Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 10 appraisals
Science advances
Human-inspired time-series health evaluation with an adaptive multimodal electronic skin
Electronic skin powered with artificial intelligence could enable next-generation robotic and medical devices, yet integrating multimodal sensors and analyzing heterogeneous, multifrequency time series remain challenging. Most wearable machine learning architectures are time-invariant and trained for a specific task, limiting transfer across modalities and users. We present a multimodal electronic skin that captures diverse physiological signs with an adaptive learning framework that rapidly generalizes to unseen tasks with minimal labeled data. Our streamlined end-to-end framework uses a spectral variational autoencoder to denoise and compress multifrequency biosignals into a shared, unified second-wise latent space that preserves the spectral-temporal structure, followed by a transformer to capture temporal dependencies to support diverse downstream tasks with data-efficient learning. We demonstrate robust adaptation with 94.7% accuracy in activity recognition and 90.2% precision in fatigue assessment across various users and daily activities regardless of device and user variations, highlighting a scalable route to generalized physiological time-series analytics and human performance assessments.
3 Aug 2026
Read appraisal →Science advances
Multispectral infrared-to-full-color upconversion expanding human vision
The human visual system is inherently blind to infrared radiation due to the insufficient energy of infrared photons to trigger the photoisomerization of the retinal chromophore, resulting in the loss of over half of the solar spectrum. Here, we report a colloidal quantum dot (CQD)-based infrared-to-visible upconverter that enables ultrasensitive upconversion of multispectral infrared light radiation as full-color visible vision. The photon-energy-selective excitonic transitions in quantum-confined states and the photon flux, respectively, enable infrared wavelength- and intensity-dependent number of photogenerated carriers. A dual-emissive-layer organic architecture with the strategically engineered hole-injection barrier could route these carriers into distinct color emission channels, resulting in correlated wavelength/intensity-to-color/luminance mapping. This paradigm shift yields a discrimination sensitivity for subtle infrared variations exceeding more than two orders of magnitude higher than conventional single-color modes, capitalizing on the human eye's intrinsic superiority in chromatic differentiation over only brightness contrast. The resulting upconverter exhibits broadband detection extending beyond 2 μm, luminance exceeding 700 cd m-2, and a photon-to-photon conversion efficiency of 3.85%. The upconverter could be applied as a lightweight, semi-transparent wearable eyeglass that projects multispectral infrared as full-color vision directly onto the retina. Besides, upconverters bound to light-sensitive proteins, potentially as an implantable retinal photoreceptor, confer innate infrared vision. By surpassing the evolutionary constraints of natural vision, this work establishes a versatile foundation for next-generation visual prosthetics and human-integrated sensory expansion.
1 Aug 2026
Read appraisal →Clinica chimica acta; international journal of clinical chemistry
Cortisol as a stress biomarker: analytical perspectives and challenges
Point-of-care testing (POCT) has emerged as a transformative approach in modern healthcare for the rapid detection of physiological abnormalities through minimally or non-invasively collected samples. Biological matrices such as saliva, urine, hair, blood, and interstitial fluid contain clinically significant biomarkers that may serve as indicators of physiological disorders. Among these, cortisol is the key stress biomarker and exerts substantial effects on body metabolism, acting on both peripheral tissues and the CNS. This review comprehensively outlines the evolution of cortisol detection strategies, progressing from conventional laboratory-based immunoassays to advanced analytical platforms, including electrochemical biosensors, wearable devices, and microfluidic systems. Accurate and reliable detection of elevated cortisol levels is crucial for improving diagnostic, therapeutic, and preventive strategies for stress-related disorders. By tracing the analytical window, the work describes the detection of cortisol from traditional immunoassays to innovative biosensing platforms. Moreover, recent advances in nanomaterials, sensor design, and data integration have enabled continuous, on-site monitoring of cortisol levels, thereby enhancing their applicability across diverse clinical and non-clinical settings. This integration of physiological insight with technological advancement provides a comprehensive overview of developments in cortisol assessment, connecting fundamental endocrine science with practical diagnostic applications. The review underscores the potential of next-generation POCT systems to improve early diagnosis, therapeutic monitoring, and personalized healthcare through real-time biomarker analysis.
