Journal of Clinical and Translational Science

Background: Recruitment of underrepresented populations, including Black and Hispanic populations, for Food is Medicine (FIM) and cardiovascular trials, may pose significant challenges. Methods: We implemented a multi-component recruitment approach for the THRIVE (AdapTive personalized dietitian coacHing and messaging with pRoduce prescrIptions to improVE healthy dietary behaviors) pilot trial to engage primarily Black and Hispanic adults in a Food is Medicine for hypertension intervention. The recruitment approaches included community engagement at approximately 40 community events (cultural festivals and neighborhood gatherings); partnerships with 8 community and faith-based service hubs and food distribution sites; recruitment through safety net primary care clinics, digital outreach via the study website, and social media campaigns; and direct recruitment at places of worship. We report lessons learned from the community engagement process, recruitment efficiency, representativeness, and retention outcomes. Results: Within 6 months, the enrollment target was exceeded by 40%, with an accrual index of 1.04. Over 1,000 individuals were reached through the direct-to-community engagement process, while faith-based partnerships engaged about 900 adults. There were 2,673 visits to the study webpage, and social media achieved 12,259 impressions with 399 clicks. About 95% of participants resided within 10 miles of the faith-based recruitment sites. Face-to-face engagement at the food distribution sites within faith-based organizations or community service hubs outperformed digital methods. Faith leader endorsements and follow-up in-person meetings (following unsuccessful email outreach) dramatically increased recruitment. Regarding retention, pre-randomization attrition was 6%, and 82% of participants completed the study. Conclusion: Culturally tailored, community-engaged recruitment grounded in faith-based and local community partnerships, was highly effective in engaging Black and Hispanic populations in this FIM cardiovascular trial. This provides a replicable model for implementing equitable and sustainable cardiovascular health interventions.

Introduction: Academic health centers have invested in academies and related structures to promote health professions education (HPE) scholarship, yet many struggle to sustain vibrant scholarly communities. We aimed to identify lessons for building and sustaining scholarly communities that support HPE scholarship. Methods: Using a constructivist approach, we conducted a qualitative interview study in 2025 with leaders from across all four geographic regions of the U.S. Inclusion criteria required that participants direct an academy or other institutional structure intended to promote educational scholarship, and that they could speak to building and sustaining scholarly communities of practice in their local context. The Communities of Practice framework informed interview guide development and data interpretation. Interviews were audio-recorded, transcribed, de-identified, and analyzed using a six-phase thematic analysis process. Results: Twenty-one academy leaders described five interrelated forms of leadership work that shaped sustainable scholarly communities: (1) building foundations that legitimize educational scholarship by securing institutional investment, leadership buy-in, succession planning, and guiding frameworks; (2) cultivating scholarly sanctuary to counter isolation through psychologically safe, inclusive communities; (3) making scholarship feasible under constraints by creating low-barrier entry points, translating value to leaders, and addressing time, productivity, and infrastructure barriers; (4) tending growth through layered, incremental development, including cohort programs, consultation, mentoring, grants, and flexible participation; and (5) making educational scholarship visible and valued through recognition, dissemination, and outcome tracking. Discussion: Viewed through the Communities of Practice framework, the themes illuminate how leaders cultivated a shared domain of legitimate educational scholarship, a community of relational support, and a practice of tools, routines, and developmental infrastructure. The themes also reveal that sustainable communities of practice do not emerge from any single academy model, but from context-sensitive alignment of structure, culture, and incentives. Institutions seeking to strengthen HPE scholarship should invest in foundational resources, cultivate psychologically safe communities, adopt incremental growth strategies, and create pathways for recognition and dissemination that legitimize educational scholarship.

