Explore the vast range of titles available.

Substance use disorder (SUD) remains a major public health crisis in the United States, with significant challenges in treatment access, retention, and workforce capacity. SUD care teams, including addiction medicine physicians and peer recovery coaches (PRCs), support patients receiving SUD treatment but face heavy workloads and burnout. Artificial intelligence (AI) innovations, particularly large language model (LLM)-based chatbots, may extend PRC support and provide patients with on-demand recovery support between clinic visits and PRC contacts. However, evidence on their development, feasibility, acceptability, and usability in addiction services remains limited. This study describes the development, feasibility, acceptability, and usability of an AI-powered health coaching chatbot (Suzy) designed to support patients in SUD recovery. A total of 2 clinicians, 5 researchers, and 2 technology developers led a small, multiphase pilot study. In the formative phase, they conducted focus groups and qualitative in-depth interviews with 12 health care professionals and 8 patients with substance use histories to specify chatbot functions and develop a rule-based chatbot. In phase 2, they conducted usability testing of the rule-based chatbot with 8 patients who reported substance use and completed standardized tasks, surveys, and qualitative interviews. Measures included the System Usability Scale (SUS), Net Promoter Score (NPS), and Single Ease of Use Question (SEQ). In phase 3, they developed an LLM-based chatbot co-designed and fine-tuned with PRCs and other SUD experts. Rule-based chatbot functions included craving management, appointment reminders, resource referrals, care team contacts, and goal setting. Usability task testing supported feasibility. In this small pilot sample, quantitative and qualitative feedback indicated acceptability and usability, with an average SUS score of 93 (benchmark 68), an NPS of 63 (benchmark 35), and a mean SEQ score of 6.5/7. Patients valued Suzy's approachable, nonjudgmental language and features that promoted accountability, self-monitoring, and 24/7 availability, while emphasizing that chatbots should supplement but not replace human support. The LLM-based chatbot development emphasized information accuracy, safety escalation protocols to mitigate risks of inappropriate chatbot responses, human-in-the-loop features, and expanded conversational flexibility and personal tailoring. In this pilot study, a rule-based chatbot designed to support SUD care demonstrated feasibility, usability, and acceptability. LLM-based chatbot development required more robust safety and emergency reporting features, while offering more patient-responsive conversational functions. By providing on-demand coaching, referrals, and reminders, Suzy may extend the reach of care teams, alleviate provider burden, and enhance patient engagement. Additional work is needed to understand how to best integrate Suzy into patients' recovery journeys to ensure human support remains accessible and prioritized. LLM evaluation was based on expert testing and safety review. Clinical effectiveness, including the impact on substance use, was not evaluated. Next steps include evaluating the LLM chatbot in real-world settings with larger samples and assessing its efficacy in reducing substance use.

Understanding the kinetic behavior at the scale of a single bubble is crucial for understanding cavitation flow properties. In this study, experiments and numerical analysis of shock waves resulting from the crumpling of a solitary adjacent wall vacuole have been conducted. Shock wave characteristics induced by near-wall bubble collapse were investigated using high-speed photography and shadowgraphy techniques. Numerical simulations were conducted of near-wall vacuole collapse-induced shock-wave dynamics using the OpenFOAM cavitatingFoam solver. (1) The shock wave displays an essentially symmetrical distribution. The pressure maxima diminished along the sagittal diameter. The intensity of the second shock wave generated near the wall was decreased by approximately 21.2% compared to the initial shock wave. The simulated wave speeds exhibit a high level of concordance with the experimental data, and the calculated errors are below 7.9%. (2) The pressure and velocity at which the shock wave propagates in water exhibit a power function and an exponential decay function, respectively, as they travel across distance. And the perturbation profile of the velocity aligned with the direction in which the shock wave propagated. This result indicates that the shock wave acts as a catalyst for the creation of disturbances in the velocity field. (3) Constructing a transformation relation for the wave energy of near-wall vacuole collapse. During its first collapse, the near-wall cavitation bubble lost an average of 85% of its energy. This allowed for the assessment of the erosive impact of cavitation-induced shock waves on rigid surfaces.

