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Air pollution-related immune gene prognostic signature for hepatocellular carcinoma: network toxicology, machine learning and multi-omics analysis

Front Immunol. 2025 Sep 12;16:1638445. doi: 10.3389/fimmu.2025.1638445. eCollection 2025.

ABSTRACT

BACKGROUND: Air pollution may crosstalk with immune system to promote hepatocellular carcinoma (HCC) development, but its precise mechanisms and prognostic significance remain unclear.

OBJECTIVE: This study aims to construct a prognostic signature for HCC based on air pollutant-related immune genes (APIGs).

METHODS: We obtained mRNA-seq and scRNA of HCC from GEO, TCGA and ICGC. AP-related target genes were retrieved from several online databases. APIGs were obtained using WGCNA, differential gene expression analysis and immune infiltration analysis. Molecular subtypes were conducted based on APIG expression to characterize immune features. A total of 101 combinations of 10 machine learning algorithms were used to construct an APIG-based prognostic signature (APIGPS). Furthermore, we performed qRT-PCR, survival analyses, functional enrichment, immune infiltration and single-cell analyses. Subsequently, LASSO, RF, and RFE-SVM were employed to identify diagnostic genes, followed by pan-cancer analysis.

RESULTS: We identified 19 APIGs. HCC samples were divided into 3 subtypes, with C1 exhibiting a pro-tumor immune microenvironment and poorer prognosis. APIGPS constructed by 7 APIGs (CDC25C, MELK, ATG4B, SLC2A1, CDC25B, APEX1, GLS), demonstrated robust predictive ability independent of clinical features. The biological pathway differences between APIGPS-based high- and low-risk groups involved immune responses and cell proliferation and migration. APIGPS genes had stable binding to 7 APs and were mainly expressed in macrophages, with HRG exhibiting higher macrophage abundance. CDC25C was identified as the hub gene after intersecting diagnostic genes and APIGPS genes. CDC25C was associated with survival of 10 cancers, MSI in 10 cancers, TMB in 21 cancers, and immune cell abundance in 13 cancers.

CONCLUSIONS: We identified key APIGs and constructed a robust APIG-based prognostic signature for HCC. CDC25C was a key target through which APs impact HCC and multiple other cancers.

PMID:41019083 | PMC:PMC12463942 | DOI:10.3389/fimmu.2025.1638445

Genomically matched therapy in advanced solid tumors: the randomized phase 2 ROME trial

Nature Medicine, Published online: 29 September 2025; doi:10.1038/s41591-025-03918-x

In the proof-of-concept phase 2 ROME trial, comprehensive genomic profiling followed by molecular tumor board evaluation and randomization of patients with metastatic solid cancer to receive personalized therapy or standard of care led to a significantly higher objective response rate and longer progression-free survival in patients who received personalized therapy.

Application of Behavioral Science in Digital Therapeutics for Individuals With Prediabetes: Scoping Review

Background: Digital therapeutics are increasingly used to manage prediabetes due to their accessibility and potential for personalization. Their success depends heavily on applying behavioral science and integrating theoretical models into digital platforms. However, there has not been a comprehensive account of how behavioral science has been used in digital therapeutics for individuals with prediabetes. Objective: This scoping review aimed to examine the use of behavioral theories and techniques in digital therapeutic interventions for individuals with prediabetes, and to identify opportunities to optimize theory-driven and technology-supported strategies. Methods: A scoping review was conducted following the Arksey and O’Malley framework and guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We systematically searched PubMed, Embase, Web of Science, the Cochrane Library, Scopus, CNKI, and VIP Database for Chinese Technical Periodicals for studies published up to March 10, 2025. Eligible studies included adults (≥18 years) with prediabetes, as defined by the American Diabetes Association, and examined digital therapeutic interventions informed by behavioral science. All study designs were eligible; included studies were screened, and key characteristics were charted. Results: Of the 21 included studies, 17 were randomized controlled trials. The most frequently used behavioral theories were social cognitive theory, theory of planned behavior, and transtheoretical model; however, 11 studies applied behavior change techniques without explicitly stating a theoretical framework. In terms of delivery, digital modalities often comprised smartphone apps (14/21, 67%), human coaching (13/21, 62%), messaging tools (9/21, 43%), wearable devices (9/21, 43%), and web platforms (3/21, 14%). About behavior change techniques, the most frequently used were self-monitoring of behavior (19/21), instruction on performing the behavior (16/21), goal setting (15/21), information about health consequences (15/21), and unspecified social support (11/21). Across studies, outcomes were typically assessed for metabolic and body composition (19/21), glycemic control metrics (17/21), cardiovascular risk and physiological function metrics (16/21), behavioral and cognitive intervention indicators (11/21), and, less frequently, comprehensive health outcome measures (2/21). Conclusions: Behavioral science plays a crucial role in developing effective digital therapeutics for individuals with prediabetes. However, greater clarity in theory selection, better integration between models and digital functions, and more culturally inclusive research are needed to improve the scalability and impact of these interventions.