Background Scientific mistrust contributes to lower participation and underrepresentation of Black Americans in genomics studies limiting understanding of how genomic variation and environmental exposures influence health disparities. Community-engaged research requires rebuilding scientific trust; however, there is a need for practical models that operationalize guidance for researchers without community-engaged research training. Therefore, we developed an educational intervention for genomics researchers initiating partnerships with Black American communities. Our intervention creates a bidirectional teaching environment that allows potential community and academic partners to discuss areas of expertise for each stakeholder, partnership perspectives and needs, while exploring modules related to genomics research and community-academic partnership. We report a novel and structured approach for prospective academic and community partners to mutually orient one another and assess partnership practicability. Methods Ten participants, recruited through established community channels, attended a four-hour workshop containing nine interactive modules about scientific mistrust, research safeguards, community-engaged research, genomics, and research for community-defined goals. We also experimented with humor to enhance engagement and trust. We used mixed-methods, single-arm research design and assessed feasibility through recruitment success and retention. Using inductive rapid thematic analyses, we assessed participant responses to eight workshop prompts. Preliminary quantitative data, used for descriptive purposes due to low sample size, were analyzed from pre- and post-Likert scale surveys assessing associations between the intervention and four domains, including scientific trust. Results All 10 enrolled participants completed the study, meeting a priori criteria of 100% for recruitment and show rate. Engagement was strongest during early workshop modules and declined in later modules. Survey data completeness was limited by missing responses. Survey instrument design limitations were identified for modification in future studies. Participants articulated expectations for partnership that aligned with community-based participatory research principles. Conclusions The intervention is feasible to deliver as a bidirectional educational experience in partnership with a community organization. The strongest implementation refinements needed were workshop duration, module prioritization, and survey instrument design, particularly the trust domain. A community advisory board is co-developing modules and refining the intervention to evaluate in a pilot version of the study with a larger sample.

Academic medical centers face growing demand for clinical data access that traditional informatics infrastructure cannot support at scale. We describe HABITAT, a governed, tiered research data ecosystem at the University of Missouri integrating internal and external sources, including unstructured clinical data, into a layered architecture supporting PCORnet and OMOP common data models. A three-tier model provides self-service feasibility tools, secure cloud analytics, and curated honest broker services under a Five Safes governance framework. From mid- 2022 through February 2026, HABITAT received 1,150 requests with 689 fulfilled and supported 29 externally funded projects. Median fulfillment for internal data requests improved from 30 to 20 days, and an early survey captured 54 scholarly outputs, including peer-reviewed publications in high-impact journals. HABITAT supported coursework to multi-site research without proportional staff increases, while cost r

Introduction No widely adopted guidelines exist for collecting and reporting donor-level metadata in tissue-based research, limiting interpretability, reproducibility, and potentially introducing bias. This study aimed to inform ethical and appropriate metadata practices. Methods Semi-structured interviews were conducted with 16 investigators from the Human BioMolecular Atlas Program. Thematic analysis using inductively derived codes identified metadata elements and perspectives on their collection and reporting. Results Participants identified 80 metadata variables across six domains: demographic, sociodemographic, medical history, personally identifying information, cause of death, and tissue/organ data. Most supported routine collection and reporting of demographics and medical history, whereas views on cause of death and sociodemographic data were mixed. Conclusion We recommend routinely collecting and reporting demographics and medical history, while restricting cause of death and sociodemographic variables to situations with explicit consent or justification. These findings provide initial evidence to inform ethical donor metadata guidelines, with further stakeholder engagement and consensus-building needed.

Background: Almost 1 in 2 adults in the US has obesity, with women facing the highest prevalence of severe obesity. Emerging evidence shows that the gut microbiome and its metabolites play a key role in metabolic regulation, acting as signals in active metabolic tissues such as adipose and skeletal muscle, thereby contributing to the deterioration of cardiometabolic health in individuals with obesity. Recent findings suggest that functional characteristics of the gut microbiome, rather than compositional changes alone, may partially explain why some individuals experience greater metabolic benefits from exercise than others. We designed a pilot trial to assess the acute response to an exercise bout across distinct obesity phenotypes and to identify microbial signatures associated with lifestyle interventions. Methods: We proposed a pilot trial in which 40 young adults (21 to 40 years old) with distinct exercise (< 150 minutes per week or > 4 hours per week) and body compositions (body mass index [BMI] 18.5 to 24.99 or > 30 kg/m2) would undergo an acute exercise bout. The outcomes of this pilot trial are as follows: (1) Examine the effects of a 30-minute bout of moderate-intensity aerobic exercise (60 to 70% heart rate reserve) on the abundance and functional activity of short-chain fatty acid (SCFA)-producing gut bacteria across different obesity phenotypes in women; (2) Assess the acute effects of the same exercise bout on SCFA concentrations in stool and circulating plasma metabolomic profiles. Discussion: The results of this pilot study will inform the feasibility of a larger trial to establish the gut-synthesized

