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464 papers

Synergistic Regulation of Postharvest Physiology and Biochemical Quality of Peach (Prunus persica L.) Through Salicylic Acid and Plant-Based Edible Treatments.

Shajari S et al. · Jun 25, 2026

Postharvest deterioration represents a major challenge in maintaining the market quality of peach fruit, and the application of environmentally benign treatments such as edible coatings has gained increasing attention as an effective strategy to extend storage life. Accordingly, the present study evaluated the effects of several natural coating materials on the postharvest quality of peach ( Prunus persica L.). The experimental treatments consisted of salicylic acid at three concentrations (0, 1, and 2 mM), Aloe vera gel at 0%, 20%, and 30%, and clove extract at 0, 150, and 300 ppm. Overall, the application of edible coatings significantly enhanced fruit storability and quality attributes compared with untreated control fruit. Among the treatments, fruit treated with 2 mM salicylic acid and 300 ppm clove extract exhibited the highest fruit weight (89.66 g). Whereas the fruits without salicylic acid application showed the greatest fruit weight loss (15.55%) and the highest vitamin C (32.02 mg 100 g -1 FW) was obtained at 2 mM salicylic acid treatment. In terms of clove extract treatments, fruit coated with 300 ppm clove extract maintained the greatest fruit texture firmness (3.69 kg cm -2 ), total phenolic content (219.88 mg GAE 100 g -1 FW), vitamin C (mg 100 g -1 FW), and total antioxidant capacity (446.94 μmol TE g -1 FW), whereas no application treatment recorded the highest fruit weight loss (14.72%) and total acidity (4.16 g malic acid 100 g -1 FW). In conclusion, the findings demonstrate that natural edible coatings, particularly when applied in combination, are effective in reducing oxidative stress, suppressing enzymatic browning, and improving postharvest quality, thereby representing a promising and sustainable approach for extending the shelf life of peach fruit. These findings suggest that activation of antioxidant system likely stimulated by salicylic acid and supplemented by aloe vera or clove extract was a central mechanism underlying quality preservation.

Materials Science

Accuracy of administrative data in ascertaining health conditions: a systematic review.

Campbell AC et al. · Jun 25, 2026

Objectives To conduct a systematic review of studies assessing the accuracy of International Classification of Diseases (ICD) and Diagnostic and Statistical Manual of Mental Disorders (DSM) codes in administrative data for ascertaining health conditions when compared to a reference standard. Materials and methods We searched MEDLINE, Embase, and PsycINFO, and reported study characteristics and accuracy measures, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). We synthesized information about primary and validation sources of administrative data used in this literature and visually described accuracy measures by ICD chapter. Results Our review included 280 studies; only two were conducted in low or middle-income countries. The majority of studies used hospital records as the primary administrative data source (52.1%; n = 146) and medical chart reviews as the data source for validation (53.6%; n = 150). The IQRs of accuracy measures across studies and ICD chapters were 44.0-91.4, 90.0-99.6, 59.4-91.1, and 90.0-99.5 for sensitivity, specificity, PPV, and NPV, respectively. Discussion The assessed literature is heavily skewed towards data from high-income countries. The variance we observed in accuracy measures, particularly for sensitivity and PPV, indicates that we need more evidence on and ongoing monitoring of the accuracy of ICD/DSM codes in administrative data, which are now widely used in population-based epidemiologic studies and therefore highly relevant for public health policymaking. Conclusion Health conditions ascertained using ICD/DSM have moderate to high accuracy in identifying true positives and high to very high accuracy in identifying true negatives.

Health Professions

Patient Perceptions and Acceptance of Blockchain-Based Health Data Sharing in Oncology: Cross-Sectional Survey.

