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Abstract Feature extraction and selection from medical data are the basis of radiomics and image biomarker discovery for various architectures, including convolutional neural networks (CNNs). We herein describe the typical radiomics steps and the components of a CNN for both deep feature extraction and end-to-end approaches. We discuss the curse of dimensionality, along with dimensionality reduction techniques. Despite the outstanding performance of deep learning (DL) approaches, the use of handcrafted features instead of deep learned features needs to be considered for each specific study. Dataset size is a key factor: large-scale datasets with low sample diversity could lead to overfitting; limited sample sizes can provide unstable models. The dataset must be representative of all the “facets” of the clinical phenomenon/disease investigated. The access to high-performance computational resources from graphics processing units is another key factor, especially for the training phase of deep architectures. The advantages of multi-institutional federated/collaborative learning are described. When large language models are used, high stability is needed to avoid catastrophic forgetting in complex domain-specific tasks. We highlight that non-DL approaches provide model explainability superior to that provided by DL approaches. To implement explainability, the need for explainable AI arises, also through post hoc mechanisms. Relevance statement This work aims to provide the key concepts for processing the imaging features to extract reliable and robust image biomarkers. Key Points The key concepts for processing the imaging features to extract reliable and robust image biomarkers are provided. The main differences between radiomics and representation learning approaches are highlighted. The advantages and disadvantages of handcrafted versus learned features are given without losing sight of the clinical purpose of artificial intelligence models. Graphical Abstract

Abstract Background Integrating advanced machine-learning (ML) algorithms into clinical practice is challenging and requires interdisciplinary collaboration to develop transparent, interpretable, and ethically sound clinical decision support (CDS) tools. We aimed to design a ML-driven CDS tool to predict opioid overdose risk and gather feedback for its integration into the University of Florida Health (UFHealth) electronic health record (EHR) system. Methods We used user-centered design methods to integrate the ML algorithm into the EHR system. The backend and UI design sub-teams collaborated closely, both informed by user feedback sessions. We conducted seven user feedback sessions with five UF Health primary care physicians (PCPs) to explore aspects of CDS tools, including workflow, risk display, and risk mitigation strategies. After customizing the tool based on PCPs’ feedback, we held two rounds of one-on-one usability testing sessions with 8 additional PCPs to gather feedback on prototype alerts. These sessions informed iterative UI design and backend processes, including alert frequency and reappearance circumstances. Results The backend process development identified needs and requirements from our team, information technology, UFHealth, and PCPs. Thirteen PCPs (male = 62%, White = 85%) participated across 7 user feedback sessions and 8 usability testing sessions. During the user feedback sessions, PCPs (n = 5) identified flaws such as the term “high risk” of overdose potentially leading to unintended consequences (e.g., immediate addiction services referrals), offered suggestions, and expressed trust in the tool. In the first usability testing session, PCPs (n = 4) emphasized the need for natural risk presentation (e.g., 1 in 200) and suggested displaying the alert multiple times yearly for at-risk patients. Another 4 PCPs in the second usability testing session valued the UFHealth-specific alert for managing new or unfamiliar patients, expressed concerns about PCPs’ workload when prescribing to high-risk patients, and recommended incorporating the details page into training sessions to enhance usability. Conclusions The final backend process for our CDS alert aligns with PCP needs and UFHealth standards. Integrating feedback from PCPs in the early development phase of our ML-driven CDS tool helped identify barriers and facilitators in the CDS integration process. This collaborative approach yielded a refined prototype aimed at minimizing unintended consequences and enhancing usability.

In this study, we explored how a reimagined EdD supports leaders to develop the knowledge, skills, and dispositions necessary for effective school and district leadership. We analyzed the usefulness of inquiry-focused, equity-based participatory action research (PAR) in EdD dissertations by using case study methodology to analyze four graduates during and after the EdD program. The findings indicate participants successfully implemented PAR studies while simultaneously bolstering their leadership capacity. Findings have practical use for: (1) EdD graduates as they continue to use the PAR methodology in their current work and communities; and (2) leadership programs that choose to use PAR as a methodology for scholarly practitioners.

