tbuckley/cabot-search huggingface dataset:
Changes in Food Insecurity Among US Adults With Low Income During the COVID-19 Pandemic
Authors: Yingfei Wu, Jessica Cheng, Anne N. Thorndike
Journal: JAMA Network Open (2025)

Importance Racial and ethnic minority groups disproportionately experience food insecurity. During the COVID-19 pandemic, the US enacted temporary food assistance policies, including emergency allotments for Supplemental Nutrition Assistance Program (SNAP) benefits. The effects of the pandemic and these policies on food insecurity by race and ethnicity are unclear. Objective To examine prevalence trends in food insecurity by racial and ethnic groups and SNAP use before and during the pandemic. Design, Setting, and Participants This cross-sectional survey study analyzed National Health Interview Survey data before (January 2019 to March 2020) and during the COVID-19 pandemic (April 2020 to December 2022). Participants were noninstitutionalized US adults (≥18 years) with low income (&amp;amp;lt;200% federal poverty level). Statistical analysis was performed from September 25, 2023, to February 27, 2024. Exposure COVID-19 pandemic time period. Main Outcomes and Measures Food insecurity was measured using the 10-item US Department of Agriculture Adult Food Security Survey module, categorizing participants as food secure (high or marginal food security) or insecure (low or very low food security). Survey-weighted Poisson regressions were modeled to examine changes in food insecurity prevalence over time by race and ethnicity (Asian, Black, Hispanic, and White) and by race and ethnicity and SNAP use (yes or no) including a 3-way interaction term (time × race and ethnicity × SNAP). Results Among 30 396 adults with low income, approximately one-half were female (56.0% [95% CI, 54.7%-57.2%] during the pre–COVID-19 time period; 57.4% [95% CI, 56.4%-58.4%] during the COVID-19 time period). Food insecurity prevalence decreased from 20.9% (95% CI, 19.9%-22.0%) before the COVID-19 pandemic to 18.8% (95% CI, 17.9%-19.7%) during the pandemic ( P &amp;amp;lt; .001). SNAP use prevalence increased overall (from 31.5% [95% CI, 30.1%-32.9%] to 36.0% [95% CI, 34.8%-37.3%]; P &amp;amp;lt; .001) and for each racial and ethnic group. There were no significant differences in food insecurity changes over time by racial and ethnic group (Wald test F = 1.29; P = .28 for 2-way interaction). Among SNAP participants, food insecurity decreased for Asian, Hispanic, and White adults but did not change for Black adults; among non-SNAP participants, food insecurity did not change for Black, Hispanic, and White adults but increased for Asian adults (Wald test F = 4.43; P = .02 for 3-way interaction). Conclusions and Relevance During the COVID-19 pandemic, food insecurity decreased among SNAP participants in most racial and ethnic groups but did not decrease among non-SNAP participants in any group. These results suggest that during the pandemic, increased SNAP benefit amounts were associated with ameliorating food insecurity for many US adults who were able to access SNAP but did not reduce racial and ethnic disparities in food insecurity.