Moraes MV et al. · Jun 25, 2026

Background Fragmentation of electronic health records in oncology hinders coordinated care, delays diagnoses, and limits therapeutic personalization. Blockchains promise to promote secure, interoperable, and patient-centered data governance; however, patient perceptions of blockchains remain underexplored, particularly in middle-income countries such as Brazil. Objective We assessed opinions, attitudes, and willingness among patients with cancer to digitally share clinical information and the feasibility of applying blockchains to restructuring secure health data sharing in the Brazilian public health context. We had three research questions: (1) What is the level of digital health tool acceptance among patients with cancer in Brazil? (2) Which sociodemographic factors are associated with willingness to share health data? (3) Are blockchains feasible and acceptable for restructuring secure oncology data sharing? Methods An exploratory, descriptive, cross-sectional self-report survey was conducted at Hospital Santa Izabel, a national oncology reference center in Salvador, Bahia, Brazil, between September and November 2023. A convenience sample of 110 outpatients with cancer was recruited systematically; data were collected via a self-administered questionnaire. The 20-item instrument, developed de novo and validated via expert panel and pilot testing, covered 5 content domains yielding 3 composite scoring domains: self-management, adherence, and governance. We used Cronbach α to assess internal consistency, independent 2-tailed t tests, 1-way ANOVA, and Pearson correlations to compare domain scores across sociodemographic groups, and a chi-square goodness-of-fit test to examine trust proportions across recipient types. Results We received sufficiently complete responses from 94.5% (104/110) of patients. The sample was predominantly female (63/98, 64.3%), self-identified as pardo (mixed-race; 64/98, 65.3%), and lower income (55/96, 57.3% earned less than twice the minimum wage). Acceptance of technology was high: 86.4% (95/110) would use health apps and 89.1% (98/110) expressed interest in prevention-focused applications. Trust in data sharing varied significantly across recipient types (χ23=210.4; P Conclusions Patients with cancer in Brazil demonstrated high acceptance of digital health tools and openness to data sharing when privacy, security, and governance are guaranteed. This supports the feasibility of blockchain-based health data management systems, provided they incorporate patient-centered principles, digital inclusion strategies, and robust governance aligned with Brazilian regulations (the General Data Protection Law) and the Unified Health System (Sistema Único de Saúde) infrastructure. Importantly, patient support reflected acceptance of blockchain's functional principles, data security, anonymization, and auditability rather than familiarity with the technology itself, a distinction with direct implications for future implementation studies.

Computer Science

Virtual Reality Simulation in Postgraduate Pediatric Critical Care Training Based on Trainee Perceptions in London: Exploratory Mixed Methods Study.

Berlin AC et al. · Jun 25, 2026

Background Simulation-based training has established itself as integral to clinical education, particularly for high-stakes, low-frequency pediatric emergencies. Innovations incorporating virtual reality (VR) are rapidly gaining traction for offering scalable, repeatable, and immersive opportunities for scenario-based learning. Understanding its role and applicability in postgraduate pediatric training, however, remains limited, with further exploration required into how pediatric trainees perceive, conceptualize, and anticipate VR-based simulation within real-world training contexts. Objective This study explored London-based pediatric trainees' perceptions of VR simulation as an adjunct for developing skills in recognizing and managing critically ill children. Methods An exploratory mixed methods study was conducted among pediatric trainees across all training levels within the London School of Paediatrics between April 2024 and July 2024. Data were collected using a 35-item online questionnaire containing Likert-scale, categorical, and open-ended questions, alongside virtual semistructured interviews. The questionnaire explored current training practices; confidence and preparedness in managing critically ill children; familiarity and experience with VR; and perceived benefits, limitations, barriers, and facilitators to adoption. Quantitative data were analyzed descriptively, with exploratory Mann-Whitney U tests and Spearman correlations where appropriate. Internal consistency of key domains was assessed using Cronbach α. Qualitative data from open-ended responses and interviews were analyzed thematically using the Braun and Clarke reflexive approach. Quantitative and qualitative strands were integrated at the interpretation stage to contextualize survey patterns with illustrative qualitative insights. Results Thirty trainees participated in the survey (30/450, 6.7%; female: 16/30, 53%), with participants spanning all 8 training years. Two senior trainees participated in interviews. Clinical exposure or experience and simulation training were identified as central to developing skills in managing pediatric emergencies. Trainees also described limited exposure to high-acuity scenarios; variable access to high-fidelity simulation; and constraints related to workload, supervision, and feedback. Most participants (21/30) had no prior VR exposure in a medical setting, while 17% (5/30) had used VR training, and all reported positive experiences. Despite limited exposure, 93% (28/30) of participants were willing to try VR simulation for exposure to rare scenarios, structured decision-making, and confidence-building. Key perceived barriers included high cost (24/30, 80%), technological literacy (17/30, 57%), infrastructure (15/30, 50%), and limited stakeholder familiarity or support (25/30, 83%). Participants suggested taster sessions, faculty advocacy, leadership engagement, and phased implementation as potential facilitators. Internal consistency of attitudinal survey items was good (Cronbach α=0.80). Conclusions Despite limited exposure, pediatric trainees viewed VR simulation as a valuable adjunct to existing critical care training, particularly for those in earlier stages of training. However, these findings represent anticipatory perceptions rather than evidence of educational effectiveness. The implementation of VR will depend on addressing key infrastructural, organizational, educational, and equity-related barriers. Further multicenter studies are needed to evaluate the educational impact and feasibility, learning outcomes, and cost-effectiveness in postgraduate pediatric critical care training programs.