17 July 2026
Read appraisal →Telemedicine journal and e-health : the official journal of the American Telemedicine Association
Utilization of Telemedicine Among Offshore Health Care Workers and Its Influencing Factors
INTRODUCTION: Telemedicine has become an essential tool for providing health care to offshore workers. Despite its advancements, there is still a lack of understanding about its optimal use and the factors affecting it among health care providers in offshore settings. The objective of this work was to study and determine the level of telemedicine utilization among offshore health care workers and its associated factors in Malaysia. METHODS: In this cross-sectional study, online questionnaires were distributed to health care workers involved in offshore medical services. The questionnaire includes sociodemographic information and the validated Malay version of the Telemedicine Acceptance Model (TAM) Questionnaire. A total of 73 offshore health care workers were recruited from a local company using universal sampling. Data analysis involved descriptive statistics as well as simple and multiple logistic regression. RESULTS: A total of 65.8% of offshore health care workers reported using telemedicine in their practice. Multiple logistic regression analysis indicated that Chinese and Indian workers were significantly more likely to use telemedicine compared with Malay workers, with adjusted odds ratios of 32.11 (p = 0.045) and 33.51 (p = 0.037), respectively. Workers with a good attitude toward telemedicine had 11.84 times higher odds of utilization (p = 0.004), while those with high behavioral intention were 25.80 times more likely to use telemedicine compared with their counterparts with low behavioral intention (p < 0.001). CONCLUSIONS: A majority of offshore health care workers utilize telemedicine, with Chinese and Indian ethnicity, good attitude, and high behavioral intention significantly predicting its utilization.
3 July 2026
Read appraisal →Langmuir : the ACS journal of surfaces and colloids
An Ultrasoft Initiator-Free Eutectogel for Strain Sensing and Gesture Recognition Assisted by Machine Learning
With the rapid development of Internet of Things and artificial intelligence technologies, flexible wearable sensors have shown great potential in human-machine interaction and health monitoring fields. However, traditional hydrogel sensors face challenges such as water loss, freezing, and the use of toxic initiators during the preparation process, which lead to biological safety issues. To address these challenges, this paper proposes a green, initiator-free polymerization strategy based on the deep eutectic solvent system composed of choline chloride (ChCl) and D-sorbitol. By utilizing the property that the nitrogen-containing quaternary ammonium group in the ChCl molecule can generate free radicals upon ultraviolet irradiation, this study achieves the rapid polymerization of acrylamide in an initiator-free manner. The prepared eutectogel exhibits high transparency (≈96%), skin-fitting elastic modulus, good antifreezing performance, suitable breathability, and broad-spectrum adhesion. The flexible strain sensor constructed based on the eutectogel has high sensitivity, wide detection range, and good fatigue resistance. Combined with machine learning algorithms, this sensor system achieves a high accuracy (98.5%) of recognizing Curwen gestures. This research provides an innovative approach for developing safe, reliable, and environmentally adaptable intelligent wearable devices and has broad application prospects in intelligent music education and modern human-machine interaction.
1 July 2026
Read appraisal →Diving and hyperbaric medicine
Evidence-informed decision aid for fitness-to-dive assessment after otologic surgery
INTRODUCTION: Fitness-to-dive after otologic surgery is often approached conservatively, with some procedures historically labelled as absolute contraindications despite limited empirical evidence. The available literature is heterogeneous and includes clinical reports, experimental pressure studies, guidance documents, and manufacturer specifications, leading to uncertainty in clinical counseling. We aimed to characterise the available evidence regarding fitness-to-dive after otologic surgery and to develop an evidence-informed clinical decision aid. METHODS: A scoping review was conducted in accordance with PRISMA-ScR guidance. PubMed/MEDLINE, Embase, Scopus, and relevant non-indexed sources were searched. Eligible sources included clinical reports and series, experimental or hyperbaric chamber studies, guidance or consensus documents, and manufacturer statements providing explicit pressure- or depth-related information. Data were charted descriptively by procedure type and evidence stream. RESULTS: The search identified 324 records; after removal of duplicates and screening, 40 sources were included. The evidence base was predominantly non-comparative. Across procedures, recommendations emphasised postoperative stability and reliable pressure equalisation rather than surgical history alone. Canal wall down mastoidectomy was consistently portrayed as incompatible with diving, whereas selected middle ear reconstructions and stapes surgery were commonly described as potentially compatible in appropriately selected individuals. For cochlear implantation, guidance was mainly conditional and based on hyperbaric testing, limited clinical diving reports, and manufacturer-specified pressure or depth limits. Communication emerged as an additional practical consideration in cases of significant hearing loss. CONCLUSIONS: Relevant evidence is limited and heterogeneous, and does not consistently support blanket prohibitions for all otologic procedures. A function-based, individualised approach is supported, while specific higher-risk scenarios warrant restriction. Prospective registries and standardised outcome reporting are needed to refine procedure-specific recommendations.
