Breaking Barriers in Student Mental Health Care With AI-Enhanced Group Cognitive Behavioral Therapy: Pilot Feasibility Study

Background: University students experience elevated psychological distress, with limited access to mental health services. While cognitive behavioral therapy (CBT) demonstrates efficacy for anxiety and depression, treatment gaps persist due to access barriers and insufficient between-session support. Large language model (LLM) chatbots could improve and scale CBT delivery. However, the scientific evaluation of chatbot-enhanced protocols is just emerging. Objective: This pilot study aimed to assess the feasibility, acceptability, and preliminary efficacy of an LLM-based ChatBot as an adjunct to group Unified Protocol (UP) therapy for between-session support in university students with subclinical anxiety and depression symptoms. Methods: A single-arm feasibility trial recruited university students aged 18 years and older with moderate subclinical symptoms (Social Phobia Inventory: 21‐40, Patient Health Questionnaire-9: 5‐14, or Generalized Anxiety Disorder-7: 5‐14), excluding those with current psychiatric disorders, suicidal ideation, or psychotropic medication use. The intervention comprised 4 weekly group UP counseling sessions complemented by an adjunctive Claude 3.7-Sonnet LLM ChatBot programmed with UP-based therapeutic prompts for between-session support rather than a stand-alone therapeutic agent. Primary feasibility outcomes included treatment adherence, chatbot engagement metrics, and system usability (System Usability Scale). Secondary outcomes assessed changes in generalized anxiety (Generalized Anxiety Disorder-7 Scale), social anxiety (Social Phobia Inventory), depression (Patient Health Questionnaire-9), and well-being (Short Warwick-Edinburgh Mental Wellbeing Scale) using paired tests. Qualitative feedback was collected through focus group interviews and analyzed using thematic analysis. Results: Of 72 screened participants, 37 met eligibility criteria and 19 initiated treatment (mean age 22.06, SD 1.78 years; 70.6% female). Retention was high with 17 completers (10.5% dropout rate). Among completers, 94.1% (16/17) attended ≥3 group sessions. The engagement with the CBT ChatBot was substantial: participants were active on a median of 23 days during the 34-day study period and exchanged a median of 15 messages in total. System usability was rated as excellent (mean 84.94, SD 10.98 out of 100). Pre-to-post comparisons revealed significant improvements in generalized anxiety (mean change −3.00, SD 3.46; =3.01, =.004; Cohen =0.71) and mental well-being (mean change +2.29, SD 3.65; =−2.17, =.02; Cohen =0.69). Social anxiety and depression showed nonsignificant trends toward improvement. Qualitative feedback highlighted the CBT ChatBot’s accessibility and nonjudgmental support while noting limitations in personalization. No adverse events or inappropriate chatbot interactions occurred. Conclusions: Augmenting a group UP therapy with an LLM ChatBot demonstrated high feasibility, acceptability, and preliminary efficacy signals for university students with subclinical symptoms. The hybrid intervention package achieved strong retention and engagement while maintaining safety. These findings support progression to a randomized controlled trial to definitively evaluate this technology-enhanced approach for expanding access to evidence-based mental health interventions.
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Using a Virtual Reality CAVE–Based Mindfulness Intervention to Promote Mental Well-Being in Adolescents With Anxiety Symptoms: Pre-Post Mixed Methods Pilot Study

Background: Adolescent anxiety is a growing public health concern associated with significant social and emotional impairment. Mindfulness-based interventions (MBIs) have shown promise in reducing anxiety and improving well-being; however, engagement remains challenging. Virtual reality (VR)–based delivery may enhance immersion and attention, potentially addressing barriers of traditional mindfulness formats. Evidence on VR-based mindfulness interventions for adolescents, particularly in Hong Kong, remains limited. Objective: This study aimed to evaluate the feasibility and acceptability of a VR-MBI delivered via a CAVE, an enclosed VR environment with three projected walls displaying immersive natural scenes and ambient sounds, for adolescents with mild-to-moderate anxiety symptoms in Hong Kong. Secondary aims were to explore preliminary effects on psychological outcomes and physiological stress regulation and to identify facilitators and barriers to engagement. Methods: A mixed methods, single-group pre-post study was conducted with adolescents experiencing mild-to-moderate anxiety symptoms, recruited from secondary schools and youth service organizations in Hong Kong. Participants completed an 8-week group-based VR-MBI. Feasibility and acceptability were assessed using recruitment, attendance, retention, homework practice frequency, dropouts, and adverse events. Psychological outcomes were measured using the Depression Anxiety Stress Scale–21 and the Mindful Attention Awareness Scale. Heart rate variability indices, including the standard deviation of normal-to-normal intervals and root-mean-square of successive differences, were collected at baseline and postintervention using a wearable device. Focus group interviews explored participants’ experiences. Paired-sample tests and Wilcoxon signed rank tests examined pre-post changes, and qualitative data were analyzed using thematic analysis, with findings integrated through triangulation. Results: A total of 42 participants (mean age 14.88, SD 1.90 years; 20/42, 47.6% female; 22/42, 52.4% male) enrolled and completed both assessments. Attendance was high, with 73.8% (31/42) of participants attending at least 80% (8/10) sessions, and participants engaged in regular homework practice. No dropouts or adverse events were reported. No significant pre-post changes were observed in self-reported distress, anxiety, depression, stress, or trait mindfulness (all >.05). However, significant improvements were observed in both heart rate variability indices, standard deviation of normal-to-normal intervals (mean difference 17.6 ms, 95% CI −33.88 to −1.32; =.04; Cohen =0.38) and root-mean-square of successive differences (mean difference 20.20 ms, 95% CI −38.76 to −1.65; =.03; Cohen =0.39), which may suggest preliminary enhancements in physiological stress regulation. Qualitative findings suggested perceived benefits in emotional regulation, stress reduction, focus, and sleep, with the immersive environment and group-based format identified as key facilitators. Conclusions: The CAVE-based VR-MBI was feasible and acceptable for adolescents with mild-to-moderate anxiety symptoms in Hong Kong. Despite no significant changes in self-reported outcomes, physiological improvements and positive qualitative feedback suggest early benefits not captured by self-report measures. These findings support further investigation of using controlled designs and longer follow-up periods.

