and feedback skills among EM learners and faculty. High engagement, relevance to practice, and strong facilitator impact highlight this effectiveness. The thematic analysis findings underscore the value of connecting improv techniques to patient care and feedback delivery. Relationship-centered communication, feedback, applied improvisation.
This article examines changes in labour-market discrimination against second-generation immigrants in Finland over an 8-year period, focusing on five groups. It draws on two large-scale field experiments conducted in 2016 and 2024, in which 10,000 matched applications were sent to 2000 vacancies across five sectors. The findings show a nuanced shift in employer attitudes, reflecting both progress and persistence in discrimination. Discrimination against non-European applicants has declined significantly, while bias towards European-origin candidates shows no improvement. Non-European men have seen a greater reduction in employer reluctance, while male disadvantage among European-origin candidates has remained stable. Despite these improvements, results from both periods highlight enduring structural biases, with immigrant applicants continuing to receive fewer callbacks than their Finnish counterparts. The findings underscore that achieving a fair labour market remains a long-term generational challenge rather than a quick policy fix, and provide support for ethnic hierarchies and social distance thesis, and the subordinate male target hypothesis. Cet article examine l'évolution de la discrimination sur le marché du travail à l'égard des immigrants de deuxième génération en Finlande sur une période de huit ans, en se concentrant sur cinq groupes. Il s'appuie sur deux expériences de terrain à grande échelle menées en 2016 et 2024, dans le cadre desquelles 10 000 candidatures appariées ont été envoyées pour 2000 postes vacants dans cinq secteurs. Les résultats montrent une évolution nuancée des attitudes des employeurs, reflétant à la fois des progrès et la persistance de la discrimination. La discrimination à l'égard des candidats non européens a considérablement diminué, tandis que les préjugés envers les candidats d'origine européenne ne montrent aucune amélioration. Les hommes non européens ont bénéficié d'une plus forte réduction de la réticence des employeurs, tandis que le désavantage des hommes parmi les candidats d'origine européenne est resté stable. Malgré ces améliorations, les résultats des deux périodes mettent en évidence des préjugés structurels persistants, les candidats immigrés continuant de recevoir moins de réponses que leurs homologues finlandais. Les résultats soulignent que la mise en place d'un marché du travail équitable reste un défi générationnel à long terme plutôt qu'une solution politique rapide, et viennent étayer les thèses sur les hiérarchies ethniques et la distance sociale, ainsi que l'hypothèse de la cible masculine subordonnée.
Blood cultures obtained in the emergency department (ED) may become positive after discharge. Healthcare professionals must determine if these results represent true infection or a likely contaminant. An institutional algorithm was developed to assist with healthcare professional response to positive blood cultures for S. aureus and coagulase-negative staphylococci (CoNS) in these situations. We conducted a single system, multisite cohort study comparing before and after implementation of an ED decision-making algorithm from November 2022 to December 2023. Adults were included if they were discharged from the ED before blood cultures became positive for Staphylococcus species. The primary outcome was the difference in rates of patients called back to the ED pre- and postalgorithm implementation. Secondary endpoints evaluated algorithm adherence and safety. A total of 253 patients, 188 pre- and 65 postimplementation, were enrolled. There was a 7.3% reduction in patients called back to the ED after algorithm implementation (95% CI [-21.1 to 6.3], P = .3). Algorithm adherence after implementation was 84.6% with a difference in actual and algorithm-based callback rates of 4.6%. After algorithm implementation, no patients deemed to have a contaminant experienced an infectious-related safety event. This time-saving algorithm was well received by our ED professionals and served as a helpful tool in safely and effectively triaging patients who had positive blood cultures for Staphylococcus species after discharge to determine who should be called back for further evaluation. There was a nonstatistically significant but clinically meaningful reduction in callback rates. Postimplementation algorithm adherence was high, and the majority of callback decisions were appropriate.
Acute lung injury (ALI) is a severe clinical syndrome with high mortality. Jingfang Granules (JFG), a modern formulation of the traditional Chinese medicine (TCM) compound Jingfang Baidu Powder, has been widely used to treat ALI. However, its protective effects and underlying mechanisms in ALI remain poorly understood. This study is based on a lipopolysaccharide (LPS)-induced ALI rat model, which was intervened with low, medium, and high dose of JFG. We carried out metabolomic analysis and identified 12 blood metabolites, the levels of core metabolites were regulated under JFG intervention, including L-Carnitine, Citric acid, Taurocholic acid, Arachidonic acid (AA), and Linoleic Acid (LA). Besides blood metabolites, 11 urine metabolites were also callback under JFG intervention, including Valine, Citric acid, L-Phenyalalanine, and Leukotriene B4, mainly involving the LA metabolism, AA metabolism, and phenylalanine, tyrosine and tryptophan biosynthesis. Comprehensive analysis shows that the restored enrichment pathways are mainly concentrated in inflammatory response, amino acid metabolism, and fatty acid metabolism. These findings reveal the potential mechanism of JFG in LPS-induced ALI, and its pathway nodes facilitate rapid translation from laboratory to clinical applications.