Medicine

Augmented Reality-Assisted Training Tool for Mental Health Task-Sharers: Pilot Mixed Methods Usability Study.

Ngiam LLV et al. · Jun 25, 2026

Background The growing global mental health (MH) burden, especially in underresourced communities, calls for innovative, scalable, and culturally responsive training approaches to expand care access and improve outcomes. Task-sharing has shown promise in addressing workforce shortages but is limited by training and supervision challenges. Traditional methods, such as role-playing and standardized patients, are resource-intensive and less scalable. Virtual simulations, including augmented reality (AR), present novel opportunities for immersive and interactive training. An AR-assisted training tool can enable culturally sensitive training while fostering empathy, communication skills, and confidence in handling nuanced MH scenarios. However, AR's usability and effectiveness for MH task-sharing training remain underexplored. Objective This study aimed to assess the usability of an AR-assisted MH task-sharing training tool that uses virtual patient (VP) simulation and evaluate its potential to enhance training. Additionally, we developed design recommendations for future related XR-assisted clinical training tools. Methods We conducted a formative, explorative sequential mixed-methods usability study. A convenience sample of 5 MH trainees or workers (ages 18-60 years; female: n=3, male: n=2; identifying as African American, Asian, and Hispanic) participated. Participants were recruited through a university-affiliated MH training program. The usability testing protocol included a semistructured prestudy interview, orientation to the AR headset (Magic Leap 2), a think-aloud user testing session, and a poststudy quantitative questionnaire and qualitative interview. Usability was assessed using a modified Post-Study System Usability Questionnaire (PSSUQ), which measures system usefulness, information quality, and interface quality. Data were analyzed using descriptive statistics and thematic analysis. Results The AR simulation was positively received by participants, demonstrating above-average usability. The overall mean PSSUQ score was 3.46 (SD 1.71), with subscale scores for system usefulness (mean 3.46, SD 1.77), information quality (mean 3.76, SD 1.73), and interface quality (mean 2.83, SD 1.59). Thematic analysis highlighted high realism fostered trainees' empathy toward the VP, while increasing immersion and interaction quality. Despite some hardware limitations and user discomfort that broke immersion, participants recognized the tool's potential and usefulness for training in various MH scenarios. Based on these findings, we proposed design recommendations across environmental context, training structure, VP behavioral realism (body language, voice, eye movement, and technical hardware considerations). Conclusions This pilot study is among the first to evaluate AR-based VP simulation for training lay MH task-sharers, filling the technology and population gaps of prior VR- and desktop-focused simulation research. Preliminary empirical usability evidence from a validated instrument (PSSUQ) demonstrates above-average usability, and findings informed design recommendations for future research. These findings suggest AR-based training could provide a less resource-intensive solution for realistic MH training practice in underresourced settings. Further research includes larger sample sizes for inferential analysis, comparison studies with traditional methods, and generalizing to other MH conditions.

Psychology

A Comprehensive Analysis of Dietary Fishmeal Replaced by Black Soldier Fly (Hermetia illucens L.) in Largemouth Bass (Micropterus salmoides).

