Impact of study design on adenoma detection in the evaluation of artificial intelligence-aided colonoscopy: a systematic review and meta-analysis.

BACKGROUND AND AIMS: Randomized controlled trials (RCTs) have reported that artificial intelligence (AI) improves endoscopic polyp detection. Different methodologies-namely, parallel and tandem designs-have been used to evaluate the efficacy of AI-assisted colonoscopy in RCTs. Systematic reviews and meta-analyses have reported a pooled effect that includes both study designs. However, it is unclear whether there are inconsistencies in the reported results of these 2 designs. Here, we aimed to determine whether study characteristics moderate between-trial differences in outcomes when evaluating the effectiveness of AI-assisted polyp detection. METHODS: A systematic search of Ovid MEDLINE, Embase, Cochrane Central, Web of Science, and IEEE Xplore was performed through March 1, 2023, for RCTs comparing AI-assisted colonoscopy with routine high-definition colonoscopy in polyp detection. The primary outcome of interest was the impact of study type on the adenoma detection rate (ADR). Secondary outcomes included the impact of the study type on adenomas per colonoscopy and withdrawal time, as well as the impact of geographic location, AI system, and endoscopist experience on ADR. Pooled event analysis was performed using a random-effects model. RESULTS: Twenty-four RCTs involving 17,413 colonoscopies (AI assisted: 8680; non-AI assisted: 8733) were included. AI-assisted colonoscopy improved overall ADR (risk ratio [RR], 1.24; 95% confidence interval [CI], 1.17-1.31; I2 = 53%; P < .001). Tandem studies collectively demonstrated improved ADR in AI-aided colonoscopies (RR, 1.18; 95% CI, 1.08-1.30; I2 = 0%; P < .001), as did parallel studies (RR, 1.26; 95% CI, 1.17-1.35; I2 = 62%; P < .001), with no statistical subgroup difference between study design. Both tandem and parallel study designs revealed improvement in adenomas per colonoscopy in AI-aided colonoscopies, but this improvement was more marked among tandem studies (P < .001). AI assistance significantly increased withdrawal times for parallel (P = .002), but not tandem, studies. ADR improvement was more marked among studies conducted in Asia compared to Europe and North America in a subgroup analysis (P = .007). Type of AI system used or endoscopist experience did not affect overall improvement in ADR. CONCLUSIONS: Either parallel or tandem study design can capture the improvement in ADR resulting from the use of AI-assisted polyp detection systems. Tandem studies powered to detect differences in endoscopic performance through paired comparison may be a resource-efficient method of evaluating new AI-assisted technologies.

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination.

Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the "self-focused" type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one's daily activities, not only limited to those related to "self". A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today's context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the "Flow Model of Rumination (FMR)", which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human-device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.

The Relationship Between Market Culture, Clan Culture, Benevolent Leadership, Work Engagement, and Job Performance: Leader's Dark Triad as a Moderator.

Benevolent leadership is one of the leadership styles which provides a positive influence on employees. However, the current leadership literature has yet to investigate how benevolent leadership leads to job performance, the processes involved, the relationship between organizational culture and benevolent leadership, and the role of dark side of leaders in affecting this relationship. Using the leader-culture fit framework within an Eastern context, the current study first investigates the relationship between benevolent leadership and job performance through work engagement. The study then compares two contrasting organizational culture (i.e., market culture and clan culture) on benevolent leadership. Finally, the study investigates how leaders' dark triad affects the relationship between organizational culture and benevolent leadership. 374 full-time white-collar employees (Males = 54.01%; Mean age: 32.7 years) from various private organizations within the service industry participated in this study. The results showed that work engagement mediated benevolent leadership and job performance. Market culture showed a negative relationship with benevolent leadership while clan culture showed a positive relationship with benevolent leadership. Benevolent leadership mediated clan culture (but not market culture) and work engagement. Under a high market culture with a high dark triad leader, benevolent leadership is at its lowest level. Under a high clan culture with a low dark triad leader, benevolent leadership is at its highest level. The findings suggest the importance of benevolent leadership within a clan culture (rather than market culture), in aligning with the leader-culture fit framework in increasing employees' work engagement and job performance.