Super-resolution microscopy enables the observation of cells at unprecedented detail but usually entails high light exposure and slow imaging. Thus, often only a few manually selected regions are imaged, limiting the ability to capture the distribution of quantitative features in a population of cells in an unbiased fashion. An exciting strategy to circumvent these limitations are imaging pipelines in which informative regions are detected on-the-fly by software and imaged automatically. Point-scanning methods like STimulated Emission Depletion (STED), in particular, can be sped up by selective imaging of small regions. Here, I present autoSTED, a flexible Python-based framework to construct automated imaging pipelines for STED microscopy. Instead of fixed acquisition loops defined at the beginning of an experiment, autoSTED employs a priority queue of acquisition tasks. After each image acquisition, callback functions can trigger actions like adding new tasks based on data, enabling dynamic and adaptive imaging. Complex experimental pipelines can be built from easily exchangeable building blocks or expanded through custom code, facilitating integration of state-of-the-art computer vision methods. autoSTED can drastically speed up super-resolved imaging of subcellular structures and enables autonomous operation of a microscope for days with minimal hands-on time and bias.
Lung cancer remains one of the leading causes of cancer-related mortality worldwide, and accurate early diagnosis plays a critical role in improving patient survival. In this study, a comparative analysis of multiple lightweight Convolutional Neural Network (CNN) variants is presented for multi-class lung cancer classification using histopathological images. Four CNN architectures were designed to systematically explore the trade-off between model complexity and classification performance. Each variant was trained and evaluated within a unified experimental framework incorporating data augmentation, class balancing via computed class weights, and a custom macro-F1-based early stopping callback to ensure stable and fair performance comparison. The models were trained on three histopathological classes, Lung Benign Tissue, Lung Adenocarcinoma, and Lung Squamous Cell Carcinoma. The training process involved automated generation of accuracy, loss, and validation F1 curves, along with confusion matrices for both validation and test datasets. To assess robustness, the best-performing model was evaluated across multiple random seeds and statistical significance was established using paired McNemar's tests against competing variants. Among the proposed variants, one model (Lite-V2) achieved superior macro-F1 performance and demonstrated strong generalization capability on unseen test data, confirming the effectiveness of lightweight CNNs in achieving high accuracy with reduced computational cost. This work highlights the potential of custom lightweight CNN architectures for efficient and reliable lung cancer classification, offering a reproducible framework that can be extended to larger datasets or adapted for clinical diagnostic applications.
This study aimed to investigate the blood biomarkers for a rat model of spleen-stomach dampness-heat syndrome(SSDHS) treated by Lianpu Drink and unravel the underlying material basis based on the strategy of chinmedomics. Firstly, the rat model of SSDHS was established by a combined method of internal induction(200 g·L~(-1) honey water + wine + lard) + external exposure(artificial climate box). Metabolomics based on ultra-high performance liquid chromatography-quadrupole-time-of-flight mass spectrometry(UPLC-Q-TOF-MS) was employed to identify the blood biomarkers. The efficacy of Lianpu Drink in treating SSDHS was evaluated by observation of the general conditions of the rats and examination of the pathological changes in the gastrointestinal tissue. In addition, metabolomics was employed to unravel the endogenous small-molecule metabolites regulated by Lianpu Drink. A total of 32 blood biomarkers of SSDHS model rats were identified. Lianpu Drink significantly reduced the rectal temperature and alleviated the pathological changes in the gastrointestinal tissue of the model rats. 12-Ketodeoxycholic acid, glycodesoxycholic acid, oleoylcarnitine, lysophosphatidylcholine(LysoPC) P-18:0, LysoPC 20:1 sn1, monoacylglycerol(0:0/22:6/0:0), and 3β,16α-dihydroxyandrostenone sulfate were identified as the key callback metabolites in the Lianpu Drink treatment of SSDHS. UPLC-Q-TOF-MS-based serum pharmacochemistry of traditional Chinese medicine was adopted to investigate the in vivo constituents of Lianpu Drink under observable therapeutic effects and a total of 12 in vivo constituents of Lianpu Drink were identified. Molecular docking was adopted to predict the correlation between in vivo constituents and key metabolic enzymes. The results showed that coptisine, berberine, epiberberine, jatrorrhizine, palmatine, shanzhiside, phellodendrine, gentiobioside, magnoloside F, and magnolol had good binding affinity with the key enzymes of callback metabolites, including choloylglycine hydrolase(CGH), 7α-dehydroxylase(7α-DH), phospholipase A2(PLA2), carnitine palmityl transferase Ⅰ(CPT-Ⅰ), sulfotransferase 2A1(SULT2A1), and sulfatase(SULF). In conclusion, the results suggest that Lianpu Drink may treat SSDHS by regulating the enterohepatic circulation of bile acids, inflammatory responses, and energy metabolism. The material basis of Lianpu Drink in the treatment of SSDHS may be coptisine, berberine, epiberberine, jatrorrhizine, palmatine, shanzhiside, phellodendrine, gentiobioside, magnoloside F, and magnolol. This study provides a theoretical basis for the optimization of preparation process, the establishment of quality standards, and the development of innovative drugs for Lianpu Drink.