Article: Disaggregation in Large Language Models: The Next Evolution in AI Infrastructure

29 September 2025 at 19:00

Large Language Model (LLM) inference faces a fundamental challenge: the same hardware that excels at processing input prompts struggles with generating responses, and vice versa. Disaggregated serving architectures solve this by separating these distinct computational phases, delivering throughput improvements and better resource utilization while reducing costs.

By Anat Heilper

Multi-Omics Feature Selection to Identify Biomarkers for Hepatocellular Carcinoma

Metabolites. 2025 Aug 28;15(9):575. doi: 10.3390/metabo15090575.

ABSTRACT

INTRODUCTION: Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer, ranks as the third leading cause of mortality globally. Patients diagnosed with HCC exhibit a dismal prognosis mostly due to the emergence of symptoms in the advanced stages of the disease. Moreover, conventional biomarkers demonstrate insufficient efficacy in the early detection of HCC, hence highlighting the need for the identification of novel and more effective biomarkers.

METHODS: In this paper, we investigate methods for integration of multi-omics data we generated by both untargeted and targeted mass spectrometric analysis of serum samples from HCC cases and patients with liver cirrhosis. Specifically, the performances of several feature selection methods are evaluated on their abilities to identify a panel of multi-omics features that distinguish HCC cases from cirrhotic controls.

RESULTS: The integrative analysis identified key molecules associated with liver including such as leucine and isoleucine as well as SERPINA1, which is involved in LXR/RXR Activation and Acute Response signaling. A new method that uses recursive feature selection in conjunction with a transformer-based deep learning model as an estimator led to more promising results compared to other deep learning methods that perform disease classification and feature selection sequentially.

CONCLUSIONS: The findings in this study reinforce the importance of adapting or extending deep learning models to support robust feature selection, especially for integration of multi-omics data with limited sample size to avoid the risk of overfitting and the need for evaluation of the multi-omics features discovered in this study via blood samples from a larger and independent cohort to identify robust biomarkers for HCC.

PMID:41002959 | PMC:PMC12471784 | DOI:10.3390/metabo15090575

The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023

Lancet. 2025 Sep 24:S0140-6736(25)01635-6. doi: 10.1016/S0140-6736(25)01635-6. Online ahead of print.

ABSTRACT

BACKGROUND: Cancer is a leading cause of death globally. Accurate cancer burden information is crucial for policy planning, but many countries do not have up-to-date cancer surveillance data. To inform global cancer-control efforts, we used the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 framework to generate and analyse estimates of cancer burden for 47 cancer types or groupings by age, sex, and 204 countries and territories from 1990 to 2023, cancer burden attributable to selected risk factors from 1990 to 2023, and forecasted cancer burden up to 2050.