Socioeconomic Characteristics of Communities With Primary Care Practices With Nurse Practitioners
Authors: Monica O’Reilly-Jacob, Kyle G. Featherston, Hilary Barnes, Ying Xue, Lusine Poghosyan
Journal: JAMA Network Open (2025)

Importance Given the disparities in access to primary care and the growing nurse practitioner (NP) workforce, it is important to understand the distribution of primary care practices with NPs across communities of varying socioeconomic characteristics. Objective To compare the socioeconomic characteristics of communities that have primary care practices with or without NPs. Design, Setting, and Participants This secondary, cross-sectional analysis of 79 743 primary care practices used 4 merged data sources: the IQVIA 2023 OneKey database, the 2020 US biennial Census, the 2017-2022 American Community Survey, and the 2021 Area Deprivation Index (ADI). US Census Tracts and Divisions from 2023 were used to examine differences in socioeconomic characteristics across communities. Exposure Primary care practices with NPs vs without NPs. Main Outcomes and Measures Socioeconomic characteristics of Census Tracts and Block Groups, including racial and ethnic composition, median household income, percentage below the federal poverty level, educational attainment, and the ADI (an ordinal percentile ranking of Census Block Groups from 1 to 100, with 1 being least disadvantaged and 100 being most disadvantaged). Results Of 79 743 primary care practices, 42 601 (53.4%) employed NPs in 2023. Practices with NPs, compared with those without, were significantly more likely to be in communities classified as low income (23.3% vs 17.0%; P &amp;amp;lt; .001) and rural (11.9% vs 5.5%; P &amp;amp;lt; .001). On average, these communities had a higher proportion of the population living below the federal poverty level (14.4% [95% CI, 14.3%-14.5%] vs 12.8% [95% CI, 12.7%-12.9%]; P &amp;amp;lt; .001) and without a high school diploma (19.8% [95% CI, 19.7%-19.9%] vs 18.5% [95% CI, 18.4%-18.6%]; P &amp;amp;lt; .001). Communities with practices with NPs also had significantly higher mean ADI percentiles than communities with practices without NPs (53.3% [95% CI, 53.1%-53.6%] vs 42.5% [95% CI, 42.2%-42.7%]; P &amp;amp;lt; .001). As the number of primary care practices decreased in disadvantaged areas, the proportion of practices with NPs increased. In most US Census Divisions, there were more primary care practices with NPs than without, a difference that was marked in low-income communities. Conclusions and Relevance This cross-sectional study of primary care practices in the US found that primary care practices with NPs, compared with those without NPs, were more likely to be located in communities with lower income and educational attainment and greater levels of overall socioeconomic disadvantage. This finding suggests that NPs are key to ensuring access to primary care in communities with socioeconomic disadvantage.
Medical Toxicology Consultations and Mortality Among Patients With Poisonings in the PICU
Authors: Paul M. Wax, Rachel E. Culbreth, Jeffrey Brent, Christina Hantsch, Theresa Mikhailov, Nancy Brundage, Kim Aldy
Journal: JAMA Network Open (2025)

Importance Poisonings are a leading cause of preventable mortality and morbidity among children. Pediatric poisonings are commonly managed in pediatric intensive care units (PICUs) and may require complex treatment and specialized evaluation. Physicians specializing in medical toxicology are trained to treat poisoned patients of all ages; however, they are not universally part of the medical staff across hospital systems. Objective To determine if there is a difference in mortality and length of stay for patients with toxicological exposures who receive a medical toxicology consultation. Design, Setting, and Participants This is a secondary analysis of an ongoing, cross-sectional registry of patients admitted to PICUs from January 2019 to June 2023 as part of the Virtual Pediatric System (VPS), a database of PICU admissions across 135 medical sites in the US. Patients with toxicological exposure who were admitted to PICUs that participate in the VPS database were included. Data analysis occurred from May to August 2024. Exposures Medical toxicology consultations. Main Outcomes and Measures The primary outcome was mortality in the PICU and in the hospital overall. Secondary outcomes were length of stay in the PICU and in the hospital. Multilevel models were used to assess associations of toxicology consultations with the primary and secondary outcomes. Results There were a total of 52 836 patients with toxicological exposures (29 867 aged 12 to &amp;amp;lt;21 years [56.5%]; 29 401 female [55.6%]), including 2857 (5.4%) patients with medical toxicology consultations and 49 979 (94.6%) without a consultation. Patients who received medical toxicology consultations had similar risk of mortality at baseline, as measured by the Pediatric Risk of Mortality, compared with those without consultations. After adjusting for severity of illness, poisoning type, and other covariates, medical toxicology consultations were associated with 64% lower odds of death in the PICU (adjusted odds ratio, 0.36; 95% CI, 0.20 to 0.63) and 61% lower odds of mortality at any time during the hospitalization (aOR, 0.39; 95% CI, 0.24 to 0.64). Additionally, medical toxicology consultations were associated with a 15% reduced PICU length of stay (log estimate, −0.16; 95% CI, −0.21 to −0.11) and 10% reduced hospital length of stay (log estimate, −0.10; 95% CI, −0.14 to −0.06) after adjusting for all covariates and differences across hospital sites. Conclusions and Relevance In this study of patients with toxicological exposures requiring PICU care, having a medical toxicology consultation was associated with lower mortality and shorter LOS compared with not having a consultation, which suggests that medical toxicology consultations may provide life-saving treatment, particularly for the most severe poisonings in the PICU.