Evaluation of Adjuvant Chemotherapy-Associated Steatosis (CAS) in Colorectal Cancer.

Chemotherapy-associated steatosis is poorly understood in the context of colorectal cancer. In this study, Stage II-III colorectal cancer patients were retrospectively selected to evaluate the frequency of chemotherapy-associated steatosis and to determine whether patients on statins throughout adjuvant chemotherapy develop chemotherapy-associated steatosis at a lower frequency. Baseline and incident steatosis for up to one year from chemotherapy start date was assessed based on radiology. Of 269 patients, 76 (28.3%) had steatosis at baseline. Of the remaining 193 cases, patients receiving adjuvant chemotherapy (n = 135) had 1.57 (95% confidence interval [CI], 0.89 to 2.79) times the adjusted risk of developing steatosis compared to patients not receiving chemotherapy (n = 58). Among patients who underwent chemotherapy, those using statins for pre-existing hyperlipidemia (n = 37) had 0.71 (95% CI, 0.10 to 2.75) times the risk of developing steatosis compared to patients who were not prevalent users of statins (n = 98). Chemotherapeutic treatment of Stage II-III colorectal cancer appears to be consistent with a moderately increased risk of steatosis, although larger studies are necessary to assess the significance of this observation. Prospective trials should be considered to further explore the potential for protective use of statins in this curative patient population.

Combination of copigmentation and encapsulation strategies for the synergistic stabilization of anthocyanins.

Copigmentation and encapsulation are the two most commonly used techniques for anthocyanin stabilization. However, each of these techniques by itself suffers from many challenges associated with the simultaneous achievement of color intensification and high stability of anthocyanins. Integrating copigmentation and encapsulation may overcome the limitation of usage of a single technique. This review summarizes the most recent studies and their challenges aiming at combining copigmentation and encapsulation techniques. The effective approaches for encapsulating copigmented anthocyanins are described, including spray/freeze-drying, emulsification, gelation, polyelectrolyte complexation, and their combinations. Other emerging approaches, such as layer-by-layer deposition and ultrasonication, are also reviewed. The physicochemical principles underlying the combined strategies for the fabrication of various delivery systems are discussed. Particular emphasis is directed toward the synergistic effects of copigmentation and encapsulation, for example, modulating roles of copigments in the processes of gelation and complexation. Finally, some of the major challenges and opportunities for future studies are highlighted. The trend of integrating copigmentation and encapsulation has been just started to develop. The information in this review should facilitate the exploration of the combination of multistrategy and the fabrication of robust delivery systems for copigmented anthocyanins.

A Spiderweb-Like Metal-Organic Framework Multifunctional Foam.

Processing metal-organic frameworks (MOFs) into hierarchical macroscopic materials can greatly extend their practical applications. However, current strategies suffer from severe aggregation of MOFs and limited tuning of the hierarchical porous network. Now, a strategy is presented that can simultaneously tune the MOF loading, composition, spatial distribution, and confinement within various bio-originated macroscopic supports, as well as control the accessibility, robustness, and formability of the support itself. This method enables the good dispersion of individual MOF nanoparticles on a spiderweb-like network within each macrovoid even at high loadings (up to 86 wt %), ensuring the foam pores are highly accessible for excellent adsorption and catalytic capacity. Additionally, this approach allows the direct pre-incorporation of other functional components into the framework. This strategy provides precise control over the properties of both the hierarchical support and MOF.

Comparing empowering, transformational, and transactional leadership on supervisory coaching and job performance: A multilevel perspective.

With a leader being able to possess different types of leadership styles, there is a lack of literature investigating which leadership style best facilitates supervisory coaching behavior. The current study aimed to investigate which leadership style would exhibit supervisory coaching behavior, and if supervisory coaching behavior would mediate the relationship between leadership styles and job performance. The study compared the effects of three leadership styles-transformational, transactional, and empowering leadership-on supervisory coaching behavior, which has been reported to influence job performance. A multilevel approach was adopted in this study using 500 employees from 65 organizations within Malaysia. The study found that only empowering and transactional leadership styles exhibited supervisory coaching behavior, which in turn mediated their relationships with job performance. Overall, the findings suggest the importance of leadership styles that prioritize employee development, as these would lead to improved job performance in employees.