Prevalence and Predictors of Self-Reported Adverse Experiences in Digital Meditation Training: 2 Randomized Controlled Trials

Background: Digital meditation-based interventions (MBIs) reach vast global audiences with millions of active users, yet concerns persist about the frequency and nature of adverse experiences (ie, AExs) occurring during meditation training. Some researchers have argued that AExs are substantially underdetected and reflect iatrogenic harm caused by meditation (ie, adverse effects [AEfs]). Others contend that these experiences largely reflect common stressors that would be experienced without meditation. These competing perspectives underscore the need for further research, particularly in the context of digital MBIs, the most widely used form of meditation training. Objective: This study examined the prevalence, predictors, and subjective evaluations of AExs during a digital MBI and tested whether reported experiences may be caused by meditation practice via comparisons between meditation-exposed and nonexposed participants. Methods: Data were drawn from 2 trials of the Healthy Minds Program. Exploratory study 1 (n=315) consisted of a sample of distressed US undergraduate students to estimate the prevalence of AExs and identify baseline predictors. Preregistered confirmatory study 2 (n=594) sampled distressed US adults from all 50 states to replicate findings from study 1 and to examine participants’ subjective evaluations of AExs. Study 2 additionally compared AEx rates between participants who did and did not complete guided meditations to assess whether AExs could be caused by meditation exposure. Study 3 (n=87) used qualitative methods to analyze study 1 participants’ responses to an open-ended question regarding their strategies for coping with AExs. Results: In studies 1 and 2, 27.9% (88/315) and 10.1% (40/396) of participants, respectively, reported at least one AEx during the study period, with 6.7% (21/315) and 3% (12/396) reporting functional impairment, largely aligning with previous research. Critically, in study 2, rates of AExs did not significantly differ between participants who did and did not complete guided meditations, suggesting that these experiences were not caused by meditation practice. Higher baseline depression, anxiety, loneliness, experiential avoidance, and perceived barriers to meditation predicted more frequent AExs. In studies 1 and 2, 89.8% (79/88) and 90% (36/40) of participants who reported AExs, respectively, indicated that they were glad to have learned to meditate. Qualitative analyses showed that participants used diverse coping strategies, often using skills learned through the Healthy Minds Program. Conclusions: AExs were relatively common but occurred at comparable rates among participants who did and did not meditate, challenging claims that such experiences were caused by meditation practice in distressed individuals. Although a small subset of participants reported some degree of functional impairment, most evaluated their AExs as tolerable and described their overall MBI experience as positive. Together, these findings highlight the importance of distinguishing AExs that likely reflect epiphenomena of preexisting distress or symptoms from iatrogenic harm attributable to MBIs. Trial Registration: Study 1: ClinicalTrials.gov NCT04741529; https://clinicaltrials.gov/study/NCT04741529; Study 2: ClinicalTrials.gov NCT06282523; https://clinicaltrials.gov/study/NCT06282523
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STAT+: Trump administration revisits policy to close Medicare drug price negotiation loophole

WASHINGTON — The Trump administration on Friday proposed to change a policy that is designed to prevent drugmakers from avoiding Medicare price negotiation by adding active ingredients to drugs. 

The policy is part of an annual proposed rule that establishes the process that the Centers for Medicare and Medicaid Services uses to choose the next 20 drugs and biologics for price negotiation. Those drugs will be announced by Feb. 1, 2027, and their negotiated prices will take effect in 2029. The administration also considered a similar policy last year but put off a decision to study it further.