Basal cell carcinoma (BCC) is the most frequent malignancy in the general population. To date, dermoscopy is considered a key tool for the diagnosis of BCC; nevertheless, line-field confocal optical coherence tomography (LC-OCT), a new non-invasive optical technique, has become increasingly important in clinical practice, allowing for in vivo imaging at cellular resolution. The present study aimed to investigate the possible correlation between the dermoscopic features of BCC and their LC-OCT counterparts. In total, 100 histopathologically confirmed BCC cases were collected at the Dermatologic Clinic of the University of Siena, Italy. Predefined dermoscopic and LC-OCT criteria were retrospectively evaluated, and their frequencies were calculated. The mean (SD) age of our cohort was 65.46 (13.36) years. Overall, BCC lesions were mainly located on the head (49%), and they were predominantly dermoscopically pigmented (59%). Interestingly, all dermoscopic features considered had a statistically significant agreement with the LC-OCT criteria (all p < 0.05). In conclusion, our results showed that dermoscopic patterns may be associated with LC-OCT findings, potentially increasing accuracy in BCC diagnosis. However, further studies are needed in this field.

Abstract Human glial progenitor cells (hGPCs) exhibit diminished expansion competence with age, as well as after recurrent demyelination. Using RNA-sequencing to compare the gene expression of fetal and adult hGPCs, we identify age-related changes in transcription consistent with the repression of genes enabling mitotic expansion, concurrent with the onset of aging-associated transcriptional programs. Adult hGPCs develop a repressive transcription factor network centered on MYC, and regulated by ZNF274, MAX, IKZF3, and E2F6. Individual over-expression of these factors in iPSC-derived hGPCs lead to a loss of proliferative gene expression and an induction of mitotic senescence, replicating the transcriptional changes incurred during glial aging. miRNA profiling identifies the appearance of an adult-selective miRNA signature, imposing further constraints on the expansion competence of aged GPCs. hGPC aging is thus associated with acquisition of a MYC-repressive environment, suggesting that suppression of these repressors of glial expansion may permit the rejuvenation of aged hGPCs.

The Stimulated Raman Adiabatic Passage (STIRAP) on a three-state system interacting with a spin bath is considered, focusing on the efficiency of the population transfer. Our analysis is based on the perturbation treatment of the interaction term evaluated beyond the Rotating Wave Approximation, thus focusing on the limit of weak system–bath coupling. The analytical expression of the correction to the efficiency and the consequent numerical analysis show that, in most of the cases, the effects of the environment are negligible, confirming the robustness of the population transfer.

The East Carolina University International EdD supports school leaders in the United States and across the globe to address local educational equity challenges. To achieve this, we prepare and support school and district leaders to use evidence as practitioner-researchers together with members of their educational community. As a result, the reimagined EdD harnesses the power and utility of participatory action and activist research to address a contextualized, equity-focused dissertation in practice. We explore how two doctoral students have transformed their practices during and after their EdD experience.

BackgroundHealth outcomes are significantly influenced by unmet social needs. Although screening for social needs has become common in health care settings, there is often poor linkage to resources after needs are identified. The structural barriers (eg, staffing, time, and space) to helping address social needs could be overcome by a technology-based solution. ObjectiveThis study aims to present the design and evaluation of a chatbot, DAPHNE (Dialog-Based Assistant Platform for Healthcare and Needs Ecosystem), which screens for social needs and links patients and families to resources. MethodsThis research used a three-stage study approach: (1) an end-user survey to understand unmet needs and perception toward chatbots, (2) iterative design with interdisciplinary stakeholder groups, and (3) a feasibility and usability assessment. In study 1, a web-based survey was conducted with low-income US resident households (n=201). Following that, in study 2, web-based sessions were held with an interdisciplinary group of stakeholders (n=10) using thematic and content analysis to inform the chatbot’s design and development. Finally, in study 3, the assessment on feasibility and usability was completed via a mix of a web-based survey and focus group interviews following scenario-based usability testing with community health workers (family advocates; n=4) and social workers (n=9). We reported descriptive statistics and chi-square test results for the household survey. Content analysis and thematic analysis were used to analyze qualitative data. Usability score was descriptively reported. ResultsAmong the survey participants, employed and younger individuals reported a higher likelihood of using a chatbot to address social needs, in contrast to the oldest age group. Regarding designing the chatbot, the stakeholders emphasized the importance of provider-technology collaboration, inclusive conversational design, and user education. The participants found that the chatbot’s capabilities met expectations and that the chatbot was easy to use (System Usability Scale score=72/100). However, there were common concerns about the accuracy of suggested resources, electronic health record integration, and trust with a chatbot. ConclusionsChatbots can provide personalized feedback for families to identify and meet social needs. Our study highlights the importance of user-centered iterative design and development of chatbots for social needs. Future research should examine the efficacy, cost-effectiveness, and scalability of chatbot interventions to address social needs.