A key barrier to an effective care cascade for Hepatitis C virus (HCV) is limited awareness, especially among patients undergoing elective surgery. To address this issue, we introduced an electronic medical record (EMR)-based automatic alert system in 2021 to enhance surgical healthcare providers' awareness of HCV screening and referral rates. The alert system was designed to alert surgeons to order preoperative HCV antibody testing for patients undergoing elective surgery before admission and, at discharge, recommend hepatology consultation for patients with positive HCV antibody testing. The system significantly improved the HCV screening rate by 73,834 (96.8 %) among 76,310 patients undergoing surgery after system implementation, compared to 106,854 (82.8 %) among 129,065 patients between 2016 and 2020 (P < 0.001). Among them, the system alerted 12,048 (16.3 %) cases, and 463 patients tested positive for HCV antibodies. However, only 42 (15.3 %) were referred out of 275 (59.4 %) who required hepatology consultation. Linkage failure was associated with other surgery departments than hepatobiliary and transplant surgery departments (odds ratio [OR]=5.940, 95 % confidence interval [CI], 3.080-12.410, P < 0.001) and shorter hospitalization duration (OR=0.980, 95 % CI, 0.950-0.990, P = 0.012). The EMR-based automatic alert system effectively increased HCV screening for patients undergoing elective surgery before admission. However, it could not link them to care cascade in surgery departments. Combining more proactive approaches would be beneficial, such as reflex testing or a call-back strategy.
Alberta's Virtual MD program was established to enhance nurse tele-triage and divert low-acuity patients from the emergency department (ED). This study describes the use of Virtual MD and its impact on healthcare utilization. Demographic and clinical characteristics of Virtual MD patients were compared with Health Link 811 callers and the overall Alberta population between April 1, 2022, and March 31, 2023. Virtual MD recommendations included seeing a primary care provider, going to ED/urgent care, and self-management at home. Concordance with recommendations was determined using linked health administrative data. Virtual MD patients (n = 19,312) had a mean age of 34.8 years and were mostly female (62.3%). Compared to Health Link 811 callers, Virtual MD patients were slightly older (≥ 55 years) (20.8% vs. 25.0%). Of patients called within 4 h, 55.7% visited primary care within 14 days as advised, 60.0% visited ED within 2 days as advised and 52.5% of those advised to self-manage care at home did not use any healthcare within 14 days. Those advised to seek primary care had a higher odds [OR = 1.65 (95%CI: 1.24-2.21)] of family practice-sensitive conditions when they presented at ED compared to those advised to seek ED care. Hospitalization within 2 weeks was lower for patients advised to see primary care compared to those advised to see ED [4 h callback: OR = 0.33 (95%CI: 0.26 - 0.43), 24 h callback: OR = 0.15 (95%CI 0.08 - 0.28)]. Virtual MD effectively triaged patients, with over half following through on recommendations to see primary care, see ED, or self-manage care at home. Patients referred to primary care, but instead choosing to visit ED, were more likely to present with family practice-sensitive conditions, demonstrating appropriateness of the initial primary care advice. Overall, the Virtual MD service enables patients to access more appropriate levels of care for their healthcare needs. RéSUMé: OBJECTIFS: Le programme Virtual MD de l’Alberta a été créé pour améliorer le télétriage des infirmières et détourner les patients atteints d’une acuité visuelle faible du service des urgences (DE). Cette étude décrit l’utilisation de Virtual MD et son impact sur l’utilisation des soins de santé. MéTHODES: On a comparé les caractéristiques démographiques et cliniques des patients du programme Virtual MD avec celles des 811 appelants de Health Link et de l’ensemble de la population albertaine entre le 1er avril 2022 et le 31 mars 2023. Les recommandations de MD virtuel comprenaient la visite d’un fournisseur de soins primaires, l’accès aux services de réanimation et de soins urgents et l’autogestion à