Medicare must wait seven to 11 years after a product is approved by the Food and Drug Administration before it can negotiate its price, depending on the type of medicine. Biologics that are typically administered in doctor offices get more time than drugs taken orally. 

Continue to STAT+ to read the full story…

Passive Smart Home Monitoring for Delirium-Relevant Anomaly Detection in People Living With Dementia: Proof-of-Concept Study

<strong>Background:</strong> Delirium superimposed on dementia is associated with poor outcomes yet remains underdetected in home settings. Current detection relies on face-to-face clinical assessment (eg, the Confusion Assessment Method criteria), which is rarely applied outside hospitals. <strong>Objective:</strong> This proof-of-concept study developed a theory-driven framework for detecting delirium-consistent anomalous patterns in home-dwelling people with dementia, using passive smart home sensor data. <strong>Methods:</strong> The Technology Integrated Health Management dataset, an open access resource comprising a clinically derived cohort of older adults (aged 50 years) with a confirmed diagnosis of dementia or mild cognitive impairment, was used. The analysis included 13 patients who had at least 50% valid data for at least one 10-day analysis window, with data collected between April 1, 2019, and June 30, 2019. Individualized anomaly detection algorithms, including Isolation Forest and Long Short-Term Memory models, were applied to identify delirium-related anomalies within each participant. Predictor features consisted of theory-driven digital markers approximating key Confusion Assessment Method criteria, including agitation, disrupted sleep-wake cycles, and disorientation (indexed by activity entropy), along with clinically relevant indicators, such as physiological instability (early warning scores) and urinary tract infections. <strong>Results:</strong> Using matched thresholds, the Isolation Forest identified 77 anomalies (anomaly rate: 15.65%), and the Long Short-Term Memory model identified 78 anomalies (anomaly rate: 15.85%), with anomalies typically occurring in short temporal clusters; agreement between methods ranged from 0% to 40% across individuals. Feature importance analyses indicated that activity entropy, sleep quality, and early warning scores were the most influential features, with stronger interfeature correlations observed during anomaly periods than during nonanomaly periods. <strong>Conclusions:</strong> This study demonstrates the technical feasibility of detecting delirium-related anomalies through passive smart home monitoring. While lacking ground truth validation, the approach shows promise for early intervention in community settings. Future validation studies with clinically confirmed delirium labels are essential. <strong>Trial Registration:</strong>

Teleguided Point-of-Care Ultrasound for Fluid Assessment in Geriatric Inpatients Performed by Nurses and Medical Students: Prospective Observational Feasibility Study

<strong>Background:</strong> Fluid assessment in geriatric inpatients is challenging, as clinical signs are often unreliable. Inferior vena cava (IVC) ultrasound provides a rapid, noninvasive estimation of intravascular volume. Teleguided point-of-care ultrasound (POCUS) allows examiners without prior ultrasound experience to perform scans under real-time supervision. <strong>Objective:</strong> This study aimed to evaluate the feasibility, accuracy, efficiency, and user satisfaction of remote-guided IVC ultrasound performed by medical students and nurses without prior ultrasound experience in a geriatric inpatient setting. <strong>Methods:</strong> This prospective feasibility study was conducted between February and March 2025 in a geriatric inpatient ward at a German tertiary care hospital. Thirty hospitalized geriatric patients were recruited using a pragmatic convenience sampling approach on predefined study days. Each patient underwent 2 IVC ultrasound examinations (n=60) using a handheld device with TeleGuidance; one was performed by a medical student and one by a nurse. All scans were remotely supervised by an ultrasound-experienced cardiologist, who subsequently performed a third, independent IVC scan on each patient, serving as the reference standard. Examiners were 2 final-year medical students and 2 nurses, all without ultrasound experience, each performing 15 scans. Primary outcomes were technical feasibility (successful teleguidance connection), accuracy of IVC diameter measurement (≥80% within +2 mm to –2 mm), and examination duration (≤10 minutes). The secondary outcome was user satisfaction (≥75 on a 0-100 numeric rating scale). <strong>Results:</strong> Connectivity and remote supervision were consistently stable, enabling completion of all scans (feasibility 100%). IVC visualization was successful in 90% (27/30) of cases. Accuracy was achieved in 80% (48/60; 95% CI 67-88) of scans. Mean duration was 3.3 (SD 2.0) minutes. Mean user satisfaction was 89%, with all ratings ≥85%. <strong>Conclusions:</strong> Telemedicine-guided IVC ultrasound was feasible and well accepted in this geriatric inpatient setting. Nonexpert examiners were able to obtain clinically usable measurements under remote supervision within a few minutes after minimal training. These findings suggest that teleguided POCUS is a promising approach to support task sharing in geriatric care. Further studies are needed to confirm these results and to evaluate integration into clinical practice. <strong>Trial Registration:</strong> German Clinical Trials Register DRKS00035821; https://www.drks.de/search/de/trial/DRKS00035821/details

Age-Related Mutations in Brain Immune Cells Linked to Alzheimer’s Inflammation

Researchers have uncovered evidence that age-related genetic mutations commonly associated with cancer and blood disorders may also contribute to the chronic brain inflammation characteristic of Alzheimer’s disease.