Returning individual results to research participants is increasingly expected in genomic studies. Yet, genomic dietary data have unique characteristics. New DNA sequencing techniques reconstruct diet from the residual plant and animal DNA recoverable in stool, reporting not nutrients or calories but a list of the species a person ate. Turning that list into something a participant can understand does not yet have an established framework. The Everyone EATS (Edible Atlas Through Sequencing) study returned personalized genomic dietary profiles to a non-clinical pilot cohort. Participants collected a stool sample at home, samples were processed with FoodSeq, and each participant received an interactive Diet Data Return Report that translated detected taxa into familiar food groups and benchmarked them against prior FoodSeq cohorts. No monetary compensation was offered, and the Diet Data Return Report was the sole incentive. Of 111 kits mailed, 80 were returned (72.1%) and sequenced (100% sequencing success for plant DNA; 98.7% for animal). Among report recipients with engagement data (n = 73), all accessed their report and 74% engaged interactively with its content. Among 16 feedback survey completers, 13/16 (81.2%) found the report easy to understand, 13/16 (81.2%) reported improved understanding of their dietary variety, and 5/16 (31.2%) reported a dietary behavior change. Curiosity about personal dietary data and supporting broader research goals were the most common reasons for enrolling (79.8%, respectively). Notably, the foods participants flagged as missing or unexpected clustered among herbs, spices, seafood, and processed items, the foods most easily forgotten in self-report and least readily assigned from sequence. Overall, our results suggest that genomic dietary data can be returned in a form participants find understandable and engaging, and that curiosity alone can motivate participation without payment.

In Competency-based medical education (CBME), longitudinal data is generated continuously. The judgments a Clinical Competency Committee (CCC) makes about trainee learning and performance are a valuable resource, supporting both resident and program development. Such data as well can enables the evaluation of rating quality and of CBME instruments such as Milestones and Entrustable Professional Activities (EPAs) which can help address a gap in the CBME literature, where evidence on the performance of these instruments remains limited. Objective Routinely gathered CCC data of six cohorts in a four-training ACGME-I-accredited family medicine residency in Al Ain, United Arab Emirates, was studied to describe growth trajectories, rating-system behavior, and the concurrent agreement of CBME instruments. As well as investigating the prospective predictive validity of two CBME instruments, EPA and Milestones, and the In-Training Exam (ITE). Methods The longitudinal CCC data for 80 residents across six cohorts (2019-20 to 2024-25) were assessed at up to eight time points (mid- and end-year; R1-R4). The pooled dataset included 10,458 EPA item ratings across 334 resident-time points, 5,021 Competency Milestone item ratings across 285 resident-time points, and 185 ITE scores. Five research questions were examined: growth trajectories; within- and between-resident variation and straight-lining (identical scores on assessed items at a single time point); EPA-Milestones agreement; the validity of supervisor ratings against the ITE (anchoring diagnostic, same-year correlations, prospective regressions); and EPA blueprint fidelity (the mapping of EPAs against the ACGME-I subcompetency). Al Ain trajectories were benchmarked against an international family medicine reference. Results All three instruments rose steadily across the eight timepoints. By End R4, the Milestones mean (4.00, range 3.83-4.24) matched US end-of-training norms (3.84-4.02). With regards to rating quality, pooled R1-R3 Milestones straight-lining was 2.3% (EPA 0%), below US benchmarks; between-resident discrimination was preserved (SD 0.41-0.54); and longitudinal halo was ruled out (within-domain growth-slope r = 0.61 vs across-domain r = 0.37). End R1 Overall EPA was the strongest prospective predictor of Final Competency (B = 0.96, p < 0.001) and Final ITE (B = 96.88, p = .006). Medical Knowledge ratings were independent of prior ITE scores from Mid R2 onward, and End R2 MK ratings predicted ITE 17 months later at r=0.88, confirming supervisor judgment was not anchored to test results. With regards whether individual EPAs correlate with individual Milestone subcompetencies at each timepoint, a significant EPA and Milestones correlations were negligible at End R1 (1 of 222 item-level cells significant) and converged by End R3 (36 cells), while resident-mean stepwise regressions showed the two instruments (EPA and Milestones) behaved as overlapping predictors throughout, indicating that EPAs and Milestones are complementary at the level of specific content but convergent at the level of aggregate resident judgment. Blueprint fidelity rose from 30% of cells reaching r [&ge;] 0.40 at End R2 to 80% at End R3 in the same cohort, indicating that apparent fidelity is materially affected by measurement timing. Conclusion By graduation, residents demonstrated substantial and progressive competency achievement across both instruments, with the majority reaching the entrustable threshold on both EPA and Milestone ratings. The rating system demonstrated disciplined assessment behavior of supervisors and both concurrent and prospective validity relative to the ITE. Overall EPA at End R1 was the strongest prospective predictor of all three terminal outcomes, final ITE score, graduating Competency Milestones, and graduating overall EPA, outperforming Milestones and baseline knowledge. Routine CCC data support an evidence-based quality assurance framework spanning rater-process diagnostics, outcome-validity diagnostics, and the asymmetric-instrument diagnostic, requiring no additional data collection beyond existing program processes.