Mitigating the Astringency of Acidified Whey Protein in Proteinaceous High Internal Phase Emulsions.

The demand for high-protein food products has rapidly increased in recent years because of the growing health awareness of consumers. Whey protein is an abundant byproduct from the dairy industry with a high nutritional value. However, it is a substantial challenge to mitigate the astringent taste in acidified whey protein food products. Water-in-oil (W/O) emulsion with a high internal aqueous phase represents a unique opportunity to simultaneously deliver the high concentration of whey protein and mitigate the astringent taste in spreadable foods. To incorporate protein into the high internal phase emulsion (HIPE), whey protein-polysaccharide complexes (PPCs) are formed to minimize destabilization of the emulsion. Such whey PPCs are found to not only stabilize protein but also play a role in mitigating astringency. The protein astringency is studied through real-time monitoring of the protein-saliva mucin interaction on a quartz crystal microbalance. Our results showed that PPC showed less mucin interaction compared to whey protein and preventing protein-mucin interaction can lead to decreased astringency perception. By fabricating the PPC into the HIPE, the astringency of protein can be further minimized with improved protein loading capacity (20 wt %) and viscoelasticity (103-104 Pa). Incorporation of whey protein at acidic pH in W/O HIPE imparts advantages, such as decreased protein degradation as well as increased emulsion spreadability and stability. Furthermore, the resultant emulsions are less astringent in sensory studies, indicating HIPE's potential to integrate acidified whey protein at a high concentration with a low astringency profile.

A Robust Aqueous Core-Shell-Shell Coconut-like Nanostructure for Stimuli-Responsive Delivery of Hydrophilic Cargo.

Conventional delivery systems for hydrophilic material still face critical challenges toward practical applications, including poor retention abilities, lack of stimulus responsiveness, and low bioavailability. Here, we propose a robust encapsulation strategy for hydrophilic cargo to produce a wide class of aqueous core-shell-shell coconut-like nanostructures featuring excellent stability and multifunctionality. The numerous active groups (-SH, -NH2, and -COOH) of the protein-polysaccharide wall material enable the formation of shell-cross-linked nanocapsules enclosing a liquid water droplet during acoustic cavitation. A subsequent pH switch can trigger the generation of an additional shell through the direct deposition of non-cross-linked protein back onto the cross-linked surface. Using anthocyanin as a model hydrophilic bioactive, these nanocapsules show high encapsulation efficiency, loading content, tolerance to environmental stresses, biocompatibility, and high cellular uptake. Moreover, the composite double shells driven by both covalent bonding and electrostatics provide the nanocapsules with pH/redox dual stimuli-responsive behavior. Our approach is also feasible for any shell material that can be cross-linked via ultrasonication, offering the potential to encapsulate diverse hydrophilic functional components, including bioactive molecules, nanocomplexes, and water-dispersible inorganic nanomaterials. Further development of this strategy should hold promise for designing versatile nanoengineered core-shell-shell nanoplatforms for various applications, such as the oral absorption of hydrophilic drugs/nutraceuticals and the smart delivery of therapeutics.

Ultrastable Water-in-Oil High Internal Phase Emulsions Featuring Interfacial and Biphasic Network Stabilization.