riSCC: A personalized risk model for the development of poor outcomes in cutaneous squamous cell carcinoma
Authors: Anokhi Jambusaria-Pahlajani, Vincent Jeanselme, David M Wang, Nina A Ran, Emily E Granger, Javier Cañueto, David G Brodland, David R Carr, Joi B Carter, John A Carucci, Kelsey E Hirotsu, Emily E Karn, Shlomo A Koyfman, Aaron R Mangold, Fabio Muradás Girardi, Kathryn T Shahwan, Divya Srivastava, Allison T Vidimos, Tyler J Willenbrink, Ashley Wysong, William Lotter, Emily S Ruiz
Journal: Journal of the American Academy of Dermatology (2025)
Integrated computational analysis identifies therapeutic targets with dual action in cancer cells and T cells
Authors: Ce Luo, Rui Zhang, Rui Guo, Lijian Wu, Teng Xue, Yufeng He, Yiteng Jin, Yanping Zhao, Zongxu Zhang, Peng Zhang, Sitong Ye, Xiaohong Li, Dian Li, Wubing Zhang, Chenfei Wang, Luhua Lai, Qiang Pan-Hammarström, Kai W Wucherpfennig, Zhidong Gao, Deng Pan, Zexian Zeng
Journal: Immunity (2025)
Splenic TNF-α signaling potentiates the innate-to-adaptive transition of antiviral NK cells
Authors: Adriana M Mujal, Mark Owyong, Endi K Santosa, John C Sauter, Simon Grassmann, Anna-Marie Pedde, Philippa Meiser, Claire K Wingert, Marine Pujol, Veit R Buchholz, Colleen M Lau, Jan P Böttcher, Joseph C Sun
Journal: Immunity (2025)
IL-17RA signaling provides dual tumor-suppressor function during late-stage colorectal carcinogenesis
Authors: Dominic Denk, Mallika Ramakrishnan, Claire Conche, Charles Pallangyo, Marina Pesic, Fatih Ceteci, Kilian B Kennel, Asude C Kirisözü, Esther Engel, Kathleen Mohs, Birgit Ritter, Angeles Macias Pardo, Ezgi Özkurt, Falk Hildebrand, Ari Waisman, Melek C Arkan, Florian R Greten
Journal: Immunity (2025)

Expression of interleukin (IL)-17 family cytokines is associated with tumor-promoting inflammation. We found that low expression of IL17RA associated with worse prognosis in late-stage colorectal cancer (CRC) patients. Deletion of Il17ra in intestinal epithelial cells (IECs) in a murine model of CRC enhanced epithelial-to-mesenchymal transition (EMT) via increased expression of the epidermal growth factor receptor and subsequent activation of the kinase Src. Yet, these mice were protected from metastatic disease; Il17ra deletion impaired intestinal barrier function and enhanced systemic fungal invasion and associated immunity. However, in macrophages, IL-17RA was required for spleen tyrosine kinase (Syk) activation upon fungal-induced dectin-1 engagement, and Il17ra ablation impaired IL-18 release and protective CD8+ T cell-mediated anti-tumor immunity. Combining recombinant IL-17 and heat-killed Candida albicans rendered colorectal tumors sensitive to α-PD-1 treatment in a model of microsatellite stable (MSS) CRC. Thus, IL-17RA engages two distinct tumor-suppressive mechanisms in CRC, linking EMT and fungal-induced anti-tumor immunity during tumor progression.
Neutrophil recruitment during intestinal inflammation primes Salmonella elimination by commensal E. coli in a context-dependent manner
Authors: Yassine Cherrak, Andrew Abi Younes, Eugenio Perez-Molphe-Montoya, Luca Maurer, Koray Yilmaz, Ursina Enz, Christophe Zeder, Patrick Kiefer, Philipp Christen, Ersin Gül, Julia A Vorholt, Christian von Mering, Wolf-Dietrich Hardt
Journal: Cell Host & Microbe (2025)

Foodborne bacterial diarrhea involves complex pathogen-microbiota-host interactions. Pathogen-displacing probiotics are increasingly popular, but heterogeneous patient outcomes highlighted the need to understand individualized host-probiotic activity. Using the mouse gut commensal Escherichia coli 8178 and the human probiotic E. coli Nissle 1917, we found that the degree of protection against the enteric pathogen Salmonella enterica serovar Typhimurium (S. Tm) varies across mice with distinct gut microbiotas. Pathogen clearance is linked to enteropathy severity and subsequent recruitment of intraluminal neutrophils, which differs in a microbiota-dependent manner. By combining mouse knockout and antibody-mediated depletion models with bacterial genetics, we show that neutrophils and host-derived reactive oxygen species directly influence E. coli-mediated S. Tm displacement by potentiating siderophore-bound toxin killing. Our work demonstrates how host immune factors shape pathogen-displacing probiotic efficiency while also revealing an unconventional antagonistic interaction where a gut commensal and the host synergize to displace an enteric pathogen.