Chen Y et al. · Jun 25, 2026

Black soldier fly larvae meal (BFLM) is characterized by high yield and a well-balanced nutritional profile, making it a promising alternative protein source for aquafeeds in the near further. Previous studies have demonstrated its potential to partially replace fishmeal (FM) in aquatic diets. Therefore, a 56-day feeding trial was conducted in largemouth bass (LMB) to evaluate the effects of graded level of BFLM (0%, 17%, 34%, 51%, and 68%) as a substitute for FM on growth performance, antioxidant, immune responses, and muscle quality. The results showed that dietary BFLM replacement levels above 17% significantly reduced SGR, FER, and whole-body crude lipid content, thereby impairing growth performance. In addition, higher substitution levels disrupted the antioxidant system, promoted the expression of inflammatory cytokines through activation of the nrf2-keap1 pathway, and consequently induced inflammatory responses. Furthermore, BFLM replacement exceeding 17% decreased muscle hardness and chewiness, reduced the content of aroma-, umami-, and sweet-related compounds, and increased the levels of off-flavor substances and SFAs, ultimately leading to deterioration in muscle quality. Based on the present results, the optimal replacement level of BFLM in diets for LMB should not exceed 17%. A comprehensive analysis of the adverse effects associated with high levels of BFLM substitution indicated that the high content of saturated fatty acids (FAs) and the low content of long-chain polyunsaturated FAs in BFLM were the key factors limiting growth performance, inducing oxidative stress, and reducing muscle quality. To improve the efficiency of BFLM as a substitute for FM, it is necessary to optimize FA composition while comprehensively considering growth performance, antioxidant and immune status, and muscle quality.

Agricultural and Biological Sciences

Adenosquamous carcinoma of the lung: Comparative CT and pathological features versus adenocarcinoma and squamous cell carcinoma.

Yuan Q et al. · Jun 24, 2026

Objective Adenosquamous carcinoma (ASC) of the lung, containing both adenocarcinoma (AC) and squamous cell carcinoma (SCC) components, is associated with aggressive behavior and poor prognosis. Due to overlapping imaging features with AC and SCC, its preoperative diagnosis remains challenging. This study aimed to compare CT and pathological characteristics among ASC, AC, and SCC; identify key differentiators. Methods This retrospective study included 27 patients with pathologically confirmed ASC who underwent surgical resection from November 2018 to January 2025. Forty cases each of AC and SCC, matched for age, sex, and smoking history, were selected for comparison. Clinical, radiological, and pathological features were analyzed. Variables with statistical significance (P Results Compared with SCC, ASC lesions were more peripheral and associated with higher distance ratios (DR), pleural retraction, spiculation, and lymph node metastasis (LNM). Compared with AC, ASC tumors were larger, more often solid, and exhibited lobulation, bronchial cutoff sign, and advanced staging. Among the evaluated analyses, the combined pathology-imaging approach showed the highest discriminatory performance, with AUCs of 0.909 (ASC vs SCC) and 0.900 (ASC vs AC). LNM and DR were more strongly associated with ASC relative to SCC, whereas larger tumor size, ill-defined margins, and advanced stage were more strongly associated with ASC relative to AC. Conclusion Certain CT imaging features, especially DR and LNM, were associated with ASC and may provide useful information for preoperative radiological assessment and subtype stratification.

Medicine

Uncovering the genetic basis of crown rust resistance in a northern-by-southern oat biparental population.