Background: Since 2025, US states have rapidly adopted waivers to restrict the purchase of "non-nutritious items" like soda and candy with Supplemental Nutrition Assistance Program (SNAP) benefits. States have proposed various approaches in terms of food categories restricted and implementation strategies, which may influence the downstream effects of waivers on program participation and participants diets and health. Objective: To examine and describe contextual information related to the adoption and implementation of state-level SNAP food restriction waivers. Design: A content analysis was conducted including publicly available state-level: (1) bills introduced related to SNAP food restriction waivers (2025 to early 2026), (2) waiver requests, and (3) waiver approvals (up to June 2026). Codebooks that captured key elements, such as food and beverage group restrictions and definitions, rationale for restrictions, implementation supports, and evaluation plans, were applied independently by two coders, and discrepancies were resolved through consensus. Participants/setting: United States Intervention: N/A Main outcome measures: N/A Statistical analyses performed: Descriptive statistics were used to summarize the presence of coded elements in documents. Results: Seventy-one bills, 22 waiver requests, and 23 waiver approvals were included. Bills mostly proposed restricting candy (65%) and soft drinks (59%). Of the approved waivers, all restrict the purchase of specific beverage groups with SNAP benefits and 65% restrict the purchase of specific food groups with SNAP benefits. There is a high level of variability in how the same food or beverage groups (e.g., soda) are defined across states. States varied in the implementation supports described in waiver requests, describing strategies like communications plans, nutrition education, and staff training. Conclusions: The current state of SNAP food restriction waivers is highly variable and shifting rapidly. Understanding characteristics of early-adopting states can inform future impact and implementation evaluations of waivers and efforts of additional states that may pursue SNAP food restriction waivers.

IntroductionThe acquisition of National Institutes of Health (NIH) grants is an increasingly competitive undertaking. Many early-career biomedical investigators lack sufficient grant writing skills. This pragmatic, 2x2 factorial, group-randomized trial tested the effects of coaching duration and mode of engagement of participants scientific mentors in a grant writing coaching group intervention on grant application outcomes. MethodsA national US sample of 367 faculty and postdoctoral fellows, organized into 76 coaching groups across 6 cohorts (2020-2022), was randomized to 1 of 4 arms that differed by coaching duration (5 months vs 5 months plus 18 months of access to 1:1 coaching) and mode of scientific mentor engagement (structured vs unstructured). Primary outcomes were national-level grant application submissions and awards, and success rate among submitters, assessed via surveys and verified through award databases 30 months after study initiation. ResultsAmong 271 faculty and 96 postdoctoral fellows, 69% submitted at least 1 national application and 32% were awarded at least 1 grant. Submission rates did not differ by experimental arm. Among faculty, the structured engagement of a mentor in coaching was associated with significantly higher odds of any award (adjusted OR = 1.87) and any NIH mentored career development (K) award (adjusted OR = 3.32), and with higher success rates for these proposal types. Extended coaching duration showed a positive but not statistically significant association with faculty awards after adjustment. Neither factor significantly affected outcomes for postdoctoral fellows. Faculty success rates exceeded national NIH-reported success rates for research project grants equivalent to the R01 mechanism (43% vs 17.6%) and K awards (51% vs 36.5%). ConclusionParticipation in a national, cross-institutional, group coaching model yielded high grant submission outcomes, and award rates were higher relative to NIH benchmarks. Structured integration of scientific mentors with the coaching intervention had a greater effect than extended coaching duration on faculty outcomes.