In a study published in Cell, investigators from the Icahn School of Medicine at Mount Sinai and Boston Children’s Hospital identified somatic mutations in brain immune cells from patients with Alzheimer’s disease. The findings suggest that genetic alterations acquired during aging may reshape the behavior of these cells, driving inflammatory processes linked to neurodegeneration.

The work introduces a potential new biological mechanism connecting aging, immune dysfunction, and Alzheimer’s disease, a condition that affects millions of people worldwide and remains one of the leading causes of dementia.

Linking aging, immunity, and neurodegeneration

Inflammation has long been recognized as a central feature of Alzheimer’s disease. Activated immune cells are commonly observed surrounding amyloid plaques and other pathological hallmarks of the disease. However, the factors that initiate and sustain these harmful immune responses have remained incompletely understood.

The new study focused on microglia, the brain’s resident immune cells. These specialized cells play critical roles in maintaining neural health by clearing cellular debris, regulating synaptic connections, responding to injury, and coordinating immune activity within the central nervous system.

Previous research has shown that microglia can adopt disease-associated states during Alzheimer’s progression, but the molecular triggers responsible for these changes have been unclear.

“Our data suggest that some immune cells in Alzheimer’s disease undergo genetic changes over time that alter their behavior and potentially contribute to chronic inflammation in the brain,” said senior author Samuele Marro, PhD, associate professor in the Nash Family Department of Neuroscience and The Friedman Brain Institute at Mount Sinai.

“These findings provide a new framework for understanding how aging, immune dysfunction, and neurodegeneration may intersect in Alzheimer’s disease.”

Large-scale analysis of Alzheimer’s brains

To investigate whether acquired mutations might contribute to disease pathology, researchers analyzed 311 postmortem brain samples from individuals with Alzheimer’s disease and age-matched controls.

Using ultra-deep sequencing, the team screened 149 genes frequently associated with cancer and clonal hematopoiesis, an age-related condition in which blood stem cells acquire mutations that allow certain cell populations to expand disproportionately over time.

The analysis revealed significantly higher numbers of somatic mutations in Alzheimer’s disease brains compared with controls.

Several of the most frequently mutated genes, including TET2, DNMT3A, and ASXL1, are well-known drivers of clonal hematopoiesis and have previously been implicated in age-related blood disorders and cancer development.

Many of these mutations were highly enriched in microglia-like immune cells while being largely absent from neurons, suggesting that immune cells may be a primary target of these age-related genetic alterations.

Evidence for blood-derived immune cell involvement

The researchers also examined matched blood samples from some patients and found that many of the same mutations detected in the brain were present in circulating blood cells.

This observation suggests a possible route by which mutated immune cells originating from the blood may enter the brain and adopt microglia-like functions.

Growing evidence has indicated that peripheral immune cells can contribute to neuroinflammation under certain conditions. The new findings raise the possibility that age-related expansion of mutated blood cell clones could influence inflammatory processes within the brain.

Such a mechanism would provide a direct biological link between clonal hematopoiesis—an increasingly recognized consequence of aging—and neurodegenerative disease.

Functional effects of Alzheimer’s-associated mutations

To determine whether these mutations actively alter immune cell behavior, the researchers combined single-cell analyses with stem cell-based experimental models.

Using CRISPR gene editing, they engineered induced pluripotent stem cell-derived microglia-like cells carrying mutations identified in Alzheimer’s disease samples.

The resulting cells displayed profound changes in gene expression, adopting inflammatory programs and disease-associated microglial states that have previously been linked to neurodegeneration.

“Our study provides functional evidence that mutations commonly associated with aging blood cells and cancer biology can directly alter the behavior of brain immune cells,” said co-corresponding author Eirini Papapetrou, MD, PhD, professor of oncological sciences at Mount Sinai and director of the Center for Advancement of Blood Cancer Therapies.

“These mutated cells showed inflammatory signatures strongly associated with neurodegeneration.”

The findings suggest that these mutations are not merely bystanders but may actively influence cellular pathways involved in disease progression.

A potential new contributor to Alzheimer’s pathology

The study expands the growing view of Alzheimer’s disease as a disorder involving complex interactions between the immune system and the nervous system.

Historically, Alzheimer’s research has focused heavily on amyloid-beta plaques and tau tangles. More recently, attention has shifted toward the role of neuroinflammation and immune dysfunction as key drivers of disease progression.

The identification of somatic mutations in microglia-like cells adds another layer to this emerging picture. Rather than being solely inherited or environmentally driven, some aspects of Alzheimer’s pathology may arise from genetic alterations that accumulate naturally with age.