Sapkota S et al. · Jun 24, 2026

Crown rust, caused by the fungal pathogen Puccinia coronata f. sp. avenae (Pca), is a destructive foliar disease of oat. Use of host resistance is the preferred method of disease management. However, frequent emergence of new Pca races has hindered crown rust management in oat. Identification and deployment of non-race-specific genetic resistance will aid oat breeding efforts to develop germplasm with durable crown rust resistance. To map and characterize crown rust resistance, a recombinant inbred line (RIL) population was developed from a cross between LA07065_SBSBSB_32-2 and CDC Dancer and evaluated for crown rust reaction in four field environments for two years. The RIL population was genotyped using the oat 6K Infinium iSelect single nucleotide polymorphism (SNP) array and a total of 956 polymorphic SNP markers were used to construct the linkage map. Quantitative trait loci (QTL) mapping detected a total of six QTL on chromosomes 2D, 4A, 7A, 7C, and 7D influencing crown rust resistance. Two of these QTL were validated using genotype-phenotype association analysis in an independent set of oat lines. The identified QTL demonstrated additive effects on crown rust resistance within the RIL population. A major QTL on chromosome 7C, QPca-ars-7C, was detected consistently across environments and explained up to 16.54% of the phenotypic variation. Markers linked to QPca-ars-7C, and other QTL detected in this study have the potential to be used in marker-assisted selection for crown rust resistance.

Agricultural and Biological Sciences

Proteomics risk scores and mortality in heart failure: Generalizability across populations.

Shearer JJ et al. · Jun 23, 2026

Background Heart failure (HF) is a complex syndrome with high mortality. Proteomics risk scores have shown promise in predicting mortality beyond guideline-recommended clinical tools. It is crucial to understand how risk scores generated by different methods and populations perform, and whether they highlight the same protein targets relevant to outcomes. Methods To examine whether the study design impacts proteomics scores designed to predict mortality in HF, we evaluated three published risk scores that used the SomaScan assay to measure plasma proteins in a community cohort, clinical trial, and registry. Each score was assessed in the aforementioned community cohort and Cox models examined the association of a 1-standard deviation increase in score with mortality, with and without adjustment for clinical covariates. Performance of each risk score to predict 5-year mortality risk was assessed using calibration plots and time-dependent area under the curve and compared with a clinical model. Results Risk scores were similarly distributed and moderately correlated (Pearson correlation coefficient = 0.59-0.76). A 1-standard deviation increase in each risk score was associated with an increased risk of all-cause mortality: community cohort (HR = 2.70, 95% CI: 2.50-2.91); clinical trial (HR = 1.76, 95% CI: 1.65-1.88); registry (HR = 1.70, 95% CI: 1.6-1.81). Risk remained after adjustment for clinical covariates, although slightly attenuated, and similar across different ejection fraction categories. All risk scores showed strong calibration across the risk levels, alone, with an average expected over observed ratio ranging between 0.96-1.56. Seven proteins were included in at least two risk scores, with renin being included in all three. Conclusions All three proteomics risk scores improved risk stratification in HF patients beyond guideline recommended clinical tools, independent of study design and ejection fraction. These results demonstrate that proteomics risk scores can enhance risk stratification across the HF syndrome, even when derived from different methods and populations.

Chemistry

Towards modeling phage therapy.

de Boer RJ et al. · Jun 22, 2026

Patients infected with life-threatening multi-drug resistant (MDR) bacteria have been treated with cocktails of bacteriophages. This is a complicated form of personalized medicine as the phages given to a patient have to be selected beforehand on the basis of their lytic capacity of the infecting bacteria. Because bacteria rapidly become resistant, the evolution of resistance to a diverse cocktail of phages is a complicated dynamical process, during which competing bacterial strains replace one another by accumulating several resistance mechanisms, each of which may involve a fitness cost. As a consequence, it is typically not known why a particular phage therapy succeeded or failed, and how one can optimize the composition of the cocktails to maximize the rate of success. To improve upon this, we extend an existing in vivo-calibrated mouse model into a novel mathematical model for the human situation, and include multiple phages infecting multiple bacterial strains, differing in their resistance to each of the phages. We adjust several parameter estimates of the bacterial model to the human situation, and use the model to describe a successful case of phage therapy involving several cocktails, each containing several phages. In the model, treatment success crucially depended on pretreatment resistance levels, and on the diversity and the timing of the cocktails. Once an appropriate cocktail is found, it is less important to further optimize the infection rates of the phages. Resistant bacterial strains expand rapidly when sensitive strains decline, and the higher the infectivity of the phages, the faster resistant strains expand. Because resistance evolves rapidly, it is best to provide a diverse set of phages right from the start of therapy, i.e., to hit hard and early, and create a high genetic barrier to bacterial resistance.

Environmental Science