In this work, we present gel-in-gel water-in-oil (W/O) high internal phase emulsions (HIPEs) that feature high stability by structuring both phases of the emulsion. Compared to significant advances made in oil-in-water (O/W) HIPEs, W/O HIPEs are extremely unstable and difficult to generate without introducing high concentrations of surfactants. Another main challenge is the low viscosity of both water and oil phases which promotes the instability of W/O HIPEs. Here, we demonstrate ultrastable W/O HIPEs that feature biphasic structuring, in which hydrogels are dispersed in oleogels, and self-forming, low-concentration interfacial Pickering crystals provide added stability. These W/O HIPEs exhibit high tolerance toward pH shock and destabilizing environments. In addition, this novel ultrastable gel-in-gel W/O HIPE is sustainable and made solely with natural ingredients without the addition of any synthetic stabilizers. By applying phase structuring within the HIPEs through the addition of various carrageenans and beeswax as structurants, we can increase the emulsion's stability and viscoelastic rheological properties. The performance of these gel-in-gel W/O HIPEs holds promise for a wide range of applications. As a proof of concept, we demonstrated herein the application as a gelled delivery system that enables the co-delivery of hydrophilic and hydrophobic materials at maximized loads, demonstrating high resistance to gastrointestinal pHs and a controlled-release profile.

Combination of internal structuring and external coating in an oleogel-based delivery system for fish oil stabilization.

In this study, we created oleogel-based formulations featuring varying degrees of beeswax for internal structure and whey protein isolate (WPI) as external coating to improve the oxidative stability of fish oil. Oleogel was characterized by rheological analysis to access gelation behavior, and morphology was visualized using electron microscopy. It was found that the WPI-coated oleogel displayed strong physical stability during storage. The oxidative assay demonstrated that WPI-coated oleogel had the best protection against fish oil oxidation under both thermal treatment and ultraviolet-C radiation. The oxidation of fish oil was inhibited by 2-3 fold, compared to its unencapsulated form. This stability was attributed to the modulation of beeswax and WPI on the micropolarity and microviscosity of the formulation, as evidenced by pyrene fluorescence measurement. Our approach combining internal structuring and external coating may contribute to the development of oleogel system for efficient delivery of lipophilic bioactive components.

Oleogel-structured composite for the stabilization of ω3 fatty acids in fish oil.

This study examined the encapsulation and stabilization of É·3 in fish oil into a multi-compartment system consisting of ß-cyclodextrins (ß-CD) complexation within an oleogel structure, which was further coated with a layer of whey protein isolate (WPI). The formation of ß-CD-fish oil complex was confirmed by thermogravimetric analysis and Fourier-transform infrared spectroscopy. Particle size and ζ-potential of the oleogel-based oil-in-water emulsion did not change significantly over a 28-day storage period under different pH conditions (pH 3.5-7) and NaCl concentrations (50-500 mg L-1). The WPI-coated oleogel and ß-CD-fish oil complex were subjected to UVC light exposure and quantified by their eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) contents. Results indicated that more than 50 wt% of both EPA and DHA were retained after a 4 h UV exposure period in the WPI-coated system. In addition, sensory evaluation results showed a decreased fish oil odor in the WPI-coated oleogel samples. Overall, the results from this study demonstrated that this oleogel-structured composite incorporating ß-CD-fish oil complexes can be formed successfully to retain lipophilic components with decreased undesirable fish oil odor.

Polyelectrolyte microcapsules built on CaCO3 scaffolds for the integration, encapsulation, and controlled release of copigmented anthocyanins.

The all-polysaccharide based polyelectrolyte microcapsules combining copigmentation for anthocyanin encapsulation and stabilization were fabricated. Copigmented complexes of chondroitin sulfate and anthocyanin were preloaded in CaCO3 scaffold, and then microcapsules were created by coating the sacrificial CaCO3 using layer-by-layer technique. It was observed that the preloading of copigmented complex affected the precipitation reaction of CaCO3 and the subsequent entrapment of anthocyanin. With addition of anthocyanin from 0.125 to 0.75 mg, copigmentation can significantly increase the encapsulation efficiency of anthocyanin in CaCO3, whereas such effect was not obvious at higher loadings. The leakage of anthocyanin during CaCO3 core dissolution and storage was also inhibited by two polysaccharide layers coupled with copigmentation, which may be related to the formation of interconnecting networks. Additionally, a higher anthocyanin antioxidant activity was provided by carbohydrate matrix. These findings may allow for the encapsulation of large amounts of water-soluble components; particularly natural colorant by copigmented complex-polyelectrolyte structures.