Because clonal hematopoiesis becomes increasingly common in older adults, the findings may have implications beyond Alzheimer’s disease and could influence understanding of other neurodegenerative disorders characterized by chronic inflammation.

Implications for future therapies

Although the study does not establish that these mutations directly cause Alzheimer’s disease, it identifies a plausible mechanism through which age-related genetic changes could exacerbate neurodegeneration.

Future studies will be needed to determine how early these mutations emerge, whether they predict disease risk, and whether interventions targeting mutated immune cell populations could slow disease progression.

“This work highlights a potentially important connection between aging blood biology and neurodegenerative disease,” said Marro.

“If confirmed in future studies, these findings could open new avenues for therapies that target harmful inflammatory immune cell populations in the brain.”

The researchers are now planning follow-up studies in animal models to further investigate the role of mutated immune cells in Alzheimer’s disease and evaluate whether reducing their inflammatory activity can modify the course of neurodegeneration.

The post Age-Related Mutations in Brain Immune Cells Linked to Alzheimer’s Inflammation appeared first on Inside Precision Medicine.

Paper Mills and the Fight Against Scientific Fraud

Scientific publishing is facing a growing challenge from fabricated research produced by industrial-scale paper mills. But researchers and publishers are fighting back through technology and collaboration to protect the integrity of the scientific record.

Scientific publishing is based on the trust that the data are real and that peer review ensures quality. But that trust is being eroded by commercial enterprises known as paper mills—coordinated commercial operations that sell authorship slots in fraudulent or manipulated manuscripts, then submit those manuscripts to journals.

Unlike traditional misconduct, these are not lone researchers cutting corners but businesses producing research at scale, often tailored to meet the demands of specific fields, journals, and career incentives.

A recent analysis of almost 19,000 online adverts for paper mills revealed authorship slots being sold for between $36 to $5,600 depending on the position of the slot, highlighting how commercialized the market is. The average for a first author position was $1,030 and, although the study did not examine which adverts resulted in published papers, another investigation traced approximately 1,000 authorship adverts to more than 400 published papers.

The magnitude of the problem is difficult to estimate. A 2022 report by the Committee on Publication Ethics (COPE) and the International Association of Scientific, Technical & Medical Publishers (STM) found that the percentage of suspect papers submitted to journals was around two percent overall but increased sharply to as high as 46% in journals targeted by paper mills.

The pressure to publish

Adrian Barnett
Adrian Barnett, PhD
Professor
Queensland University of Technology

For honest researchers, it might be difficult to understand why paper mills even exist. At the heart of the issue is what Adrian Barnett, PhD, a professor in the Australian Centre for Health Services and Innovation at Queensland University of Technology, described as the “publish or perish” phenomenon.

“If I could do one simple thing tomorrow, I would ban all the university league tables,” said Barnett. “They’re just encouraging corruption.” Ranking systems that prioritize publication volume can push researchers toward quantity over quality, making paper mills an easy way to meet expectations.

Furthermore, publication is often not just a measure of success but a requirement for career progression. “For the clients, it’s believed that they need publications that they can’t achieve through their own efforts, either because they don’t have the time, the facilities, the training, or the money to do research and yet, for whatever reason, their employers expect them to,” explained Jennifer Byrne, PhD, a professor of molecular oncology and lead of the Publication and Research Integrity in Medical Research group at the University of Sydney.

Jennifer Byrne
Jennifer Byrne, PhD
Professor
University of Sydne

Byrne has published extensively about paper mills and publication integrity; she got into the field accidentally when she came across some papers about a gene that her team discovered many years earlier. “In 2014–2015, we realized that five or six different groups suddenly published very similar papers about this gene in different journals,” she said. “And I just thought, that doesn’t really make a lot of sense.”

Upon investigation, Byrne found that the papers, and a further 48 similar publications, showed features consistent with mass production. She has since proposed that human gene research in general is highly vulnerable to paper mills. “You can hide fake research quite effectively in experimental fields, because it’s very difficult and time-consuming to reproduce experimental studies,” she said.

Why paper mills matter

Aside from the obvious fraud, paper mills are problematic for several reasons. Byrne describes them as “a billion-dollar problem” with few resources devoted to tackling it. And although she and others have advocated for scaled investments, progress so far has been slow.

The publishing system can also reinforce the problem. Paper mills are profit-driven, but journals also benefit through article processing charges and citations, creating what Byrne describes as a “circle” in which “everyone gets what they want.”

The consequences of paper mill papers being published can influence real research. The papers are cited, reused, and built upon, wasting both time and money for all involved.

More broadly, the erosion of trust can drive researchers away from entire fields. In Byrne’s case, she stopped doing preclinical cancer research. “I left because there were a lot of papers that I couldn’t trust. When you get to the point where you can’t trust most of the recent literature, it’s very difficult to continue,” she said.

