Search Results (2,556)

Cotton damping-off caused by Rhizoctonia solani restricts seedling establishment, and locally adapted biocontrol isolates are potential components of sustainable disease management. This study evaluated Pseudomonas chlororaphis-like isolate M6 and tested whether molecular profiles in M6-protected plants differed from those in Pathogen-infected plants in directions that moved toward Healthy Control levels. Culturable bacteria from root-associated soils were screened against R. solani by dual-culture assays, and M6 was evaluated in a greenhouse cotton damping-off assay. RNA sequencing (RNA-seq) and untargeted liquid chromatography–mass spectrometry (LC–MS) data from Healthy Control, Pathogen-infected, and M6-protected plants at 0 and 7 d were analyzed using the Pathogen-infected versus Healthy Control and M6-protected versus Pathogen-infected contrasts. M6 produced the highest inhibition among the candidate isolates (81.9%). Under greenhouse conditions, the M6-protected treatment had lower disease incidence (22.2% versus 88.9%) and disease index (16.4 versus 76.8) than the Pathogen-infected treatment. At 7 d, the primary false-discovery-rate-controlled analysis identified 4457 transcripts and 1620 LC–MS features for which the change between M6-protected and Pathogen-infected plants was opposite to the pathogen-associated change and the M6-protected group mean was closer to the Healthy Control mean. Additional nominal-p-value-only results were retained as exploratory. The two contrasts involved redox regulation, phenylpropanoid/benzenoid-related metabolism, hormone/defense signaling, protein synthesis and central metabolism. Antioxidant enzyme and quantitative reverse transcription PCR (qRT-PCR) data provided independent support for selected redox- and defense-associated differences. Because pathogen biomass, bacterial colonization and antagonism-deficient mutants were not assessed, the molecular profiles are interpreted as association-based features of the protected state rather than evidence that host recovery caused disease reduction. Most LC–MS annotations are putative and were not confirmed with authentic standards. Full article

Callus cultures derived from three species of Fabaceae were compared under identical hormonal conditions using untargeted UHPLC–MS/MS metabolomics together with phenotypic and antioxidant capacity analyses. Principal component analysis with 290 metabolites revealed species identity as the dominant determinant of the metabolic profile, indicating that species-associated metabolic signatures persist in dedifferentiated tissues. Soybean calli accumulated saponins, primarily soyasapogenol derivatives. Lupin calli were characterized by diverse isoflavones detected as aglycones, glycosylated and malonylated conjugates. Calli from the pea cultivar Karacter were dominated by hydroxycinnamate derivatives: coumaroyl methylhexose, feruloyl-coumaroyl glycoside derivatives, and caffeoyl amino acid conjugates. Within each species, the calli metabolomes were furthermore influenced by genotype, explant origin, and independent callus line establishment. Antioxidant capacity correlated with metabolite subclass composition rather than total metabolite abundance, with polyphenol-rich profiles displaying higher reducing potential than saponin-dominated metabolomes. Together, these findings provide the first systematic comparative evidence that species-specific metabolic signatures are maintained in Fabaceae callus cultures, while remaining quantitatively modulated by genotype, explant origin, and somaclonal variation. Soybean, lupin, and pea callus cultures thus provide tractable model systems for the species-specific study of respectively triterpenoid saponin, isoflavonoids, and hydroxycinnamate metabolism, offering a foundation for future biotechnological development. Full article

Plant regeneration demonstrates the remarkable developmental plasticity of plants, enabling tissue repair, organ formation, and adaptation to environmental challenges through cellular reprogramming and redifferentiation. This capacity underpins numerous horticultural and biotechnological applications, including grafting, micropropagation, somatic embryogenesis, organogenesis, and genetic transformation. While regeneration has traditionally been explained by the coordinated actions of auxin and cytokinin together with key developmental regulators such as WUSCHEL, BABY BOOM, and WUSCHEL-related homeobox genes, recent studies indicate that regeneration is also influenced by stress signaling, metabolic reprogramming, reactive oxygen species, and epigenetic regulation. Among these regulatory components, polyamines have emerged as important modulators of cell division, differentiation, stress responses, and morphogenic competence during in vitro regeneration. Likewise, autophagy, a conserved intracellular recycling pathway, has gained increasing attention for its role in maintaining cellular homeostasis, facilitating metabolic adaptation, and supporting developmental transitions under tissue culture conditions. This review summarizes current knowledge on the independent roles of polyamines and autophagy in plant cell reprogramming and in vitro regeneration, with particular emphasis on wound responses, somatic embryogenesis, and organogenesis. In addition, it highlights common physiological processes through which these pathways may influence regeneration and identifies the limited understanding of their potential relationship as an important direction for future research. Full article