The bone marrow NK cell profile predicts MRD negativity in patients with multiple myeloma treated with daratumumab-based therapy
Authors: Charlotte L.B.M. Korst, Sabrin Tahri, Carolien Duetz, Wassilis S.C. Bruins, A. Vera de Jonge, Madelon M.E. de Jong, Cathelijne Fokkema, Febe Smits, Kaz Groen, Christie P.M. Verkleij, Kristine A. Frerichs, Natalie Papazian, Mark van Duin, Gregory van Beek, Remco Hoogenboezem, Thomas Baardemans, Giada Dal Collo, Elodie C.G. Stoetman, Meliha Cosovic, Inoka Twickler, Rosa Rentenaar, Merve Eken, Paola M. Homan-Weert, Elona Saraci, Mattia D'Agostino, Vincent H.J. van der Velden, Mathijs Arnoud Sanders, Francesca Gay, Annemiek Broijl, Philippe Moreau, Pieter Sonneveld, Sonja Zweegman, Tuna Mutis, Tom Cupedo, Niels W.C.J. van de Donk
Journal: Blood (2025)
Collaboration between interleukin-7 and -15 enables adaptation of tissue-resident and circulating memory CD8+ T cells to cytokine deficiency
Authors: Nicholas N Jarjour, Talia S Dalzell, Nicholas J Maurice, Kelsey M Wanhainen, Changwei Peng, Stephen D O'Flanagan, Taylor A DePauw, Katharine E Block, William J Valente, K Maude Ashby, David Masopust, Stephen C Jameson
Journal: Immunity (2025)
A heart-brain-spleen axis controls cardiac remodeling to hypertensive stress
Authors: Sara Perrotta, Lorenzo Carnevale, Marialuisa Perrotta, Fabio Pallante, Tomasz P Mikołajczyk, Valentina Fardella, Agnese Migliaccio, Stefania Fardella, Sara Nejat, Boguslaw Kapelak, Azzurra Zonfrilli, Jacopo Pacella, Francesco Mastroiacovo, Raimondo Carnevale, Calum Bain, Sarah Lena Puhl, Giuseppe D'Agostino, Slava Epelman, Tomasz J Guzik, Giuseppe Lembo, Daniela Carnevale
Journal: Immunity (2025)
Early influenza virus exposure shapes the B cell response to influenza vaccination in individuals 50 years later
Authors: Abby Spangler, Geoffrey D Shimberg, Grace E Mantus, Rory Malek, Lauren Y Cominsky, Yaroslav Tsybovsky, Ning Li, Rebecca A Gillespie, Michelle Ravichandran, Adrian Creanga, Julie E Raab, Suprabhath R Gajjala, Floreliz Mendoza, Katherine V Houser, Lesia Dropulic, Adrian B McDermott, Masaru Kanekiyo, Sarah F Andrews
Journal: Immunity (2025)
The polyamine-regulating enzyme SSAT1 impairs tissue regulatory T cell function in chronic cutaneous inflammation
Authors: Teresa Neuwirth, Daniel Malzl, Katja Knapp, Panagiota Tsokkou, Lisa Kleissl, Anna Gabriel, Baerbel Reininger, Christian Freystätter, Nara Marella, Ana P Kutschat, Elisabeth Ponweiser, Arvand Haschemi, Davide Seruggia, Jörg Menche, Erwin F Wagner, Georg Stary
Journal: Immunity (2025)
High-dose inhaled NO for the prevention of nosocomial pneumonia after cardiac surgery under cardiopulmonary bypass: A proof-of-concept prospective randomised study
Authors: Tatiana P. Kalashnikova, Nikolay O. Kamenshchikov, Yulia A. Arsenyeva, Yuri K. Podoksenov, Igor V. Kravchenko, Maxim S. Kozulin, Mark A. Tyo, Elena A. Churilina, Elena B. Kim, Yulia S. Svirko, Boris N. Kozlov, Alla A. Boshchenko
Journal: Pulmonology (2025)

Objective This study aimed to assess the safety and potential efficacy of high-dose inhaled nitric oxide therapy for the prevention of postoperative pneumonia in cardiac surgery patients
Emerging clinical applications of single-cell RNA sequencing in oncology
Authors: Emily Boxer, Nisan Feigin, Roi Tschernichovsky, Noam Galili Darnell, Alissa R. Greenwald, Rouven Hoefflin, Daniel Kovarsky, Dor Simkin, Shira Turgeman, Lingling Zhang, Itay Tirosh
Journal: Nature Reviews Clinical Oncology (2025)
Key SARS-CoV-2 testing strategies implemented in the UK: rationale and impact
