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Automated Text Message Outreach to Increase Diabetes Screening: A Pragmatic Randomized Trial

Background Despite evidence that early intervention can prevent or delay progression to type 2 diabetes, more than 80% of individuals with prediabetes in the United States remain undiagnosed, underscoring the need for scalable strategies to increase uptake. In this study, we evaluated whether a single text message could increase completion of HbA1c-based diabetes screening in routine clinical practice. Methods We conducted a pragmatic randomized controlled trial within Duke University Health System (DUHS). Patients aged 35 years or older who met American Diabetes Association 2022 screening criteria, had no previous diagnosis of diabetes, had not undergone HbA1c testing within the preceding 3 years, and had opted to receive text messages from DUHS were randomly assigned to receive either a single text message encouraging guideline-based diabetes screening and discussion with a primary care provider (intervention group; n=55,494) or usual care (control group; n=5,748). The primary outcome was HbA1c test completion within 24 weeks following message delivery (or no message for controls), analyzed using a Cox proportional hazards model stratified by wave. Secondary outcomes included piecewise hazard ratios for early (weeks 1-4), mid (weeks 5-12), and late (weeks 13-24) intervals and the between-group difference in cumulative testing rate. Findings Text message outreach significantly increased HbA1c test completion over 24 weeks (HR, 1.18 [95% CI, 1.07-1.03]) with the strongest effect in the first four weeks (HR, 1.48 [95% CI, 1.18-1.86]). By the end of the 24-week observation period, cumulative testing reached 9.14% in the messaged group vs 7.83% in controls (between-group difference, 1.31% [95% CI, 0.59-2.07]), corresponding to one additional HbA1c test per 76 messages delivered ($0.51 in messaging costs per additional HbA1c test performed). Rates of prediabetes and diabetes among those screened were similar between groups, indicating no selection bias of higher-risk patients. One additional dysglycemia case was identified per 213 messages sent ($1.43 per case detected).

Pulmonary extracellular vesicles drive alveolar macrophage dysfunction via microRNA transfer in Acute Respiratory Distress Syndrome

Background: Alveolar macrophage (AM) dysfunction contributes to Acute Respiratory Distress Syndrome (ARDS) pathogenesis. We investigated the role of extracellular vesicles (EVs) in mediating this dysfunction. Methods: Pulmonary EVs were isolated from broncho-alveolar lavage and non-directed bronchial lavage samples of ventilated sepsis patients with and without ARDS, and post-operative control patients via ultracentrifugation. AMs were isolated from lung tissue resections of lobectomy patients. AMs were treated with pooled EVs for 24 hours prior to functional, metabolic and autophagy profiling. EV cargo was profiled via small RNA transcriptomics and proteomics. Mechanistic role of EV microRNAs was assessed via mimic / antagomir transfection. Results: Pulmonary EVs from sepsis patients with ARDS impaired AM efferocytosis, and control EVs had no effect. ARDS EV treatment enhanced AM mitochondrial-linked respiration, but not glycolysis. ARDS EV treatment impaired LC3B-II and LAMP1 expression, indicating dysregulated AM autophagy-lysosomal machinery. Proteomics revealed downregulation of innate immune pathways in ARDS EVs. Transcriptomics revealed enrichment of 24 microRNAs in ARDS EVs; miR-652-3p was the most enriched, validated by RT-qPCR. EV miR-652-3p was associated with 90-day mortality (9.20 vs 0.59 RQ, p=0.0295) and inversely correlated with oxygenation (PaO2/FiO2). AM transfection with miR-652-3p mimic induced similar dysregulation of function and autophagy as ARDS EVs. Transfection of ARDS EVs with antagomirs to miR-652-3p prior to AM treatment partially rescued efferocytosis and autophagy. Conclusions: Targeting EV miR-652-3p may restore alveolar macrophage function and reduce excessive inflammation, thus offering a novel therapeutic strategy for patients with ARDS.

Kalman Linear Attention: Parallel Bayesian Filtering For Efficient Language Modelling and State Tracking

arXiv:2602.10743v2 Announce Type: replace Abstract: State-space language models such as Mamba and gated linear attention (GLA) offer linear-complexity, parallelisable alternatives to transformers, but their linear state updates limit expressivity and robust state tracking. We close this gap from a probabilistic angle, casting sequence mixing as exact Bayesian filtering with the Kalman filter as the core primitive. Classical Kalman filters give principled state and uncertainty estimates but are viewed as inherently sequential; we show that reparameterising them in information form turns their updates into an associative scan - so the per-token recurrent update is non-linear (a Möbius/precision recursion) yet remains temporally parallel. The resulting Kalman Linear Attention (KLA) layer is a drop-in sequence mixer that performs time-parallel probabilistic inference, carries an explicit belief-state uncertainty, and is strictly more expressive than GLA-style linear updates at the same computational cost. This expressivity translates directly into stronger state tracking: KLA solves permutation-composition ($A_5$) tasks that linear SSMs and attention cannot, while staying scan-parallel. As a drop-in primitive it also matches or improves on modern SSMs and GLAs across synthetic token-manipulation and zero-shot commonsense benchmarks, and is among the first stacked Bayesian-filtering primitives trained at the billion-token scale.

Upper airway disease in primary ciliary dyskinesia: Clinical management and factors influencing decision-making, a multicentre analysis

Background Upper airway disease is common in primary ciliary dyskinesia (PCD), but management evidence is limited. We aimed to describe management practices and identify factors influencing management decisions. Methods Using data from the Ear-Nose-Throat (ENT) Prospective International Cohort of patients with PCD (EPIC-PCD) and an ENT-specialist survey across participating centres, we described management practices recorded at routine follow-up. We assessed clinical factors associated with practices via mixed-effects logistic regression models. In a subgroup of patients, we assessed factors associated with initiation or discontinuation of practices. Results We included 579 patients: median age 15 years, 46% female. Nasal rinsing (54%) and nasal corticosteroids (22%) were most frequently prescribed. Among 466 patients with available data, 47 had grommets (10%) and 42 hearing aids (9%). Nasal corticosteroids and rinsing were more frequently prescribed in patients with polyps (odds ratio [OR] 3.74, 95% confidence interval [CI] 1.80-7.76; OR 3.39, 95% CI 1.37-8.37) or turbinate hypertrophy (OR 1.89, 95% CI 1.03-3.47; OR 2.89, 95% CI 1.55-5.38), and upper airway nebulisation in patients with frequent nasal symptoms (OR 2.86, 95% CI 1.11-7.39). Management practices differed between centres, as seen also by the specialists survey responses. In 177 patients with multiple visits, initiation of nasal rinsing was associated with frequent nasal symptoms (OR 3.18, 95% CI 1.24-8.18) and turbinate hypertrophy (OR 3.21, 95% CI 1.20-8.59). Conclusion Upper airway disease management in PCD varies and is partly guided by symptom burden and clinical findings. This variation across centres highlights the need for care standardisation and PCD-specific management guidelines.