There are also more sinister risks. Barnett recalled reports of paper mills exploiting their clients, including instances of potential blackmail. “If you’ve been a regular customer and then you suddenly stop, they might try and squeeze more money,” he said. “They’ve got absolutely no scruples.”

Despite these impacts, deterrents are limited. “There are almost none,” said Byrne.

Retractions are often slow, meaning damage is done before action is taken, and retraction rates are far below where they should be.

In an April 2026 report to a U.S. Congress hearing on the state of scientific publishing, Kate Travis, managing editor of Retraction Watch, showed that the retraction rate was around 0.2% in 2025, up from 0.02% in 2016. Yet, the report states that Retraction Watch “are confident that the rate […] should be about two percent—10 times what it is today.”

How to tackle the problem

Concerns about problematic papers are often raised by individual researchers or so-called science sleuths on platforms such as PubPeer. Although they have become skilled at spotting telltale signs of a paper mill, like manipulated images, distinct layouts, author affiliations that might not match the topic of the paper, unusual patterns of coauthors, and fake peer reviews, it is difficult for the untrained eye to detect problems from a single paper.

This is why there have been calls for increased awareness. “Awareness is always the first step,” said Byrne, who is working with The Lancet–World Conferences on Research Integrity Foundation commission to address critical issues related to research integrity.

Efforts to extend awareness are also being coordinated through initiatives such as United2Act, which brings together stakeholders from research institutions, publishers, sleuths, and universities to develop shared guidance and educational resources.

But even with greater coordination, human detection has limits. As paper mills scale, automated tools are becoming essential.

Earlier this year, Barnett, Byrne, and colleagues published a paper in the BMJ showing that their large language model (LLM) could flag papers suspected of being from paper mills by analyzing sentence-level patterns. The model identified 9.9% of more than 2.6 million cancer research papers for further review. Many of the papers were linked to regions with strong publication incentives, including China.

However, Barnett emphasized that the model “is not a 100% proof, it’s a quick and simple flag that should encourage reviewers to look at those papers and look for other signs of paper mill activity.”

Other paper mill detection technologies are also available. Platforms such as Clear Skies, which is used by the STM Integrity Hub, use machine learning to detect patterns across large bodies of literature, while image-forensics tools and cross-publisher data sharing help identify duplicated figures and submissions.

Alongside these tools, Barnett suggested that researchers may increasingly need to provide a “breadcrumb trail,” through preregistration of hypotheses and transparent workflows to demonstrate the authenticity of their work.

Platforms such as PubPeer and Retraction Watch also play a role, enabling researchers to flag concerns and share evidence about suspect papers after publication. These flags then prompt journal retractions and investigations, making it a critical component in the fight against paper mill activity.

A call for tighter regulation

Aside from technology, Byrne would like to see tighter regulation for the commercial publishing industry, akin to something like the ISO 9001 quality management standards that have been widely adopted across industries like manufacturing, engineering, and healthcare.

“We need a regulatory framework that rewards journals that do the right thing and that care about publishing quality,” she said. “And we need to disincentivize the current commercial drive towards publishing anything for money.”

Byrne believes that funders and researchers should be demanding these standards. “They pay for the research, the journal subscriptions, the article processing charges, and give their research for free,” she said. “They don’t ask anything in return, in terms of quality standards, and that’s unacceptable.”

Marie Soulière
Marie Soulière, PhD
Elected Trustee
COPE

Marie Soulière, PhD, an elected trustee of COPE and chair of the COPE Paper mill Working Group, acknowledged that “a standard such as ISO 9001 could help with process consistency, documentation, and accountability.” But she said, “it would not be a direct solution to publication fraud or paper mills” and “would need to sit alongside integrity-specific controls, not replace them.”

How publishers are responding

Publishers are increasingly shifting from isolated responses to coordinated action. Initiatives like the STM Integrity Hub and United2Act are driving cross-industry collaboration and shared detection approaches.

Soulière said that several recommendations from the COPE/STM 2022 “have been put into practice, particularly around cross-publisher collaboration, shared screening approaches, and investment in integrity infrastructure.”

A central strategy, highlighted in a publication from the United2Act working groups, uses the “Swiss Cheese Model,” a move toward layered screening that combines tools such as plagiarism screening, image forensics, citation analysis, and author verification. “Each safeguard has limitations, but multiple checks together make it harder for fraudulent papers to pass through,” said Soulière.

Adya Misra
Adya Misra, PhD
Associate Director
Sage

Publishers are also strengthening internal processes. As Adya Misra, PhD, associate director of research integrity at Sage, described: “Our research integrity team acts centrally to support editors and internal journal teams with both prevention of suspicious or problematic research and the correction of the scholarly record … in line with COPE guidance.”