30 June 2026
Read appraisal →ACS sensors
Machine Learning-Enabled Gas Sensor Based on MOF-Derived In2O3-CuO for Exhaled CO Detection
Noninvasive, precise breath analysis holds significant importance for the screening and monitoring of neonatal jaundice, with its core challenge lying in the specific detection of the key biomarker carbon monoxide (CO) within complex breath matrices. This research employed a controlled process to fabricate five sets of In2O3-CuO sensors derived from bimetallic metal-organic frameworks (Bi MOFs). These were assembled into a microsensor array, and by incorporating a linear discriminant analysis algorithm, an electronic nose system was constructed. This approach utilizes thermodynamic feature engineering to enhance data validity and optimize algorithm selection, thereby reducing reliance on large-scale data and computational resources. By integrating thermodynamically feature-driven machine learning, the electronic nose system-comprising merely five In2O3-CuO sensors-ultimately achieved accurate discrimination between CO and acetone. Concurrently, the single 3In2O3-CuO sensor exhibits excellent reproducibility, moisture resistance, and stability, with a low detection limit of 1 ppm and relatively rapid response/recovery times (5/21 s). By introducing machine learning algorithms to analyze the multidimensional response signals from the sensor array, the study successfully addressed the cross-sensitivity issue between CO and coexisting interfering gas C3H6O in clinical environments, achieving qualitative identification of CO ranging from 1 to 50 ppm (cross-validation accuracy reached 82%), providing a highly reliable technical platform for noninvasive screening of neonatal bilirubin metabolic abnormalities.
29 June 2026
Read appraisal →Analytical methods : advancing methods and applications
Microfluidic-electrochemical sweat patches for athletes: monitoring lactate, electrolytes, and hydration status
Wearable biochemical sensing is shifting sports physiology from intermittent laboratory sampling toward continuous, in situ readouts during training and competition. This review analyzes skin conformal systems that integrate capillary driven fluid routing, flexible sensor arrays, and wireless readout to capture dynamic changes in eccrine secretions relevant to performance management. We compare microchannel layouts that enable controlled filling, time resolved sampling, and evaporation suppression, and we discuss how material selection governs comfort and analytical fidelity, highlighting tradeoffs among polydimethylsiloxane, polyurethane, and polyethylene terephthalate substrates and their compatibility with scalable fabrication. Manufacturing pathways are assessed from soft lithography to laser cutting, three dimensional printing, and roll to roll processing for high throughput multilayer assembly. For transduction, we summarize enzymatic amperometric schemes based on lactate oxidase with hydrogen peroxide detection, including sensitivity, response time, and oxygen dependence, and we contrast these with emerging non enzymatic catalysts. We then detail potentiometric ion selective electrodes for sodium and potassium, focusing on ion selective membrane chemistry, solid state reference electrodes, Nernstian response, and dominant error sources such as drift and biofouling. System integration challenges, including chemical and electrical cross talk in multiplexed layouts, are linked to microfluidic isolation strategies and multiplexed electronics. Finally, we appraise validation practice, emphasizing the debated sweat to blood relationship, the need for synchronized comparative protocols, and the role of data analytics and machine learning for personalization, drift compensation, and prediction of thermoregulatory strain. Remaining barriers include long term stability, adhesion under motion, manufacturability, and regulatory evidence requirements in real world settings. Across these topics, the review emphasizes technology-specific limitations, engineering translation metrics, and realistic breakthrough directions rather than treating wearable sweat patches as a mature plug-and-play platform.