METHODS: Cancer estimation in GBD 2023 used data from population-based cancer registration systems, vital registration systems, and verbal autopsies. Cancer mortality was estimated using ensemble models, with incidence informed by mortality estimates and mortality-to-incidence ratios (MIRs). Prevalence estimates were generated from modelled survival estimates, then multiplied by disability weights to estimate years lived with disability (YLDs). Years of life lost (YLLs) were estimated by multiplying age-specific cancer deaths by the GBD standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were calculated as the sum of YLLs and YLDs. We used the GBD 2023 comparative risk assessment framework to estimate cancer burden attributable to 44 behavioural, environmental and occupational, and metabolic risk factors. To forecast cancer burden from 2024 to 2050, we used the GBD 2023 forecasting framework, which included forecasts of relevant risk factor exposures and used Socio-demographic Index as a covariate for forecasting the proportion of each cancer not affected by these risk factors. Progress towards the UN Sustainable Development Goal (SDG) target 3.4 aim to reduce non-communicable disease mortality by a third between 2015 and 2030 was estimated for cancer.

FINDINGS: In 2023, excluding non-melanoma skin cancers, there were 18·5 million (95% uncertainty interval 16·4 to 20·7) incident cases of cancer and 10·4 million (9·65 to 10·9) deaths, contributing to 271 million (255 to 285) DALYs globally. Of these, 57·9% (56·1 to 59·8) of incident cases and 65·8% (64·3 to 67·6) of cancer deaths occurred in low-income to upper-middle-income countries based on World Bank income group classifications. Cancer was the second leading cause of deaths globally in 2023 after cardiovascular diseases. There were 4·33 million (3·85 to 4·78) risk-attributable cancer deaths globally in 2023, comprising 41·7% (37·8 to 45·4) of all cancer deaths. Risk-attributable cancer deaths increased by 72·3% (57·1 to 86·8) from 1990 to 2023, whereas overall global cancer deaths increased by 74·3% (62·2 to 86·2) over the same period. The reference forecasts (the most likely future) estimate that in 2050 there will be 30·5 million (22·9 to 38·9) cases and 18·6 million (15·6 to 21·5) deaths from cancer globally, 60·7% (41·9 to 80·6) and 74·5% (50·1 to 104·2) increases from 2024, respectively. These forecasted increases in deaths are greater in low-income and middle-income countries (90·6% [61·0 to 127·0]) compared with high-income countries (42·8% [28·3 to 58·6]). Most of these increases are likely due to demographic changes, as age-standardised death rates are forecast to change by -5·6% (-12·8 to 4·6) between 2024 and 2050 globally. Between 2015 and 2030, the probability of dying due to cancer between the ages of 30 years and 70 years was forecasted to have a relative decrease of 6·5% (3·2 to 10·3).

INTERPRETATION: Cancer is a major contributor to global disease burden, with increasing numbers of cases and deaths forecasted up to 2050 and a disproportionate growth in burden in countries with scarce resources. The decline in age-standardised mortality rates from cancer is encouraging but insufficient to meet the SDG target set for 2030. Effectively and sustainably addressing cancer burden globally will require comprehensive national and international efforts that consider health systems and context in the development and implementation of cancer-control strategies across the continuum of prevention, diagnosis, and treatment.

FUNDING: Gates Foundation, St Jude Children's Research Hospital, and St Baldrick's Foundation.

PMID:41015051 | DOI:10.1016/S0140-6736(25)01635-6

  • ✇TechCrunch
  • Everyone’s still throwing billions at AI data centers Theresa Loconsolo
    From $100 billion OpenAI commitments to $100,000 visa fees, this week showed just how much the tech landscape is shifting. On the latest episode of Equity, Anthony Ha and Max Zeff unpack the AI infrastructure gold rush and tech’s talent shuffle. Watch the full episode for more about:   Equity is TechCrunch’s flagship podcast, produced by […]
     

Everyone’s still throwing billions at AI data centers

27 September 2025 at 01:30
From $100 billion OpenAI commitments to $100,000 visa fees, this week showed just how much the tech landscape is shifting. On the latest episode of Equity, Anthony Ha and Max Zeff unpack the AI infrastructure gold rush and tech’s talent shuffle. Watch the full episode for more about:   Equity is TechCrunch’s flagship podcast, produced by […]

Association of HTR1F with Prognosis, Tumor Immune Microenvironment, and Drug Sensitivity in Cancer: A Multi-Omics Perspective

27 September 2025 at 18:00

Biomedicines. 2025 Sep 11;13(9):2238. doi: 10.3390/biomedicines13092238.