Objective: To assess the efficacy of an executive peer coaching program, Charting Champions Program (CCP), in helping physicians manage their administrative workload, thereby improving time management, workflow and well-being. Findings: In this longitudinal survey study, physicians self-reported significant improvements in completing charting and administrative paperwork during their clinical day. Physicians reported significant improvements in mental, cognitive and emotional states after the program. Meaning: The Charting Champions Program is an effective intervention that supports physicians in problem-solving the administrative burden of their clinical day, improving workflow efficiency, completing administrative requirements during clinical hours, and enhancing work-life balance and personal satisfaction. Background: Physicians are subject to high levels of mental, physical, and emotional stress, partly due to increasing administrative burdens. Online coaching is a proven intervention to help physicians improve workflow efficiency, reduce administrative burden and improve job satisfaction. Design: This voluntary longitudinal survey took place between 2020 and 2023. Physicians were asked to complete a survey at program entry and again 30-90 days after program completion. The survey consisted of 14 Likert scale questions, and a final sample of 280 physicians completed both surveys. Intervention: CCP contains modules that teach workflow improvements for clinical days, including timely charting, administrative task workflow, managing patient consultations and reducing interruptions. Interventions include self-paced modules, live coaching, recordings and an online peer community. Results: Post-CCP physicians reported a significant decrease in hours spent charting (P<0.0001) and completing clinical paperwork outside of clinical hours (P<0.006). Physicians also reported a decrease in work-related dread (P<0.001), feelings of burnout (P<0.001), and thoughts of quitting due to administrative burdens (P<0.001). Physicians felt more focused at work (P<0.001), felt more in control of the clinical day (P<0.001), and rated their mental energy at work higher (P<0.001). The program did not affect the number of patients seen in a full clinical day (P > 0.918). Conclusion and Relevance: The CCP reduces the time physicians spend on tasks outside of clinical hours, increasing free time without decreasing the number of patients seen per day.

Background: University students experience substantial psychological well-being and body-image concerns, while scalable, personalized digital support remains underexamined in Malaysia. Artificial intelligence chatbots may deliver repeated lifestyle guidance, but the incremental value of personalization over structured chatbot support is uncertain. Objectives: This study evaluated changes in psychological well-being and body appreciation following a 12 week personalized AI-powered lifestyle intervention, NExGEN, among Malaysian university students. Methods: A two-arm, controlled, quasi-experimental pre-post study allocated 140 students aged 18 to 35 years by matched blocks to NExGEN (n = 70) or a structured-prompt ChatGPT control (n = 70). NExGEN generated adaptive weekly lifestyle actions from a 47-item onboarding assessment, whereas control participants received standardized weekly prompts covering the same lifestyle domains. Psychological well-being and body appreciation were assessed at baseline and week 12 using the World Health Organization-Five Well-Being Index and Body Appreciation Scale-2. Intention-to-treat linear mixed models estimated adjusted within-group changes and between-group differences in change, with Holm adjustment for the co-primary outcomes. Results: Week-12 assessments were completed by 121 participants (86.43%). In NExGEN, psychological well-being improved by an adjusted 8.68 points (95% CI, 6.22 to 11.14), z = 6.91, p < .001, and body appreciation improved by 0.17 points (95% CI, 0.10 to 0.24), z = 4.82, p < .001. However, between-group differences in change were not statistically significant for psychological well-being (2.87 points; 95% CI, -0.48 to 6.23; z = 1.68; Holm-adjusted p = .093) or body appreciation (0.10 points; 95% CI, 0.00 to 0.19; z = 1.99; Holm-adjusted p = .093). Median platform logins were 68.00 in NExGEN and 58.50 in control; mean acceptability scores were 3.92 and 3.59, respectively. Conclusions: NExGEN participation was associated with significant within-group improvements in psychological well-being and body appreciation, but personalized guidance did not demonstrate superiority over structured chatbot guidance. Because allocation was quasi-experimental, causal attribution remains limited. Randomized component-level trials are needed to determine whether personalization provides incremental benefit.