A spokesperson for Taylor & Francis highlighted their work on external collaborations designed to address the root causes of integrity issues. They are partnering with the National Science Library at the Chinese Academy of Sciences to develop research integrity and publishing ethics training programs, designed to ensure that students and researchers at all levels receive adequate support and to help them avoid exploitation by unethical third-party services such as paper mills.

AI changes the game

Even as safeguards improve, artificial intelligence (AI) is moving the goalposts. Many current detection strategies were developed to target structured forms of fraud; template-driven papers, recycled images, and repeated patterns across manuscripts. But these signals are beginning to disappear. “Our system worked because the paper mills would have a template, but now with AI, there is no template,” said Barnett. “It’s going to absolutely change everything.”

Barnett and his colleague Matt Spick, PhD, a lecturer in health and biomedical data analytics at the University of Surrey, recently demonstrated this by generating a complete scientific paper in just under 30 minutes using publicly available data and the OpenAI platform PRISM.

“All we did was give it the dataset and said write a paper for an Elsevier journal,” Barnett explained. “If an honors student had given me this paper, I would have been pretty pleased.”

Health engineer working at a 3D printing laboratory
Credit: Hispanolistic / Getty Images

Paradoxically, AI could also be bad news for paper mills as people realize they can create the papers themselves at little to no cost.

Reasons for cautious optimism

With AI adding to the challenges that publishers and researchers already face, the future could appear bleak. Barnett recalled an analogy describing the AI problem as an oil spill in a digital ocean, “We don’t know how deep it is, can’t get to the bottom of it, and it’s very difficult to clean up.”

Even removing a single problematic paper can require significant time and effort, while thousands more remain undetected. But Byrne remains positive that the work being done can have an impact.

“I’m actually really positive, because I think the biggest thing is awareness,” she said, noting that when she gives talks, she asks if the audience has heard of paper mills. “In 2023, that might have been five percent of people, and yet by 2025 it had increased to 30%–50%,” she said.

Soulière added that increased collaboration and transparency within scholarly publishing is another positive takeaway.

“Publishers, editors, institutions, and other stakeholders are no longer treating these issues as isolated problems,” she said. “They are investing in stronger screening systems, clearer policies, and better cross-sector coordination. In that sense, this moment is also driving progress and innovation.

“While the risks are serious, the response from the sector shows that trust can be reinforced, and that the system is becoming better equipped to detect problems earlier and protect the scholarly record more effectively,” Soulière concluded.

 

Laura Cowen is a freelance medical journalist who has been covering healthcare news for over 10 years. Her main specialties are oncology and diabetes, but she has written about subjects ranging from cardiology to ophthalmology and is particularly interested in infectious diseases and public health.

The post Paper Mills and the Fight Against Scientific Fraud appeared first on Inside Precision Medicine.

Organs-on-a-Chip Offer “Elegant Solution” to Quandary of Animal Models in Drug Design

To the untrained eye, the chip is a piece of clear silicone about the size of a AA battery. Crisscrossing chambers within house hot pink and electric blue liquids that neatly cascade toward the device’s beveled edges.

Yet inside, invisible without a microscope, is the replicated microenvironment of a human liver. The pink and blue rivulets, each a millimeter wide, are endothelial and epithelial channels, respectively. Between them dance immune, stellate, and endothelial cells, complete with extracellular matrices and a membrane, hepatocytes galore. Together, they comprise the quad-culture model of Emulate’s Liver-Chip S1.

Lorna Ewart
Lorna Ewart, PhD
CSO, Emulate

“When you first look at it, you’re like, ‘That does this?’” said Lorna Ewart, PhD, CSO at Emulate, a Boston-based biotechnology firm specializing in organs-on-a-chip. “The engineering behind it is fairly complex.”

The chip, a marvel of photolithography, is assembled in layers of polydimethylsiloxane. A porous membrane separates the blue upper channel, which has a height of 1 mm, from the pink lower channel, which stands a mere 0.2 mm tall. Emulate prepares the multicellular framework for purchase and from there, researchers are free to experiment on the tissue-tissue interface in three dimensions.

“It’s a very elegant solution,” Ewart said. “When you place the cells in this device, you are starting to create an environment that feels like home for those cells.”

In the world of drug development, the advantages of organs-on-a-chip over traditional Petri dish cultures go beyond their 3D design, Ewart stressed. Microfluidics are at play, with perfusion the “secret sauce” that mimics human physiology.

“All of your tissues in your body are perfused,” Ewart said. “Recreating that in vivo-like environment is what makes these cells function as if they’re in the body, and therefore gives greater or more predictive data to the user.”

Emulate, whose founders began their work at Harvard University’s Hansjörg Wyss Institute for Biologically Inspired Engineering, is a key player in the explosion of the organ-on-a-chip industry. Valued at $227 million last year, the global market size is projected to soar to $3.4 billion by 2034, according to market research firm Straits Research.

This growth, Ewart said, comes down to one driver: Animal models are poor predictors of drug safety and efficacy

in humans.