Belief in ghosts, spirits, and sacrificial culture is important in the Confucian tradition. Across different periods, Confucian interpretations have changed. Pre-Qin Confucianism distanced itself from earlier wu-shi 巫史 (shaman) culture, remaining agnostic about whether ghosts and spirits possess supernatural powers to govern national prosperity or personal fate. In governance and social practice, it prioritized human agency over the authority of ghosts and spirits, marginalizing their influence. While affirming the didactic function of sacrifice, Pre-Qin Confucians venerated ghosts and spirits but insisted on “ji er bu qi” (祭而不祈, “sacrificing without supplication”). Song–Ming Confucianism, responding to challenges from Buddhism and Daoism, reinterpreted these concepts and understood ghosts and spirits in terms of qi (氣, ether), framing them as the contraction and expansion of “qi” (“qi zhi qu shen”, 氣之屈伸). They did not recognize the independent existence, sentience, or supernatural powers of ghosts and spirits. Because the qi of ancestors and the living are identical, communication with ghosts and spirits could be established during ancestral worship. They favored sacrifice to ghosts and spirits but criticized the Buddhist practice of making images of them. In summary, Pre-Qin and Song–Ming Confucianism offered different explanations for why ghosts and spirits should be venerated and the relationship between sacrifice and blessings. These interpretations, shaped by efforts to distinguish themselves from wu-shi traditions and Buddhist–Daoist doctrines, reveal differences and contradictions between the two major phases of Confucian thought. Both, however, shared the aim of negating shamanistic practices and countering heterodoxy. Full article

Background/Objectives: Large multinational mass gatherings can create healthcare encounters in which severe mental health screening signals require rapid recognition, confidential assessment, language support, and referral. During Hajj, culturally and linguistically diverse pilgrims may first disclose severe psychological symptoms in general medical or field settings rather than through specialist psychiatric pathways. This study estimated the prevalence, overlap, and adjusted correlates of severe screen-positive mental health symptom signals among adult multinational Hajj pilgrims in 2025 and considered implications for multilingual healthcare encounters and referral planning. Methods: This cross-sectional field screening study analyzed de-identified coded data from 2171 adult pilgrims aged 18–95 years. Participants completed a structured, interview-administered multilingual mental health screening survey comprising 23 binary symptom items. The analysis focused on suicide-related symptoms, psychotic-like symptoms, and mood-instability/bipolar-spectrum symptoms. A severe symptom cluster was defined as positivity in at least one of these domains. Prevalence estimates with Wilson 95% confidence intervals, domain overlap, and multivariable logistic regression models were used. Results: Severe symptom cluster positivity was identified in 428 participants (19.7%; 95% CI 18.1–21.4). Mood-instability/bipolar-spectrum signals were most frequent (13.3%; 95% CI 11.9–14.8), followed by psychotic-like symptoms (8.0%; 95% CI 6.9–9.2) and suicide-related symptoms (5.6%; 95% CI 4.7–6.6). Among cluster-positive participants, 297 endorsed one severe domain, 108 endorsed two domains, and 23 endorsed all three. Current physical illness was independently associated with all severe outcomes, whereas prior psychiatric history was not independently associated with suicide-related symptoms. Conclusions: Severe screen-positive mental health signals were present in a clinically relevant minority of pilgrims. The findings support integrating confidential severe symptom screening, interpreter-supported assessment, psychological first aid, and clear referral pathways into general Hajj healthcare encounters, while emphasizing that screen-positive findings are not psychiatric diagnoses. Full article