Within our synchronous, online global health-focused upper-level microbiology course, we find that students struggle to translate learning to real-world applications. For examples, consider the recent measles outbreaks and major events such as the COVID-19 pandemic, which prompt many questions about how basic microbiological information is used by public health professionals. To address these points, we created a simulation-based curriculum that places students in an action role during an infectious disease outbreak. Our stand-alone curriculum walks through a historical measles outbreak that introduces outbreak investigation, community communication, and how these depend on microbiological knowledge. By using breakout groups, students have an opportunity to decide classifications, public messaging, and intervention metrics. We provide students with an outbreak investigation reference worksheet and interweave breakout rooms with didactic vignettes covering background information while revealing actual responses to outbreaks in conjunction with data obtained by responding scientists. Students synthesize material and apply it in real-time - allowing them to exercise critical thinking while bolstering relevance of microbiology and public health to popular media.

Importance: The transition from medical school to residency forms a national training network, yet its large-scale structure and implications for trainee outcomes remain poorly characterized. Objective: To evaluate the US residency match as a network and assess how institutional position relates to residency placement, educational debt, and specialty choice. Design: Cross-sectional analysis of publicly reported 2025 residency match outcomes. Setting: 107 US MD-granting medical schools and 301 residency institutions with available match data. Participants: 14,616 US MD students matching into residency in 2025 (convenience sample). Exposure: Institutional position within the residency match network, quantified using PageRank network centrality. The relative strength of each school's graduating class was defined as the median centrality of residency destinations across graduates (placement score). Main Outcomes and Measures: Residency placement outcomes, mean medical school debt at graduation, and specialty choice (primary care vs surgical specialties) in relation to institutional position within the residency match network. Network-derived measures were also compared with NIH funding, residency reputation, and student selectivity. Results: Among 14,616 US MD students matched across 107 medical schools and 301 residency institutions (approximately 73.5% of total US MD cohort), network-derived measures of institutional influence closely aligned with benchmarks of institutional standing such as NIH funding, residency reputation, and student selectivity (Spearman's Rho; = 0.72-0.86; all p < .001). Graduate outcomes varied systematically across institutions. Graduates of highly connected medical schools were more likely to match into highly connected residency programs (87.3% for top-quintile vs 41.0% for bottom-quintile schools). Schools with higher placement scores had graduates with lower educational debt, reduced entry into primary care, and increased entry into surgical or competitive specialties. Compared with bottom-decile schools, top-decile schools (stratified by placement score) had 37% lower mean graduate debt, 24% lower primary care entry, and 75% higher surgical specialty entry. Higher educational debt was not associated with entry into higher-compensated specialties. Conclusions and Relevance: The residency match network reflects a hierarchical structure of institutional standing. Graduates of higher- and lower-positioned medical schools experience systematically different residency placement outcomes. These findings provide a population-level, behavior-based perspective on institutional influence and its relationship to training pathways.

INTRODUCTION: Behavioral intervention studies for family care partners for those with dementia need to be both feasible and acceptable in order implement and complete the investigative work. Our study, Tele-STELLA (Support via Technology: Living and Learning with Advancing dementia), was completed in 2025. While 188 care partners enrolled, the attrition rate was high (44%). Here we describe the feasibility, acceptability, and preliminary efficacy of Tele-STELLA. We further describe our fidelity processes. METHODS: Quantitative measures were used to assess care partner burden, study participation, feasibility and acceptability. Our weekly survey assessed the prevalence of adverse events. Qualitative methods paralleled our quantitative findings, in that care partners generally found the study acceptable, but dementia progression and life demands made participation difficult for some. RESULTS: The total attrition rate was 44%, but was attenuated by increasing the sample size. This adequately-powered study found that the intervention significantly reduced burden. Overall, care partners found the study feasible, but care demands made participation difficult for 28 of the care partners resulting in their withdrawal. In addition, 21 care recipients died, and thus their care partners had to be removed from the study. Qualitive findings mirrored the results. DISCUSSION: Our findings reveal that, even in the later stages of dementia, care partners are willing to participate in intervention research. However, care demands and death can affect the sample size. Our data and recommendations for future studies will inform caregiving scientists in designing behavioral interventions in late-stage dementia.