For newly met acquaintances, deployment of a single lexical term, an emblem such as "tech" or "finance," signals where one stands in the professional universe and points to any manner of traits and characteristics or a certain type of person. This positioning and evaluation has pivotal real-world implications for occupational attainment as people decide whether a conversation is worth continuing and a contact worth advancing. This study examines self-presentation sequences at a professional networking event in Hong Kong. In the interactions at these events, professional emblems serve to locate people amongst different taxonomies, such as hierarchies of eliteness, and invoke various traits. But in highly diverse, globalized contexts like this one in Hong Kong, what happens when shared knowledge of emblems is not readily available, and how do participants negotiate this? This study seeks to answer these underexamined questions, acutely relevant in particular social circles nowadays, focusing on misrecognized, vaguely recognized, semiotically transposed, and spuriously recognized cases. It also introduces advanced visual depictions of the indexical maps that participants hold, in all their complexity, drawing both from interaction, where there are some hints of emblem uptake, and subsequent interviews, where emblems' indexicalities and their social value to social actors are made explicit. This study fills a gap in how people with diverse biographies 'cobble together' indexical meanings in the moment to position their interactants within their conceptions of the world and ascribe social value.

Dermatologists serve a vast array of patients with unique backgrounds. The National Institutes of Health (NIH) designated members of sexual and gender minorities as underrepresented in scholarly literature. Our study examines the past 10 years of studies published in highly-cited dermatologic journals, surveying each study for common data collection of sexual orientation and gender identity (SOGI) in dermatological studies. We found representation of sexual and gender minorities to be increasing in dermatological studies but recommend that SOGI data be collected regularly just as any other common variable in dermatological patient studies.

Biological aging, characterized by changes in metabolism and physicochemical properties of cells, has an impact on public health. Environment and lifestyle, including factors like diet and physical activity, seem to play a key role in healthy aging. Several studies have shown that regular physical activity can enhance antioxidant defense mechanisms, including the activity of enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase. However, intense or prolonged exercise can also lead to an increase in reactive oxygen species (ROS) production temporarily, resulting in oxidative stress. This phenomenon is referred to as “exercise-induced oxidative stress”. The relationship between physical activity and oxidative stress in aging is complex and depends on various factors such as the type, intensity, duration, and frequency of exercise, as well as individual differences in antioxidant capacity and adaptation to exercise. In this review, we analyzed what is reported by several authors regarding the role of physical activity on oxidative stress in the aging process as well as the role of hormesis and physical exercise as tools for the prevention and treatment of sarcopenia, an aging-related disease. Finally, we reported what has recently been studied in relation to the effect of physical activity and sport on aging in women.

The application of the erythrocyte sedimentation rate (ESR) in feline medicine is currently unavailable, while in canine medicine it has been rediscovered due to the introduction of an automated ESR device. Our aims were to (1) define the reference interval (RI) of the ESR in healthy cats, (2) evaluate the ESR values between healthy and ill cats, (3) evaluate relationships between the ESR and some inflammatory markers, and (4) assess ESR changes in different durations of illness (acute, chronic, or acute-on-chronic). A prospective multicentric cohort study on 200 client-owned cats: 57 healthy cats and 143 ill cats for the other aims. Healthy cats were blood donors, or young cats underwent desexing procedures. Ill cats with full clinical medical records, hematobiochemical profiles, and diagnostic procedures to reach a final diagnosis were included. The ESR was performed with MINI-PET using the same K3-EDTA tubes used for CBC, with no additional sample required. The total leukocyte count (WBC), neutrophil-to-lymphocyte ratio (NLR), fibrinogen, serum amyloid A, and albumin/globulin ratio (A/G) were concurrently measured. Based on the clinical presentation and the final diagnosis, cats were classified as having the following: acute, chronic, and acute-on-chronic conditions. The RI of the ESR ranged between 1 and 23 mm/h. Ill cats showed a significantly higher ESR (median 29 mm/h; range 12–46 mm/h) than healthy cats (median 10 mm/h; range 1–12 mm/h; p

In Trypanosoma brucei, gene expression is primarily regulated posttranscriptionally making RNA metabolism critical. T. brucei has an epitranscriptome containing modified RNA bases. Yet, the identity of the enzymes catalyzing modified RNA base addition and the functions of the enzymes and modifications remain unclear. Homology searches indicate the presence of numerous T. brucei cytosine RNA methyltransferase homologs. One such homolog, TbNop2 was studied in detail. TbNop2 contains the six highly conserved motifs found in cytosine RNA methyltransferases and is evolutionarily related to the Nop2 protein family required for rRNA modification and processing. RNAi experiments targeting TbNop2 resulted in reduced levels of TbNop2 RNA and protein, and a cessation of parasite growth. Next generation sequencing of bisulfite-treated RNA (BS-seq) detected the presence of two methylation sites in the large rRNA; yet TbNop2 RNAi did not result in a significant reduction of methylation. However, TbNop2 RNAi resulted in the retention of 28S internal transcribed spacer RNAs, indicating a role for TbNop2 in rRNA processing.