Sepsis is a life-threatening syndrome characterized by overwhelming inflammation and immune dysregulation, commonly complicated by acute lung injury. Patients with underlying conditions such as diabetes, malignancy, and chronic liver disease are particularly vulnerable. Dysregulated macrophage polarization plays a pivotal role in sepsis progression. Although exosomal microRNAs (miRNAs) have emerged as key immune modulators, the precise role of plasma-derived exosomal miR-17-5p in this process remains poorly defined. The transcription factor Bcl11b, previously linked to immune cell regulation, has not yet been studied in the context of sepsis-associated macrophage reprogramming. Extracellular vehicles (EVs) were isolated from the plasma of sepsis patients and healthy controls. A series of in vitro and in vivo experiments were conducted to investigate the effect of exosomal miR-17-5p on macrophage polarization, using qRT-PCR, flow cytometry, ELISA, and Western blot analyses. Transcriptome sequencing and dual-luciferase reporter assays were used to explore the regulatory relationship between miR-17-5p and Bcl11b. Plasma exosomes derived from sepsis patients exhibited reduced levels of miR-17-5p and promoted M1 macrophage polarization, characterized by increased iNOS and pro-inflammatory cytokines. Overexpression of miR-17-5p inhibited M1 polarization and alleviated inflammatory injury both in LPS-treated macrophages and in a CLP-induced mouse model. Mechanistically, miR-17-5p directly targeted the 3'UTR of Bcl11b, suppressing its expression. Restoration of Bcl11b reversed the anti-inflammatory effects of miR-17-5p, reinforcing M1 polarization and exacerbating lung injury. Plasma exosomal miR-17-5p promotes macrophage M1 polarization by targeting Bcl11b and contributes to sepsis-induced lung injury. These findings highlight a previously unrecognized miR-17-5p-Bcl11b regulatory axis and suggest a potential biomarker and therapeutic target for sepsis.

The unmet need for mental health care affects millions of Americans. A growing body of evidence in implementation science supports the effectiveness of task sharing in the delivery of brief psychosocial interventions. The digitization of training and processes supporting supervision can rapidly scale up task-shared interventions and enable frontline health workers (FLWs) to learn, master, and deliver interventions with quality and support. We aimed to assess the perceived feasibility and acceptability of a novel mobile and web app designed and adapted to support the supervision, training, and quality assurance of FLWs delivering brief psychosocial interventions. We followed human-centered design principles to adapt a prototype app for FLWs delivering brief psychosocial interventions for depression, drawing from an app previously designed for use in rural India. Using a multimethod approach, we conducted focus group sessions comprising usability testing and group interviews with FLWs recruited from a large health system in Texas to assess the feasibility and acceptability of the app. The positive System Usability Scale was used to determine the app's overall usability. We also calculated the participants' likelihood of recommending the app to others using ratings of 0 to 10 from least to most likely (net promoter score). Focus group transcripts were coded and analyzed thematically, and recommendations were summarized across 4 key domains. A total of 18 FLWs varying in role and experience with client care participated in the study. Participants found the app to be usable, with an average System Usability Scale score of 72.5 (SD 18.1), consistent with the industry benchmark of 68. Participants' likelihood of recommending the app ranged from 5 to 10, yielding a net promoter score of 0, indicating medium acceptability. Overall impressions of the app from participants were positive. Most participants (15/18, 83%) found the app easy to access and navigate. The app was considered important to support FLWs in delivering high-quality mental health care services. Participants felt that the app could provide more structure to FLW training and supervision processes through the systematic collection and facilitation of performance-related feedback. Key concerns included privacy-related and time constraints regarding implementing a separate peer supervision mechanism that may add to FLWs' workloads. We designed, built, and tested a usable, functional mobile and web app prototype that supports FLW-delivered psychosocial interventions in the United States through a structured supervision mechanism and systematic collection and review of performance measures. The app has the potential to scale the work of FLWs tasked with delivering these interventions to the hardest-to-reach communities they serve. The results of this project will inform future work to evaluate the app's use and efficacy in real-world settings to support task-shared mental health programs across the United States.

Here, we evaluate an alternative approach of preconditioning pancreatic islets before transplantation using a potent agonist of growth-hormone-releasing hormone (GHRH) to promote islet viability and function, and we explore the adrenal gland as an alternative transplantation site for islet engraftment. The endocrine microenvironment of the adrenal represents a promising niche with the unique advantages of exceptional high oxygen tension and local anti-inflammatory and immunosuppressive properties. GHRH agonists have been shown to promote islet graft survival and function, which may help to reduce the islet mass necessary to reverse diabetes. In the present study, the most potent GHRH agonist MR403 was tested on insulinoma cells, isolated rat islets, and adrenal β-cell cocultures in vitro. GHRH receptor is expressed on both adrenal cells and islets. MR403 caused a significant increase in cell viability and proliferation and revealed an antiapoptotic effect on insulinoma cells. Viability of rat islets was increased after treatment with the agonist and in coculture with adrenal cells. Rat islets were transplanted into diabetic mice to the intraadrenal transplant site and compared with the classical transplants underneath the kidney capsule. Graft function and integration were tested by metabolic follow-up and immunohistochemical staining of intraadrenal grafts. A rapid decrease occurred in blood glucose levels in both models, and all animals reached normoglycemia within the first days after transplantation. Our studies demonstrated that the adrenal may be an attractive site for islet transplantation and that GHRH analogs might allow reduction of the islet mass needed to reverse a diabetic status.