ABSTRACT

Background:HTR1F (5-Hydroxytryptamine Receptor 1F) encodes a G protein-coupled receptor involved in serotonin signaling. Although dysregulated HTR1F expression has been implicated in certain malignancies, its biological functions and clinical significance across cancer types remain largely unexplored. Methods: We performed an integrative pan-cancer analysis of transcriptomic and pharmacogenomic datasets covering 34 cancer types (PAN-CAN cohort, N = 19,131; normal tissues, G = 60,499). Drug sensitivity and molecular docking analyses were conducted using the GSCALite database. The protein-protein interaction (PPI) network of HTR1F was constructed via the STRING database. Additionally, we evaluated the effects of HTR1F overexpression on proliferation and invasion in human lung squamous cell carcinoma (LUSC) cell lines NCI-H520 and NCI-H226. Results:HTR1F expression was significantly upregulated in 17 cancer types and was associated with poor prognosis, with LUSC showing an AUC of 0.912 for 1-year survival prediction. In LUSC, 695 genes were upregulated and 67 downregulated in response to HTR1F overexpression. HTR1F expression correlated with immune-related genes, immune checkpoints, tumor-infiltrating immune cells, tumor mutation burden (TMB), microsatellite instability (MSI), and drug responses. Genomic alterations, including amplification and deletion, were positively associated with HTR1F expression. Drug sensitivity analysis identified compounds such as sotrastaurin (-10.2 kcal/mol), austocystin D (-9.7 kcal/mol), and tivozanib (-9.3 kcal/mol) as potentially effective inhibitors based on predicted binding affinity. Functional enrichment analyses (GO, KEGG) and GSEA revealed that HTR1F is primarily involved in cell cycle regulation, DNA replication, cellular senescence, and immune-related pathways. Functional validation showed that HTR1F overexpression promotes proliferation of LUSC cells via the MAPK signaling pathway. Conclusions: Our integrative analysis highlights HTR1F as a potential biomarker associated with prognosis, immune modulation, and drug sensitivity across multiple cancer types. These findings provide a foundation for future experimental and clinical studies to explore HTR1F-targeted therapies.

PMID:41007799 | PMC:PMC12467612 | DOI:10.3390/biomedicines13092238

Application of the Supportive Accountability Model in Digital Health Interventions: Scoping Review

Background: Digital health interventions (DHIs) harness technological innovation to address challenges in the accessibility and scalability of health care. However, the effectiveness of DHIs is challenged by low user engagement and adherence, as users tend to drop out over time. The supportive accountability model (SAM) is a theoretical framework designed to enhance adherence to DHIs by incorporating structured human support. Objective: Guided by SAM, this scoping review answers the following research questions: (1) What is the extent of research on human support factors and their influence on engagement with and adherence to DHIs? and (2) What is the extent of research applying SAM (ie, accountability, bond, and legitimacy) to improve engagement with and adherence to DHIs? Methods: Our search strategy followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). We conducted our literature search using 6 databases selected based on relevance to our research topic: MEDLINE, PsycINFO, Embase, CINAHL, Scopus, and ClinicalTrials.gov. Search terms included (“human support” OR “supportive accountability”) AND (engagement OR adherence) AND intervention, applied to titles, abstracts, and keywords. Hand-searching was also used to identify additional relevant articles. Two authors (SPYC and GK) screened articles in multiple rounds using predefined inclusion and exclusion criteria. The final sample consisted of 36 empirical, peer-reviewed articles published in scholarly journals. All articles examined human-supported DHIs. Results: Implementation of human support among the interventions varied by the source, delivery method, and frequency and duration of support. Overall, there were inconsistencies in the application of SAM to intervention designs. Support was provided by 4 main groups: peers and peer specialists, health experts and practitioners, trained coaches, and members of the research study team. Modes of communication included phone or video calls, as well as text-based support, such as messaging or email. The frequency and duration of support varied across studies and were influenced by the communication method used, with more structured and frequent contact occurring in interventions that relied on synchronous support, such as phone or video calls. In addition, we found that some studies used human support as the primary mode of intervention delivery rather than as an adjunctive tool, focusing on improving engagement and adherence, as proposed by SAM. Aside from accountability, there was also a lack of explicit focus on other constructs within the model (eg, bond and legitimacy). Conclusions: This scoping review highlights the current use of human support to promote DHI adherence and reveals gaps in the application of SAM. Future research should address all core SAM components—not just accountability—and ensure human support is used as an adjunct to enhance engagement. These steps can help maximize the impact of DHIs on health care access and outcomes.