Background: Adverse events (AEs) after hospitalization are common and disproportionately affect adults with multiple chronic conditions (MCC). Capturing patient-reported symptoms and self-assessed health may enable earlier detection of post-discharge AEs. Objective: To identify and test user requirements for an automated remote monitoring system to enhance AE surveillance during the transition home following discharge. Methods: We conducted a mixed-methods study using an iterative, user-centered design approach. Semi-structured interviews with patients and clinicians informed system requirements, followed by real-world field testing in 20 patients who used the system for up to 7 days after discharge. The prototype leveraged interoperable electronic health record data services, delivered automated post-discharge check-ins using a combined questionnaire assessing new or worsening symptoms and patient-reported outcomes (PROs), provided risk-stratified health advice (when and with whom to initiate contact), and escalated high-risk symptoms to clinicians in real-time. Descriptive statistics assessed feasibility and utilization; conventional content analysis identified user needs and implementation considerations. Results: Thirty-seven patients with MCC and 23 clinicians participated. Key requirements for patients included clear communication of personalized risk based on red-flag symptoms, and actionable guidance aligned with discharge instructions. Key requirements for clinicians included explicit delineation of responsibility across inpatient and outpatient setting, and selective escalation to minimize burden. Field testing patients completed 60% of the combined questionnaires. Seven patients received Level 2 or Level 3 health advice after reporting new or worsening symptoms. Three patients triggered Level 3 alerts, resulting in one-time, secure escalation emails to clinicians. Four of the 7 patients who received Level 2 or 3 health advice had chart-confirmed emergency department visits within 1 week of discharge. Patients found the system understandable and helpful, while clinicians noted challenges interpreting PRO trends. Conclusions: These observations support the feasibility and acceptability among patients and clinicians of collecting patient-reported symptoms and PROs during the early post-discharge period. Future iterations should prioritize clear risk communication, role clarity, and interpretable patient-reported data. Formal validation is required to assess predictive performance and clinical utility of symptom-based escalation for post-discharge AE surveillance.

Purpose: Lung cancer screening (LCS) with low-dose computed tomography (LDCT) reduces lung cancer mortality, yet screening participation remains low. We evaluated whether a brief informational video nudge delivered immediately before a scheduled clinical encounter increased LCS ordering and baseline LCS completion. Patients and Methods: We conducted a randomized feasibility trial within Kaiser Permanente Colorado from March through October 2025. LCS-eligible patients with an upcoming primary care or pulmonology appointment were assigned to intervention or usual care based on birth month. Intervention patients were split into two group, a group who received the LCS informational video nudge via text message within 24 hours of an eligible appointment; and second group who received the text plus a QR code video link during appointment rooming. Outcomes included LCS orders, baseline LCS-LDCT completion, and video engagement. Multivariable logistic regression was used to evaluate factors associated with LCS ordering. Results: Among 1,093 patients, 549 were assigned to intervention and 544 to usual care. Intervention patients were more likely to receive an LCS order within 1 day of their appointment (22.6% vs 16.4%; p=.010) and any time during follow-up (32.6% vs 24.1%; p=.002). Baseline LCS-LDCT completion was 51% higher in the intervention group, although the difference was not statistically significant (8.6% vs 5.7%; p=.078). Among the intervention group, 93 individuals (17%) viewed the video, generating 114 total views, and viewers watched an average of 79% of the video. Most views (82.5%) occurred through text-message delivery rather than QR codes. Conclusion: A brief, low-burden LCS informational video delivered immediately before a clinical encounter and integrated into existing workflows significantly increased LCS ordering and was associated with higher screening completion. Timely, scalable digital nudges may provide an effective strategy for improving LCS participation. Based on the observed effectiveness, feasibility, and efficiency of the intervention, KPCO incorporated the behavioral nudge into standard clinical care in February 2026.

BACKGROUND: Differences in renal function may affect Alzheimer disease (AD) blood biomarker levels independent of AD pathology. Although renal function was unaccounted for in foundational AD blood biomarker studies, there is potential to address this through quantification of estimated glomerular filtration rate (eGFR) from frozen serum and plasma samples. However, the validity of eGFR evaluation from long-term frozen blood samples is unknown. METHODS: Adults aged 50-85 with at least 2 vascular risk factors were recruited from vascular surgery or cardiology clinics in Tucson, Arizona from 2022-2025. Individuals with creatinine assessments in point-of-care whole blood (POC-WB) and frozen serum and plasma samples using the iSTAT (Abbott) were included. eGFR was calculated using the 2021 CKD-EPI creatinine equation without race. Agreement between POC-WB and frozen blood samples was assessed using Cohen's kappa with linear weights. RESULTS: 134 participants (mean [SD] age: 72.6 [7.5] years, 39.6% female, 23.1% chronic kidney disease) had POC-WB eGFR available. Frozen serum and plasma samples had strong agreement with POC-WB for eGFR (Kw= 0.90-0.95, P<0.001). Pre-analytical factors had minimal effect on eGFR differences between POC-WB and frozen blood samples. CONCLUSIONS: Renal function can be assessed from frozen blood samples with high consistency to POC-WB, which may be particularly relevant for interpretation of AD blood biomarkers in general aging and vascular populations who often have impaired renal function.