27 June 2026
Read appraisal →Pulmonology
Association between smoking and prognosis in idiopathic pulmonary fibrosis: A systematic review and meta-analysis
BACKGROUND: Although smoking is a well-established risk factor for idiopathic pulmonary fibrosis (IPF) development, its impact on clinical outcomes remains unclear. RESEARCH QUESTION: Is smoking associated with clinical outcomes of IPF? METHODS: A systematic search of PubMed, Embase, and the Cochrane Library was conducted to identify studies reporting associations between smoking status and IPF outcomes, including mortality, acute exacerbation (AE), lung cancer development, and baseline lung function. Summary estimates with 95% confidence intervals (CIs) were pooled using random-effects model. Subgroup analyses were conducted by study region. RESULTS: Forty-nine studies comprising 32 974 patients were included. Overall mortality did not differ by smoking status. However, significant regional differences were observed, with ever smokers demonstrating higher mortality in non - East Asian studies (Hazard ratio [HR] 1.17, 95% CI: 1.03-1.33) but lower mortality in East Asian studies (HR 0.75, 95% CI: 0.62-0.91, p-for-interaction < 0.001) compared with never smokers. Current smokers had a higher risk of developing lung cancer compared with non-current smokers (HR 1.88, 95% CI: 1.24-2.87). No significant associations were observed between smoking and the risk of AEs or baseline forced vital capacity. CONCLUSION: Smoking was not associated with overall mortality in IPF, although significant regional differences were observed.
26 June 2026
Read appraisal →Journal of medical Internet research
The Digital Exposome: A Life Course Framework for Health in the Digital Age
Digital technologies are reshaping human behavior, health care delivery, and population health; however, their cumulative effects across the lifespan remain underexplored. This viewpoint argues that exposures arising from interactions with digital technologies should be formally integrated into exposome science as a distinct, measurable component of the human environment. Our aims are to (1) redefine the digital component of the exposome (the digital exposome) within the broader exposome framework, (2) examine its life course implications for health and equity, and (3) outline a research and policy agenda to enable its systematic measurement and integration into clinical and public health practice. Digital technology-related exposures can confer benefits such as enhanced health monitoring, personalized interventions, improved access to care, and the promotion of healthy behaviors. However, they may also introduce potential risks, including mental health challenges, cognitive and circadian disruptions, sedentary lifestyles, exposure to misinformation, and widening inequities among vulnerable populations. Despite their ubiquity, digital technology-related exposures remain poorly integrated into clinical medicine, epidemiology, or public and global health policies. Drawing on interdisciplinary evidence from exposure science, epidemiology, and digital phenotyping research, we propose a refined conceptual definition of the digital exposome grounded in the classical exposome domains. We propose redefining the digital exposome as the full spectrum of exposures resulting from interactions or proximities with digital technologies and their combined influence on health across the lifespan. This framework conceptualizes digital technology-related exposures as a dynamic set of environmental influences operating through sociotechnical, behavioral, and biological pathways over the life course. To operationalize this framework, we discuss practical approaches using validated behavioral instruments, objective device use logs, ecological momentary assessments, smartphone-based digital phenotyping, and wearable sensing technologies. Systematic measurement, large-scale longitudinal studies, and harmonized exposure metrics are needed to characterize the cumulative health impacts of digital environments more accurately. Emerging tools such as digital markers or biomarkers and digital phenotypes offer promising opportunities to link real-world technology use with physiological and biological outcomes, thereby supporting precision medicine and population health strategies. Ethical governance, privacy safeguards, and equity considerations must be embedded from the start, drawing on emerging exposomethics frameworks. Recognizing the digital exposome as a modifiable determinant of health offers a foundation for evidence-based guidance, prevention strategies, and policy interventions suited to increasingly digital societies. By integrating digital technology-related exposures into exposome science, clinical practice, and public health research, this viewpoint seeks to foster interdisciplinary dialogue, guide future empirical work, and support the development of safer and more equitable digital environments across the lifespan.
12 May 2026
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