Using Large Language Models to Assess the Consistency of Randomized Controlled Trials on AI Interventions With CONSORT-AI: Cross-Sectional Survey

Background: Chatbots based on large language models (LLMs) have shown promise in evaluating the consistency of research. Previously, researchers used LLM to assess if randomized controlled trial (RCT) abstracts adhered to the CONSORT-Abstract guidelines. However, the consistency of artificial intelligence (AI) interventional RCTs align with the CONSORT-AI standards by LLMs remains unclear. Objective: The aim of this study is to identify the consistency of randomized controlled trials on AI interventions with CONSORT-AI using chatbots based on LLMs. Methods: This cross-sectional study employed six LLM models to assess the consistency of RCTs on AI interventions. The sample selection is based on articles published in JAMA Network Open, which included a total of 41 RCTs. All queries were submitted to LLMs through an API interface with a temperature setting of 0 to ensure deterministic responses. One researcher posed the questions to each model, while another independently verified the responses for validity before recording the results. The Overall Consistency Score (OCS), recall, inter-rater reliability and consistency of contents were analyzed. Results: We found gpt-4-0125-preview has the best average OCS (86.5%, 95%CI: 82.5%-90.5% and 81.6%, 95% CI: 77.6%-85.6%), followed by gpt-4-1106-preview(80.3%, 95%CI: 76.3%-84.3% and 78.0%, 95% CI: 74.0%-82.0%). The model with the worst average OCS is gpt-3.5-turbo-0125 (61.9%, 95%CI: 57.9%-65.9% and 63.0%, 95% CI: 59.0%-67.0%). Among the 11 unique items of CONSORT-AI, Item 2 (“State the inclusion and exclusion criteria at the level of the input data”) received the poorest overall evaluation across six models, with an average OCS of 48.8%. For other items, those with an average OCS greater than 80% across the six models included Items 1, 5, 8, and 9. Conclusions: GPT-4 variants demonstrate strong performance in assessing the consistency of RCTs with CONSORT-AI. Nonetheless, refining the prompts could enhance the precision and consistency of the outcomes. While AI tools like GPT-4 variants are valuable, they are not yet fully autonomous in addressing complex and nuanced tasks such as adherence to CONSORT-AI standards. Therefore, integrating AI with higher levels of human supervision and expertise will be crucial to ensuring more reliable and efficient evaluations, ultimately advancing the quality of medical research.

The Impact of Digital Health Interventions on Psychological Health, Self-Efficacy, and Quality of Life in Patients With End-Stage Kidney Disease: Systematic Review and Meta-Analysis