Identity development is a central developmental task during emerging adulthood, and religiosity has been proposed as an important factor associated with this process. However, empirical evidence from the Indian context remains limited. This cross-sectional study examined the association between religiosity and positive self-identity among 2137 university students recruited from multiple institutions across India. Data were collected using a self-administered electronic questionnaire completed during scheduled classroom sessions. Pearson’s correlation and multiple linear regression analyses were performed, with the latter adjusted for socio-demographic characteristics. Religiosity showed a significant positive correlation with positive self-identity (r = 0.390, p < 0.001). Regression analysis revealed that after adjusting for covariates (age, gender, religion, family income, and place of birth), religiosity remained a significant independent predictor of positive self-identity (β = 0.348, p < 0.001). These findings indicate that higher religiosity is independently associated with greater positive self-identity, encompassing higher self-confidence, self-esteem, self-satisfaction, ease of self-definition, and inner peace, among Indian university students. The study contributes context-specific evidence on the role of religiosity in positive identity development within the Indian socio-cultural setting. Full article

Background: Pericardial effusion has a broad differential diagnosis, whereas bacterial pericarditis is rare. Despite this, routine culturing of pericardial fluid is frequently performed, and its diagnostic yield remains uncertain. Methods: We conducted a retrospective study of all pericardial fluid cultures obtained at a tertiary medical center between January 2016 and May 2024. Cultures were classified as true positive if a recognized bacterial pathogen was isolated or if it was deemed clinically pathogenic by an infectious disease’s specialist at the medical record. Contaminants were defined according to CDC criteria. Clinical, laboratory, and imaging variables were analyzed using univariate testing and multivariable logistic regression. Results: Among 198 eligible pericardial fluid cultures, 8 (4%) yielded true bacterial pathogens, whereas 43 (23%) grew contaminants and 147 (73%) remained sterile. Thus, contaminant growth occurred more than five times as frequently as that of true pathogens. The most frequent pathogens were Staphylococcus aureus and Streptococcus species. No demographic features, presenting symptoms, or imaging findings were associated with culture positivity. In multivariable analysis, concurrent bacteremia (odds ratio [OR] 17.49; p = 0.002) and higher peripheral neutrophil percentage (OR 1.20; p = 0.012) independently predicted bacterial pericarditis. In models incorporating pericardial fluid cell counts, a lower mononuclear cell percentage was also independently associated with infection (OR 0.91; p = 0.03). Conclusions: Bacterial pericarditis is uncommon, and routine pericardial fluid cultures, of all pericardial fluid specimens, have a low diagnostic yield with substantial contamination. Laboratory markers, particularly bacteremia and neutrophilia, may help identify patients most likely to benefit from culture. A selective, laboratory-guided approach may improve diagnostic efficiency and reduce unnecessary testing. Full article

Thyroid hormone synthesis involves several key steps culminating in the organification of iodide into iodothyronines, thyroxine, and triiodothyronine. To date, there is no clear mechanistic evidence of extrathyroidal iodothyronine synthesis. Upon iodine (KI/I₂) loading, human neutrophils produced significant amounts of de novo iodothyronines as determined by diagnostic immunoassay and LCMS/MS. Treatment of neutrophils with sodium iodide resulted in a lower hormone yield, which was enhanced following the addition of copper chloride to culture media. The appearance of thyroid hormones was observed only after induction of the oxidative burst with PMA. Synthesis of hormones was abolished by the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase inhibitor, DPI. Essential components for iodothyronine synthesis included hydrogen peroxide, myeloperoxidase, and either serum or thyroglobulin serving as an iodination substrate. In a series of novel experiments, we show a serine protease requirement for liberation of thyroid hormones from reservoirs of iodinated proteins. Serine proteases, proteinase K, and neutrophil-derived elastase, but not cysteine protease cathepsin B, released thyroxine from in vitro iodinated or native thyroid-derived thyroglobulin, respectively. Our studies show that neutrophil-mediated iodothyronine synthesis is an extracellular, multi-step, enzymatic process initiated upon cellular activation, but is independent of neutrophil viability window. Overall, this report presents a series of cellular and enzymatic experiments demonstrating the induction of thyroid hormones by non-classical mechanisms that can potentially regulate localized levels of iodothyronines. Full article