Background: Clinician-scientists translate clinical observation into discovery, trials, and policy, yet this workforce is shrinking across health systems worldwide. Integrated MB-PhD training, pausing medical training to complete a PhD before clinical exposure or specialisation, is one route into this career. We aimed to evaluate the long-term value of MB-PhD training and the barriers to clinical-academic careers these face after graduation. Methods: We evaluated all 131 graduates (29.8% female) who entered the University College London (UCL) MB-PhD programme over a 25-year period (1994-2018). Bibliometric outputs were collated via an inter-linked information system. Concurrently, all 131 graduates were invited to respond to open-ended questions on career benefits and structural barriers; 99 (75.6%) responded, and responses were independently coded into themes, which were then reviewed and confirmed by a Study Group of 107 individuals, including the 91 respondents who agreed to participate further. Results: Graduates produced 5,877 publications (1,141 first-author, 819 corresponding-author), attracting 350,754 citations, with a mean relative citation ratio of 3.30 {+/-} 0.47, approximately three times the field average and sustained across three decades of programme entry. Graduates secured an estimated $157.55 million across 99 grants, released 465 public datasets, and were named investigators on 31 clinical trials across five continents. Among the 99 survey respondents, 49.5% held consultant-grade posts, 72.7% remained research-active, and 25.3% had reached senior academic grade. Open-ended responses were coded into five recurring structural barriers, subsequently confirmed by the Study Group: insufficient protected research time (72.2% of responses), unsupportive training structures and limited career opportunities (36.7%, 24.4% of responses), funding and pay barriers (22.2% of responses), and lack of mentorship or geographical/family constraints (14.4%, 13.3% of responses). Conclusions: Integrated MB-PhD training generates sustained academic productivity and leadership, but structural barriers threaten retention of graduates within clinical-academic careers. Protecting research time, stabilising funding and pay, and reducing geographic instability are needed to retain the clinician-scientists that health systems have already invested in training.

Abstract Introduction In-hospital cardiac arrest carries high mortality despite standardized ACLS training. Educators face increasing time constraints in developing assessment tools for ACLS training. Two possible solutions to this problem are using pre-medical students or using artificial intelligence to generate test questions. This study compared the quality of pre-medical student-generated ACLS test questions vs. AI-generated ACLS test questions, testing the hypothesis that AI-generated questions are non-inferior to student-generated questions. Methods Ten pre-medical students created ACLS questions following predefined criteria, while an AI model (Northwell's Artificial Intelligence Hub) generated comparable questions. A blinded ACLS-certified physician evaluated questions on the qualities of Alignment, Clarity, Cognitive Level, and Question Design using a standardized rubric (Likert scale: 1 = poor quality, 5 = excellent). Student's T-test and Chi-square analysis were used to compare the quality of questions on different rubric domains within each arm (student vs. AI) and within one domain (eg, question Clarity) between arms. The Student's T test was used when 2 comparator groups were compared (eg, Clarity of student-generated vs. AI-generated questions) within one arm. The ANOVA test was used when comparing more than 2 comparator groups (eg, Alignment vs. Clarity vs. Cognitive Level) within one arm. Statistical significance was set as a priority at p <0.05. Results Both student-generated and AI-generated questions were of high quality. AI-generated questions achieved the maximum score in the domains of Alignment, Clarity, and Question Design, but fell short of perfect scores in the domain of Cognitive Level (8 of 50 questions were less than 5). Student-generated questions achieved less-than-perfect scores in each domain. No significant difference was found in overall mean question scores between groups (students = 4.79, AI = 4.81; p = 0.9). However, AI-generated questions had significantly-greater Clarity (students = 4.8, AI = 5; p = .0461), while Alignment, Cognitive level, and Question Design showed no significant differences. Conclusion AI-generated questions demonstrated overall quality comparable to those generated by pre-medical students, supporting the potential role of AI as a scalable tool in ACLS educational assessment development. Further studies are warranted to evaluate additional AI platforms and determine optimal integration of AI in medical education assessment design.