Background: End-stage kidney disease (ESKD) imposes a significant global health burden, with patients often experiencing poor quality of life (QoL) due to psychological distress and low self-efficacy. Digital health interventions (DHIs) offer potential to address these challenges. However, their effects in this population remain inconsistent, and a comprehensive synthesis of the evidence is lacking. Objective: To assess the impact of DHIs on the psychological health, self-efficacy, and QoL of ESKD patients, and to evaluate engagement, adherence and satisfaction with these interventions. Methods: A comprehensive search was conducted across six electronic databases (PubMed, Web of Science, Cochrane Library, PsycINFO, Embase, and CINAHL) up to January 21, 2025. Randomized controlled trials (RCTs) examining DHIs effects on psychological health, self-efficacy, or QoL in ESKD patients were included. Two reviewers independently screened studies, extracted data, and assessed the risk of bias using the RoB 2 tool. Meta-analysis was performed using Review Manager 5.4, with subgroup analyses by treatment modality, intervention type, and duration. Evidence quality was assessed using the GRADE approach. Results: 23 RCTs involving 2407 ESKD patients from 12 countries were included. DHIs significantly improved depression (SMD: -0.41, 95% CI: [-0.63, -0.19], P=.003) and overall QoL (SMD: 0.55, 95% CI: [0.07, 1.03], P=.03). While DHIs did not significantly improve overall self-efficacy (SMD: 0.56, 95% CI: [-0.06, 1.18], P=.08), a benefit was observed in hemodialysis patients (SMD: 0.59, 95% CI: [0.34, 0.83], P<.001 engagement was favorable with completion rates above adherence of and generally positive patient feedback on dhis. application-based interventions improved self-efficacy ci: p overall qol telemedicine depression video-based due to high heterogeneity risk bias evidence quality rated as low for moderate general anxiety very stress self-efficacy. conclusions: dhis can significantly improve the psychological health eskd patients particularly when tailored needs delivered through interactive platforms such applications telemedicine. suggest good acceptability in clinical practice. however warrants cautious interpretation. future research should involve more high-quality rcts design that address unique elderly peritoneal dialysis kidney transplant recipients. trial: prospero crd42024629357 https:>

Integrative Spatial Omics for Systems-Level Mapping of Pathological Niches

bioRxiv [Preprint]. 2025 Sep 17:2025.09.12.675904. doi: 10.1101/2025.09.12.675904.

ABSTRACT

Spatial 'omics technologies are a powerful tool for mapping the relationship between cellular organization and molecular distributions in healthy and diseased tissue microenvironments. Here, we describe a novel multimodal pipeline that represents experimental and computational advances for spatiomolecular analysis of tissue samples across molecular classes. This adaptable method integrates matrix-assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) lipidomics, spatial transcriptomics (ST), multiplexed immunofluorescence microscopy (MxIF), and histopathological staining to uncover spatiomolecular profiles associated with unique cellular niches and pathological features. We demonstrate the power of this approach using two different complex human disease systems: Alzheimer's disease in human brain tissue and type 2 diabetes mellitus in the human pancreas. By identifying molecular markers associated with disease pathology in the pancreas and brain, we shed light on biologically significant pathways that are impacted in these two spatially complex diseases and highlight the powerful potential of accurate, high-resolution multimodal integration approaches.

PMID:41000710 | PMC:PMC12458195 | DOI:10.1101/2025.09.12.675904

FUSION: a web-based application for in-depth exploration of multi-omics data with brightfield histology

Nat Commun. 2025 Sep 25;16(1):8388. doi: 10.1038/s41467-025-63050-9.

ABSTRACT

Spatial technologies examining the cell and tissue microenvironment at near single-cell resolution are revealing important molecular insights. However, few tools enable integrated, interactive analysis of spatial-omics with tissue morphology in the same functional tissue unit. Here, we present FUSION (Functional Unit State Identification in Whole Slide Images), a web-based platform for visualizing and analyzing spatial-omics data with high-resolution histology. FUSION provides workflows for assessing cell compositions, quantitative morphometrics, and comparative tissue analyses. We demonstrate applicability across spatial assays, including 10x Visium, Visium HD, 10x Xenium, Cell DIVE, and PhenoCycler, applied to healthy and diseased tissues from kidney, small intestine, lung, and skin in the Human BioMolecular Atlas Program. FUSION is cloud-based, open-source, and accessible at https://fusion.hubmapconsortium.org/ , hosting over 50 paired datasets and tutorials. In a series of use cases, we show its capacity to distinguish renal glomeruli injury states, quantify morphometric changes, and characterize fibrosis with immune infiltration.