Authors: Tom Fowler, Chris Kenny, Sarah Tunkel, Andrew Dodgson, Jeanette Hall, Peter Marks, Paul Klapper, Malur Sudhanva, Raghavendran Kulasegaran-Shylini, Zareen Thorlu-Bangura, Obaghe Edeghere, Catherine Falconer, Robert Jenkins, Edward Blandford, Ian Hall, Iain Buchan, W John Edmunds, Tim Peto, Susan Hopkins
Journal: Journal of the Royal Society of Medicine (2025)
Investigator-initiated randomized clinical trials in infectious diseases: the BALANCE experience
Authors: Nick Daneman, Asgar H Rishu, Ruxandra Pinto, Yaseen M Arabi, Deborah J Cook, Richard Hall, John Muscedere, Rachael Parke, Steven Reynolds, Benjamin Rogers, Yahya Shehabi, Robert A Fowler
Journal: Clinical Microbiology and Infection (2025)
A differentiated β-globin gene replacement strategy uses heterologous introns to restore physiological expression
Authors: Kirby A Wallace, Trevor L Gerstenberg, Craig L Ennis, Juan A Perez-Bermejo, James R Partridge, Christopher Bandoro, William M Matern, Gaia Andreoletti, Kristina Krassovsky, Shaheen Kabir, Cassandra D Lalisan, Aishwarya R Churi, Glen M Chew, Lana Corbo, Jon E Vincelette, Timothy D Klasson, Brian J Silva, Yuri G Strukov, B Joy Quejarro, Kaisle A Hill, Sebastian Treusch, Jane L Grogan, Daniel P Dever, Matthew H Porteus, Beeke Wienert
Journal: Molecular Therapy (2025)
First-line lorlatinib versus crizotinib in Asian patients with advanced ALK-positive NSCLC: 5-year outcomes from the CROWN study
Authors: Yi-Long Wu, Hye Ryun Kim, Ross A Soo, Qing Zhou, Hiroaki Akamatsu, Gee-Chen Chang, Chao-Hua Chiu, Hidetoshi Hayashi, Sang-We Kim, Yasushi Goto, Terufumi Kato, Jianying Zhou, Victor Ho-Fun Lee, Makoto Nishio, Baohui Han, Dong-Wan Kim, Shun Lu, Anna Polli, Jean-François Martini, Francesca Toffalorio, Chew Hooi Wong, Tony Mok
Journal: Journal of Thoracic Oncology (2025)
Safety and immunogenicity of hepatitis E vaccine in compensated liver cirrhosis with chronic hepatitis B
Authors: Xuejiao Liao, Dapeng Li, Yingying Su, Xinwu Wang, Shuting Wu, Yanling Chen, Zhiyu Li, Qiyuan Tang, Zhenghua Ma, Xiaobin Wan, Jingke Dong, Liping Zhang, Changxiang Lai, Haiyan Wang, Qing He, Jun Zhang, Fang Wang, Zheng Zhang
Journal: Clinical Microbiology and Infection (2025)
Sensitizing ferroptotic and apoptotic cancer therapy via tailored micelles-mediated coenzyme and ATP depletion under hypoxia
Authors: Min Gao, Yue Song, Jing Liang, Tiantian Chen, Jiajia Luo, Panyu Du, Han Wang, Hongyu Leng, Zheng Wang, Xinlong Ma, Kai Wang, Yanjun Zhao
Journal: Journal of Controlled Release (2025)
Expert consensus on the prevention and treatment of enamel demineralization in orthodontic treatment
Authors: Lunguo Xia, Chenchen Zhou, Peng Mei, Zuolin Jin, Hong He, Lin Wang, Yuxing Bai, Lili Chen, Weiran Li, Jun Wang, Min Hu, Jinlin Song, Yang Cao, Yuehua Liu, Benxiang Hou, Xi Wei, Lina Niu, Haixia Lu, Wensheng Ma, Peijun Wang, Guirong Zhang, Jie Guo, Zhihua Li, Haiyan Lu, Liling Ren, Linyu Xu, Xiuping Wu, Yanqin Lu, Jiangtian Hu, Lin Yue, Xu Zhang, Bing Fang
Journal: International Journal of Oral Science (2025)

Abstracts Enamel demineralization, the formation of white spot lesions, is a common issue in clinical orthodontic treatment. The appearance of white spot lesions not only affects the texture and health of dental hard tissues but also impacts the health and aesthetics of teeth after orthodontic treatment. The prevention, diagnosis, and treatment of white spot lesions that occur throughout the orthodontic treatment process involve multiple dental specialties. This expert consensus will focus on providing guiding opinions on the management and prevention of white spot lesions during orthodontic treatment, advocating for proactive prevention, early detection, timely treatment, scientific follow-up, and multidisciplinary management of white spot lesions throughout the orthodontic process, thereby maintaining the dental health of patients during orthodontic treatment.