domicile. La concordance avec les recommandations a été déterminée à l’aide de données administratives liées sur la santé. RéSULTATS: Les patients atteints de MD virtuelle (n=19312) avaient en moyenne 34,8 ans et étaient majoritairement des femmes (62,3 %). Comparativement aux 811 appelants de Health Link, les patients du MD virtuel étaient légèrement plus âgés (55 ans) (20,8 % vs. 25,0 %). Parmi les patients appelés dans un délai de 4 heures, 55,7 % ont consulté les services de soins primaires dans les 14 jours suivant les recommandations, 60,0 % ont consulté les services d’urgence dans les 2 jours suivant les recommandations et 52,5 % des personnes conseillées pour l’autogestion des soins à domicile n’ont pas utilisé de soins de santé dans les 14 jours. Les personnes qui ont été conseillées de consulter un médecin de première ligne avaient une probabilité plus élevée [OR=1,65 (IC95 % : 1,24-2,21)] d’avoir des conditions sensibles à la pratique familiale lorsqu’elles se présentaient à l’urgence, comparativement aux personnes qui avaient été conseillées de consulter un médecin de première ligne. L’hospitalisation dans un délai de deux semaines était plus faible pour les patients dont on a recommandé qu’ils reçoivent des soins primaires comparativement à ceux qui ont été recommandés pour recevoir des soins d’urgence [4 heures de rappel : OR=0,33 (IC 95 % : 0,26 – 0,43), 24 heures de rappel : OR=0,15 (IC 95 % : 0,08 – 0,28)]. CONCLUSION: Le MD virtuel a efficacement trié les patients, avec plus de la moitié des personnes qui ont suivi les recommandations pour voir les soins primaires, voir les services d’urgence ou gérer elles-mêmes les soins à domicile. Les patients qui ont été orientés vers les soins primaires mais qui ont plutôt choisi de se rendre en DE étaient plus susceptibles de présenter des conditions sensibles à la pratique familiale, démontrant ainsi le caractère approprié des conseils prodigués aux premiers soins. Dans l’ensemble, le service Virtual MD permet aux patients d’accéder à des niveaux de soins plus appropriés à leurs besoins en matière de soins de santé.
Unpredictable work schedules (UWSs), which are characterized by last-minute schedule changes, on-call shifts, and short advance notice, have become increasingly common and have been linked to disrupted circadian rhythms, impaired sleep homeostasis, and poor health. However, evidence from South Korea, where long hours and low schedule autonomy are prevalent, remains scarce. This study examined the association between UWS and insomnia symptoms among wage workers in South Korea. Data from 20,534 wage workers aged 20-64 years were obtained from the 2020 Korean Working Conditions Survey. UWS was defined using three items: sudden callbacks, advance notice of schedule changes, and control over working hours. Insomnia symptoms were measured using the minimal insomnia symptom scale, with scores ≥ 6 indicating insomnia. Weighted multivariable logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for insomnia by UWS status after adjusting for demographic, socioeconomic, occupational, and psychosocial factors. Sensitivity analyses applied alternative UWS definitions (sudden recall, combined, strict, and lenient definitions). The prevalence of insomnia symptoms was 16.10% (157/975) in UWS and 7.25% (1418/19559) in non-UWS (p < 0.001). In the unweighted analysis, UWS was associated with higher odds of insomnia symptoms in the crude model (OR 2.46, 95% CI 2.05-2.94). Moreover, the association remained significant after adjustment for demographic and work-related covariates (Model 1: OR 2.15, 95% CI 1.78-2.59; Model 2: OR 1.64, 95% CI 1.34-2.01). Sensitivity analysis using alternative UWS definitions showed a consistent, statistically significant association in both crude and adjusted models. In the weighted analysis, the association remained significant after full adjustment (OR 2.30, 95% CI 1.74-3.05). UWS was found to be associated with higher odds of insomnia symptoms among Korean wage workers. Improving the predictability of schedules and ensuring the provision of advance notices may help improve sleep health. Longitudinal studies are needed to clarify causal relationships and to further investigate potential underlying pathways.