PMID:40998789 | PMC:PMC12462499 | DOI:10.1038/s41467-025-63050-9

Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation Science

Background: Clinical decision support (CDS) is one strategy to increase evidence-based practices by clinicians. Despite its potential, CDS tools have had mixed results and are often disliked by clinicians. Principles from behavioral economics, including “nudges,” may improve the effectiveness and clinician satisfaction of CDS tools. Objective: This paper outlines a pragmatic approach grounded in implementation science to identify and prioritize how to incorporate different types of nudges into CDS tools. Methods: We applied the Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments and Ego (MINDSPACE) nudge framework and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework to systematically and pragmatically identify and prioritize different types of nudges for CDS tools. A case example of a CDS tool to improve guideline-concordant prescribing for patients with heart failure was used to illustrate how these frameworks can be applied in real-life scenarios. We describe a process of how these frameworks can be used pragmatically by clinicians and informaticists or more technical CDS builders to apply nudge theory to CDS tools. Results: Four iterative steps guided by PRISM were defined: 1) engage partners for user-centered design, 2) develop a shared understanding of the nudge types, 3) determine the nudge type for the overarching CDS format, and 4) brainstorm and prioritize nudge types and forms to address each modifiable contextual issue. These steps are iterative and intended to be adapted to align with the local resources and needs of various clinical scenarios and settings. We provide illustrative examples of how this approach was applied to the case example, including who we engaged, details of nudge design decisions, and lessons learned. Conclusions: We present a pragmatic approach to guide the selection and prioritization of nudges, informed by implementation science. This approach can be used to comprehensively and systematically consider key issues in designing CDS to optimize clinician satisfaction, effectiveness, equity, and sustainability while minimizing the potential for unintended consequences. The findings can be adapted and generalized to other health settings and clinical situations, advancing the goals of learning health systems to expedite the translation of evidence into practice.

Understanding the Role of Clinical Decision Support Systems Among Hospital Nurses Using the FITT (Fit Between Individuals, Tasks, and Technology) Framework: Qualitative Study

Background: Clinical decision support systems (CDSSs) have gained prominence in health care, aiding professionals in decision-making and improving patient outcomes. While physicians often use CDSSs for diagnosis and treatment optimization, nurses rely on these systems for tasks such as patient monitoring, prioritization, and care planning. In nursing practice, CDSSs can assist with timely detection of clinical deterioration, support infection control, and streamline care documentation. Despite their potential, the adoption and use of CDSSs by nurses face diverse challenges. Barriers such as alarm fatigue, limited usability, lack of integration with workflows, and insufficient training continue to undermine effective implementation. In contrast to the relatively extensive body of research on CDSS use by physicians, studies focusing on nurses remain limited, leaving a gap in understanding the unique facilitators and barriers they encounter. Objective: This study aimed to explore the facilitators and barriers influencing the adoption and use of CDSSs by nurses in hospitals, using an extended Fit Between Individuals, Tasks, and Technology (FITT) framework. Methods: A qualitative study was conducted using semistructured interviews with 22 nurses from across the Netherlands, representing 3 hospital types: general (n=9), top-clinical (n=12), and academic (n=1). The sample included a diverse mix of practicing nurses, nurses-in-training, and clinical nurse information officers, with clinical experience ranging from 1.5 to 38 years. Interview transcripts were analyzed thematically, beginning with an inductive coding approach to identify key factors. These were then categorized deductively using the extended FITT framework. In total, 988 code instances were examined. To ensure analytical rigor, the coding process was separately conducted by 2 researchers and reviewed by an expert panel. Results: A total of 26 distinct factors were identified, categorized into 4 FITT dimensions: technology-individual, technology-task, task-individual, and organizational context. Of these, 11 factors were facilitators (eg, cognition, clarification, and prevention), 7 were barriers (eg, alarm fatigue, poor design, and limited digital proficiency), and 8 were both facilitators and barriers depending on the context (eg, acceptance, workload, and training). In addition, key value tensions emerged, such as the balance between standardization and professional autonomy, and the trade-off between enhanced decision support and increased administrative burden. Conclusions: The findings underscore the complexity of CDSS adoption in nursing practice, highlighting the interaction of facilitators and barriers across FITT dimensions. Practical recommendations include participatory design processes, targeted training programs, advanced alert management systems, and strong organizational support. Addressing value tensions and aligning CDSS functionality with nurses’ workflows can enhance adoption and optimize patient outcomes. Trial Registration:

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01852-3

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01956-w

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01954-y

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies
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