Background/Objectives: Staphylococcal scalded skin syndrome (SSSS) is a toxin-mediated skin disorder caused by Staphylococcus aureus (S. aureus), mainly affecting young children. This study aimed to describe the epidemiology, clinical features, microbiology, and management of pediatric SSSS and to explore factors associated with culture positivity, antimicrobial resistance, and complications. Methods: Retrospective cohort study of children hospitalized with SSSS at the major tertiary pediatric hospital in Greece, from January 2009 to December 2019. Exploratory association testing and parsimonious logistic regression were performed. Results: Overall, 51 children with a mean (±SD) age 2.5 ± 2 years were identified. Prior to diagnosis, 70.6% (36/51) of children had not received any antibiotic treatment. S. aureus was isolated from cultures in 43.1% (22/51) of cases. Carriage of S. aureus was detected in 34.0% (16/47) of children and 37.0% (10/27) of parents. Antibiotic resistance (%) for S. aureus was penicillin 95.5%, oxacillin 4.5%, erythromycin 4.5%, clindamycin 9.1%, mupirocin 40.9%, and fusidic acid 18.2%. Annual incidence of SSSS was estimated at 0.00–0.32/1000 hospitalizations from 2009 to 2016, but increased after 2017, reaching the highest incidence in 2019 (1.05/1000 hospitalizations); 50.7% of cases occurred in 2018–2019 (p < 0.001). During this period, resistance to oxacillin (MRSA strains) did not change (p = 0.53), whereas resistance to mupirocin increased over time, from 0% in 2009–2014 to 34.6% in 2018–2019 (p = 0.05). Penicillin was excluded from the composite drug-resistance outcome. Child nasal S. aureus carriage was independently associated with positive S. aureus culture (adjusted odds ratio [aOR] 4.18, 95% CI 1.14–15.27; p = 0.031) and with non-penicillin antibiotic resistance (aOR 25.68, 95% CI 2.64–249.50; p = 0.005). Elevated inflammatory markers were independently associated with complications (aOR 13.66, 95% CI 1.47–126.64; p = 0.021). Regarding treatment, clindamycin was the first-line agent in 58.8% (30/51) and was used as monotherapy in 49.0% (25/51). Conclusions: A notable increase in the incidence of SSSS was detected after 2017. Oxacillin resistance remained stable, but mupirocin resistance increased. Child nasal S. aureus carriage was associated with culture positivity and clinically relevant non-penicillin antibiotic resistance. Continuous surveillance is necessary as regional resistance patterns should guide therapy. Full article

Oral squamous cell carcinoma (OSCC) accounts for most head-and-neck cancers, and effective biological adjuvants remain limited. Gingival mesenchymal stem cells (GMSCs) exhibit anti-tumour paracrine activity, but the underlying molecular mechanisms and their relevance in patient cohorts remain incompletely understood. Consensus apoptosis–reactive oxygen species (ROS) effectors were identified through integrated transcriptomic analyses of TCGA-HNSC and three GEO cohorts. Candidate genes were evaluated in primary OSCC cells exposed to GMSC-conditioned medium or indirect Transwell co-culture. Findings were further examined using patient-cohort validation, single-cell ligand–receptor analysis, pathway and transcription-factor activity inference, and drug-repurposing approaches. Computational analyses identified an apoptosis–ROS network centred on BAX, BCL2, CASP3, CASP9, NOX1, and GPX1. Indirect GMSC co-culture reduced intracellular ROS, increased early apoptosis, and induced G2/M accumulation, whereas conditioned medium produced inconsistent effects, suggesting a requirement for live bidirectional paracrine signalling. BAX was the only consistently up-regulated effector. The axis demonstrated concordant differential expression across independent HPV-negative OSCC cohorts but was not independently prognostic under leakage-free cross-validation or external validation. Pathway analyses supported ROS suppression, apoptosis activation, and altered stromal–tumour communication. Drug-repurposing analyses identified HSP90 inhibitors and the FDA-approved TOP2 inhibitor mitoxantrone as candidate therapeutic agents. GMSC paracrine activity targets a biologically interpretable apoptosis–ROS axis in OSCC that is reproducibly expressed across patient cohorts but does not constitute an independent prognostic biomarker. The identified therapeutic candidates warrant further experimental investigation. Full article