We investigated the effect of growing on lactate instead of glucose in human cardiomyocyte assessing their viability, cell cycle activity, oxidative stress and metabolism by a proteomic and metabolomic approach. In previous studies performed on elite players, we found that adaptation to exercise is characterized by a chronic high plasma level of lactate. Lactate is considered not only an energy source but also a signalling molecule and is referred as “lactormone”; heart is one of the major recipients of exogenous lactate. With this in mind, we used a cardiac cell line AC16 to characterize the lactate metabolic profile and investigate the metabolic flexibility of the heart. Interestingly, our data indicated that cardiomyocytes grown on lactate (72 h) show change in several proteins and metabolites linked to cell hypertrophy and cytoskeleton remodelling. The obtained results could help to understand the effect of this metabolite on heart of high-performance athletes.

In his 2013 monograph on Structure and Method in Aristotle’s Meteorologica, Malcolm Wilson has shown both that Aristotle conceived of meteorological phenomena as analogous to the bodily processes of animals, and that for the Stagirite the sublunar world should not be seen as a single body, but rather as composed of many different individuals. However, Wilson did not articulate the relationship between these two theories—that is, he did not answer the following question: how is it possible for the Earth to behave like an animal if it is not a single body? This paper argues that the answer to this question lies in the Aristotelian statement about the different paschein of the Earth and animals. In fact, in the chapter of Meteorology dedicated to climatic changes (1.14), Aristotle, after comparing such changes to the maturing and ageing of living organisms, states that ‘only, in the case of the bodies of plants and animals being affected does not occur in each part separately, but it is necessary for the being to mature and decay all at once, whereas in the case of the Earth this occurs in each part separately, due to cooling and warming’ (351a.28-31). In his commentary, Alexander of Aphrodisias reiterates that the difference between the changes of the Earth and those of living organisms concern the way in which these different subjects undergo affections (pathê). The concept of paschein/pathos is thus fundamental to understanding how Aristotle conceives of biological analogies, which play a key role in his meteorology: as the affections of maturing and corruption show, parallels with organic processes can be found in meteorological phenomena, but always at the level of the individual parts of the Earth. Although the sublunary world can be understood in organic terms, this world is not a ‘cosmic animal’, but rather a multiplicity of ‘regional animals’. To corroborate this thesis, this paper addresses several related questions, including: the mechanics ofenvironmental changes according to Aristotle; the differences between the regions of the Earth; the lexicon used in Meteorology to refer to the transformations of the Earth; the personal notes that Alexander adds to Aristotle’s discussion. Finally, the first modern translation of the relevant section of Alexander’s commentary is also provided here.

Background Drug–drug interactions (DDIs) are common and can result in patient harm. Electronic health records warn clinicians about DDIs via alerts, but the clinical decision support they provide is inadequate. Little is known about clinicians’ real-world DDI decision-making process to inform more effective alerts.Objective Apply cognitive task analysis techniques to determine informational cues used by clinicians to manage DDIs and identify opportunities to improve alerts.Design Clinicians submitted incident forms involving DDIs, which were eligible for inclusion if there was potential for serious patient harm. For selected incidents, we met with the clinician for a 60 min interview. Each interview transcript was analysed to identify decision requirements and delineate clinicians’ decision-making process. We then performed an inductive, qualitative analysis across incidents.Setting Inpatient and outpatient care at a major, tertiary Veterans Affairs medical centre.Participants Physicians, pharmacists and nurse practitioners.Outcomes Themes to identify informational cues that clinicians used to manage DDIs.Results We conducted qualitative analyses of 20 incidents. Data informed a descriptive model of clinicians’ decision-making process, consisting of four main steps: (1) detect a potential DDI; (2) DDI problem-solving, sensemaking and planning; (3) prescribing decision and (4) resolving actions. Within steps (1) and (2), we identified 19 information cues that clinicians used to manage DDIs for patients. These cues informed their subsequent decisions in steps (3) and (4). Our findings inform DDI alert recommendations to improve clinicians’ decision-making efficiency, confidence and effectiveness.Conclusions Our study provides three key contributions. Our study is the first to present an illustrative model of clinicians’ real-world decision making for managing DDIs. Second, our findings add to scientific knowledge by identifying 19 cognitive cues that clinicians rely on for DDI management in clinical practice. Third, our results provide essential, foundational knowledge to inform more robust DDI clinical decision support in the future.