Individuals just released from prison, or returning citizens (RCs), face high mortality rates during the reentry period, with cardiovascular disease (CVD) being a leading cause. Peer mentors can support RCs' health, but they traditionally work in person, which may not always be feasible, particularly during pandemic outbreaks such as COVID-19. We used human-centered design to build a prototype of RCPeer, a web/mobile application (app) to support peer-led reentry efforts through CVD risk screening, action planning, linkage to resources addressing reintegration needs (e.g., housing, transportation), and goal-setting. We assessed feasibility, acceptability, and usability of RCPeer using mixed-methods. System Usability Scale (SUS) scores were 68 for peers and 66 for RCs, indicating good usability. Qualitative data suggests that RCPeer can support reentry tasks through RCs and peers sharing data, strengthen RC-peer relationships, and facilitate RCs meeting their goals. Future work is needed to enhance usability for RCs with limited technology experience.

Based on our recently proposed magnon-density-waves using the microscopic many- body approach, we investigate the longitudinal excitations in quantum antiferromagnets by including the second order corrections in the large-s expansion. The longitudinal excitation spectra for a general spin quantum number using the antiferromagnetic Heisenberg Hamiltonian are obtained for various spin lattice models. For bipartite lattice models, we find that the numerical results for the energy gaps for the longitudinal modes at q → 0 and the magnetic ordering wavevector Q are reduced by about 40-50 % after including the second order corrections. Thus, our estimate of the energy gaps for the quasi-one-dimensional (quasi- 1D) antiferromagnetic compound KCuF3 is in better agreement with the experimental result. For the quasi-1D antiferromagnets on hexagonal lattices, the full excitation spectra of both the transverse modes (i.e., magnons) and the longitudinal modes are obtained as functions of the nearest-neighbor coupling and the anisotropy constants. We find two longitudinal modes due to the non-collinear nature of the triangular antiferromagnetic order, similar to that of the phenomenological field theory approach by Affleck. We compare our results for the longitudinal energy gaps at the magnetic wavevectors with the experimental results for several antiferromagnetic compounds with both integer and non-integer spin quantum numbers, and also find good agreement after the higher-order contributions are included in our calculations.

Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066.

It was evaluated its antigenicity, immunogenicity and efficacy of a candidate recombinant hepatitis E virus (HEV) vaccine, referred hitherto as HEV 239 vaccine. The vaccine peptide has a 26 amino acids extension from the N terminal of another peptide, E2, of the HEV capsid protein, which has been shown to protect monkeys against HEV infection previously. The vaccine peptide is similar as E2 in that: first, the vaccine peptide migrates predominantly as dimer in SDS-PAGE and it is dissociated into monomers by heating; second, its dimeric form of which predominantly recognized by HEV reactive human serum; and third, it shows the same pattern of reaction as E2 with a panel of eight monoclonal antibodies that had been raised against E2. In contrast to E2, the vaccine peptide aggregates to form particles of 13 nm mean radius, and consequently, it is more than 240 times more immunogenic than E2. Using alum as adjuvant, immunizing dose determined in mice was 80–250 ng for the vaccine and >60 μg for E2. Rhesus monkeys twice vaccinated with a 10 μg or a 20 μg formulation of this vaccine showed essentially the same antibody response, whereas the response to a 5 μg formulation was delayed but reached similar antibody levels. All the three vaccine formulations afford complete protection against infection with 10 4 genome equivalent dose of the homologous genotype 1 virus. At higher virus dose of 10 7, the same vaccine formulation partially protected against the infection and completely protected against hepatitis. The efficacy of the vaccine was essentially the same for the homologous genotype 1 virus and heterologous genotype 4 virus.

We study the longitudinal excitations of quantum antiferromagnets on a triangular lattice by a recently proposed microscopic many-body approach based on magnon-density waves. We calculate the full longitudinal excitation spectra of the antiferromagnetic Heisenberg model for a general spin quantum number in the isotropic limit. Similar to the square lattice model, we find that, at the center of the first hexagonal Brillouin zone Γ ( q =0) and at the magnetic ordering wavevectors ±[ Q =(4 π /3,0)], the excitation spectra become gapless in the thermodynamic limit, due to the slow, logarithmic divergence of the structure factor. However, these longitudinal modes on two-dimensional models may be considered as quasi-gapped, as any finite-size effect or small anisotropy will induce a large energy gap, when compared with the counterpart of the transverse spin-wave excitations. We also discuss a possible second longitudinal mode in the triangular lattice model due to the noncollinear nature of its magnetic order.