Background/Objectives: The current study explored the relationship between cognitive distortions and alexithymia in 214 Saudi adults aged 20 to 45. Methods: Participants completed the Cognitive Distortions Scale and the Toronto Alexithymia Scale (TAS-20). Results: Results showed a significant positive correlation between cognitive distortions and alexithymia. Hierarchical regression analyses indicated that cognitive distortions were independently associated with overall alexithymia and difficulty identifying feelings after controlling for demographics, but not with difficulty describing feelings or externally oriented thinking. Gender moderation was non-significant across all outcomes, suggesting a similar cognitive–emotional pattern for both males and females. However, cognitive distortions partially accounted for the higher alexithymia scores observed in males, though this mediation finding should be interpreted cautiously given the unequal gender subgroup sizes. Culturally, these findings reflect norms in Arab societies, where emotional restraint—particularly among men—is often reinforced by values associated with honor and traditional masculinity. Such norms may inhibit emotional expression and contribute to higher levels of alexithymia. Additionally, collectivist orientations may foster cognitive styles that intersect with maladaptive cognitive distortions. Conclusions: These results highlight the need for culturally adapted cognitive-behavioral interventions that consider local beliefs about emotions and gradually enhance emotional awareness. Future research should examine the interplay of cultural, social, and religious factors with cognitive and emotional processes over time. Full article

Wastewater systems are critical reservoirs where antibiotic resistance genes, antibiotic-resistant bacteria, and pathogens converge and disseminate into receiving waters, posing risks to ecosystems and public health. Metagenomics enables culture-independent surveillance of resistome and pathogens in wastewater. After the COVID-19 pandemic, the rapid expansion of wastewater-based epidemiological surveillance, together with growing emphasis on the One Health framework, has further promoted the integration of wastewater metagenomic monitoring with public-health surveillance strategies. However, no bibliometric study has systematically mapped the global research landscape at the intersection of metagenomics, wastewater systems, antimicrobial resistance, and pathogen surveillance. This study retrieved 1161 publications from the Web of Science Core Collection and used CiteSpace to conduct bibliometric analyses. From 2010 to 2025, annual publications increased from 1 to 219, with 72.7% of the total output concentrated between 2021 and 2025. China led in publication output but showed low betweenness centrality, whereas Australia and Sweden served as key intermediaries. Keyword analysis revealed a gradual thematic evolution from the basic detection of antibiotic resistance genes in activated sludge, through studies of dissemination mechanisms, to recent work on One Health and wastewater surveillance. Literature co-citation analysis showed that integration between environmental monitoring and public health literature remains limited, suggesting that the translation of metagenomic surveillance data into health risk assessment frameworks is still at an early stage. By mapping the field’s knowledge structure and gaps, this review highlights priorities for advancing wastewater-based Antimicrobial Resistance surveillance, including standardizing analytical methods, developing artificial intelligence-assisted resistome analysis, promoting equitable participation from underrepresented regions, and operationalizing One Health surveillance, thereby supporting the translation of wastewater monitoring into actionable public-health solutions. Full article

Background and Objectives: Sepsis is a life-threatening condition characterized by organ dysfunction due to a dysregulated host response to infection. Blood cultures (BCs) remain the gold standard for diagnosing bloodstream infections, yet their positivity rate is limited and culture-negative sepsis remains poorly characterized. This study aimed to identify clinical and laboratory predictors of BC positivity in patients with suspected sepsis and to evaluate the prognostic implications of BC results on 28-, 90-, and 365-day survival. Materials and Methods: We retrospectively analyzed adult patients admitted to the Emergency Department of Policlinico di Bari (March 2023–December 2025) with sepsis or septic shock (Sepsis-3 criteria). After excluding contaminated cultures, 912 patients were included (602 culture-positive; 310 culture-negative) with a 1-year follow up. Predictors of BC positivity were assessed using logistic regression and ROC analysis; survival was evaluated with Kaplan–Meier curves and Cox models adjusted for age and Sequential Organ Failure Assessment (SOFA) score. We also evaluated time-to-positivity (TTP) for all blood culture isolates. Results: Culture-positive patients presented with greater initial severity, including higher rates of septic shock, elevated procalcitonin, CRP, lactate, and SOFA scores, and more frequent thrombocytopenia. Procalcitonin showed good discriminatory ability (AUC (area under the ROC curve) 0.785; cutoff 0.85 ng/mL; sensitivity 59.8%; specificity 83.8%). Key laboratory thresholds included a procalcitonin cutoff of 0.85 ng/mL, while CRP and platelet count did not show meaningful discriminatory cutoffs beyond their significant differences between culture-positive and culture-negative patients. Survival was consistently lower in culture-positive patients at 28 days (72.9% vs. 85.9%), 90 days (57.5% vs. 71.8%), and 365 days (44.3% vs. 61.2%). However, in adjusted Cox regression, BC positivity was not independently associated with 1-year mortality (HR 1.46; p = 0.092), whereas age and SOFA score remained significant predictors. Conclusions: Blood culture positivity identifies patients with greater initial severity, explaining their poorer unadjusted survival. However, culture positivity itself is not an independent predictor of long-term mortality, as age and organ dysfunction remain the main determinants of outcome. Procalcitonin showed solid discriminatory ability for true bacteremia. Full article