When I use a word . . . The ugliest medical words
Authors: Jeffrey K Aronson
Journal: BMJ (2025)

Some English words are more euphonious than others, and some are more cacophonic. Here I discuss the latter, the ugliest English words, of which I have analysed 415 from a large number of published lists. In contrast to the most beautiful English words, many of which are euphonious and also conjure up pleasant thoughts, the most ugly words are not necessarily cacophonic and neither do they necessarily conjure up unpleasant thoughts, although some do both. Words that are not ill sounding may nevertheless be considered ugly because they are abbreviations, Americanisms, archaisms, clichés, colloquialisms, fads, literary words, mispronunciations, portmanteau words, redundancies, sexual terms, slang, sloppy speech, twee contractions, verbed nouns, or simply vocabulary that is perceived as"woke." The medical words that people regard as ugly are often those that conjure up unpleasant ideas: anus, bowel, bruise, bunion, buttock, carbuncle, chlamydia, clot, coagulate, corpse, diarrhoea, discharge, expectorate, faeces, flatulence, follicle, genitalia, gestational, haemorrhage, hoarse, honk, meatus, membrane, mucus, nasal, obese, ointment, orifice, placenta, polyp, preggers, pregnant, puberty, pubes, puke, pus, pustule, putrid, queasy, rectum, regurgitate, saliva, scab, secretion, sluice, smegma, sphincter, sputum, syphilis, syringe, vaginal, vomit, wart, wheeze, womb, zit. "Quack" might be another, and it appears in more than one list; however, that could simply be because not only is it cacophonic, but it also conjures up the idea of an ugly duckling, rather than an ugly doctor.
Continuous multimodal data supply chain and expandable clinical decision support for oncology
Authors: Jee Suk Chang, Hyunwook Kim, Eun Sil Baek, Jeong Eun Choi, Joon Seok Lim, Jin Sung Kim, Sang Joon Shin
Journal: npj Digital Medicine (2025)

The study introduces a clinical decision support system (CDSS) developed at a single academic cancer center, integrating real-time clinical, genomic, and imaging data for over 170,000 patients across 11 cancer types. We have developed the Yonsei Cancer Data Library (YCDL) data integration framework to continuously collect and update multimodal datasets comprising over 800 features per case. Quality control measures, using 143 logical comparisons, addressed missing data and outliers, achieving median accuracies of 92.6% for surgical and 98.7% for molecular pathology. An Extract-Transform-Load (ETL) process with natural language processing transformed unstructured data, enabling survival analyses stratified by tumor stage, which revealed significant stage-dependent differences. The CDSS dashboard visualizes patient trajectories and key milestones. User feedback from oncology professionals showed strong acceptance, with satisfaction scores exceeding 4 out of 5. This framework demonstrates the potential of multimodal data integration to enhance clinical decision-making and patient outcomes, with future research needed to validate its generalizability and scalability.