Background/Objectives: Chronic lymphocytic leukemia (CLL) is characterized by clinical and biological heterogeneity shaped by intrinsic signaling programs and microenvironmental interactions. Established biomarkers, including IGHV mutation status and TP53 alterations, provide important clinical and molecular information, but do not fully capture the diversity of pathways that sustain leukemic cell fitness. Aberrant calcium signaling contributes to leukemic survival; however, the clinical relevance of Ca²⁺/calmodulin-dependent protein kinase kinase 2 (CaMKK2), a calcium-responsive kinase, has not been defined. This study evaluated CaMKK2 as a candidate marker associated with high-risk disease biology and a pathway of interest for further study. Methods: CaMKK2 expression was quantified in purified CD19⁺ CLL cells from a clinically annotated cohort balanced by immunoglobulin heavy chain variable region (IGHV) mutation status. Associations with time to treatment and overall survival were analyzed. Functional relevance was assessed by pharmacologic inhibition of CaMKK2 in primary CLL cells using metabolic (MTS) and apoptosis (Annexin V/PI) assays. Correlations between CaMKK2 expression and inhibitor sensitivity were determined. The impact of CaMKK2 inhibition on nurse-like cell (NLC) differentiation and macrophage-mediated leukemic support was evaluated in ex vivo culture systems. Results: Elevated CaMKK2 expression was enriched in IGHV-unmutated CLL and associated with shorter time to treatment and inferior overall survival. Pharmacological inhibition of CaMKK2 was associated with reduced primary CLL viability in a dose-dependent manner and increased Annexin V/PI-defined total cell death with sensitivity correlating with CaMKK2 expression levels. Inhibition also attenuated CD163⁺ macrophage polarization and impaired NLC-mediated support of leukemic cells. Conclusions: CaMKK2 expression is associated with IGHV-unmutated, high-risk CLL biology. Pharmacologic inhibition of CaMKK2 was associated with reduced leukemic cell viability and altered macrophage phenotypes in ex vivo systems. These findings are exploratory, derived from a limited cohort, and support further investigation into the role of CaMKK2 in CLL biology, but do not establish independent prognostic value or direct on-target causality. Full article

Background: Inequitable access to clinical trials persists in blood cancers despite ongoing equity, diversity, and inclusion (EDI) efforts. Despite the critical role of clinical trials in improving survival and outcomes, recruitment remains suboptimal, limiting patient access to potentially life-saving therapies. Practical and scalable approaches are therefore needed to address the non-medical barriers that hinder patient readiness upstream of enrolment. Methods: Myeloma Canada led a national, multi-phase initiative using human-centred design (HCD) to operationalize EDI in clinical trials. Following an initial systems level workshop, the two-day Phase 0 workshop used a HCD approach that convened a purposively selected multidisciplinary group of stakeholders to co-design operational solutions for non-medical barriers affecting trial participation for patients. Given the use of purposive sampling, the results should be interpreted as reflecting a balanced range of diverse, informed perspectives across the Canadian clinical trial ecosystem. Results: Participants identified persistent cultural, logistical, financial, and linguistic barriers, along with fragmented awareness of available supports. Across diverse personas and care settings, all groups independently converged on a human-centred, equity-focused pre-trial navigation model supported by simple digital tools, including AI-enabled infrastructure drawing on curated resources from validated sources with appropriate governance, privacy, and oversight. Digital tools were proposed to support, rather than replace, human support and to align with existing health system realities. Conclusions: This hypothesis-generating work proposes a feasible, sustainable, and scalable equity-embedded, protocol-agnostic navigation framework. Its external hub-and-spoke structure can reduce non-medical barriers, strengthen trial access and accrual, and enhance representativeness. Pilot implementation that assesses feasibility, uptake, workflow impact, equity effects, and implementation burden is warranted. Full article