Ancient problem meets futuristic solution

The vast majority of drug candidates—90%—fail in clinical trials, according to a 2022 report in the journal Acta Pharmaceutica Sinica B. That doesn’t include those that don’t make it past preclinical testing. The few drugs that are successful typically take more than 10 to 15 years each, and upward of $1 billion to $2 billion to go from discovery to market.

One reason for drugs’ limited success in this costly, lengthy pursuit is the inability of animal models to adequately simulate drug responses in humans.

Since antiquity, humans have relied on animals to help them understand their own anatomy and physiology. Though French chemist Louis Pasteur famously tested the rabies vaccine on animals before successfully doing so in humans in the 1880s, it wasn’t until the passage of the Food, Drug, and Cosmetic Act in 1938 that animal testing became the gold standard in U.S. clinical drug trials.

More than 80 years later, in 2022, the bipartisan Food and Drug Administration (FDA) Modernization Act 2.0 made animal testing optional. The new law encourages drug developers to conduct testing “in vitro, in silico, or in chemico, or a nonhuman in vivo test.” Organs-on-a-chip, which the FDA considers a type of microphysiological system, were listed as one such technology.

The FDA has continued to move away from animal testing. In March 2026, the agency issued draft guidance highlighting new approach methodologies (NAMs)—including organs-on-a-chip—that may be used instead.

“This draft guidance advances our commitment to replace animal testing with human-relevant, scientifically rigorous methods,” Secretary of Health and Human Services Robert F. Kennedy Jr. said in a recent statement. “Clear validation expectations will help modern tools earn regulatory confidence and speed safer, more effective therapies to patients.”

It’s a global effort. The U.K.’s Medicines and Healthcare products Regulatory Agency announced a commitment to “replace, reduce, or refine animal use in medicinal product development.” In Japan, the Pharmaceuticals and Medical Devices Agency established a NAMs Working Group. The Indian government recognizes NAMs as a valid preclinical endeavor.

Donald Ingber, MD, PhD, the scientific founder at Emulate and founding director of the Wyss Institute, has been a step ahead for the better part of two decades. In 2010, he and Dan Dongeun Huh, PhD, now a professor of bioengineering at the University of Pennsylvania and the co-founder and CSO of biotech firm Vivodyne, developed a “breathing” lung-on-a-chip. Their research, published in Science that year, is considered a seminal work in the organ-on-a-chip space.

In a video accompanying a 2010 Harvard Medical School news release about the research, Ingber described the chip as a “little, flexible device” designed “hopefully, someday, to replace animal studies.” Someday has arrived.

The FDA launched the pilot program, Innovative Science and Technology Approaches for New Drugs (ISTAND) in 2020 and adopted it as a permanent initiative in 2025. Part of Ewart’s job is to steer Emulate through this regulatory pathway. In doing so, she confronts one of the biggest hurdles in organ-on-a-chip expansion: standardization.

“When a tool is qualified, it can be used in a regulatory document without the FDA needing to reconsider or reconfirm its suitability,” Ewart said. “It saves the sponsor a lot of time, and it’s an acknowledgement that these tools perform very well. … The data that comes from them, they will use in their risk assessment of a drug as it moves into the clinic.”

Emulate was the first organ-on-a-chip company granted acceptance to ISTAND, Ewart said. The FDA noted its Liver-Chip S1 is designed to predict drug-induced liver injury, a major reason why drugs fail safety testing in trials and are withdrawn from the market.

“We’re in the final phase now of the program,” Ewart said. “Looking forward to trying to obtain qualification in 2027.”

Faster results for patients in need

As they continue their metamorphosis from futuristic concept to laboratory standard, organs-on-a-chip offer researchers and patients an unprecedented bench-to-bedside timeline.

Weiqiang Chen
Weiqiang Chen, PhD
Professor
NYU Tandon School of Engineering

While drugmakers and the general public alike stand to benefit from accelerated drug discovery, Weiqiang Chen, PhD, designs chips for patients who lack the luxury of time. Chen, a professor of biomedical, mechanical, and aerospace engineering at NYU’s Tandon School of Engineering in Brooklyn, helped develop the first immunocompetent leukemia-on-a-chip.

“It’s quite a different type of cancer,” Chen said. Most cancers form solid tumors, but leukemia, a liquid cancer, develops in the bone marrow. “It’s more challenging to generate the microenvironment for leukemia. … It involves a lot of immune cells, immune functions, and immune interactions.”

The leukemia-on-a-chip, commissioned by NYU Langone Health, is circular, roughly the size of a quarter. Green and vermilion pools surround a blue ring at the center. Within that lies a red liquid dot.

“Outside, we have one layer of osteoblasts, the bone cells, and inside are the central sinus and the vasculature and some mesenchymal stem cells,” Chen said. “All the immune cells are located within the vascularized niche, similar to real bone marrow.”

The technology allows Chen and his team at NYU’s Applied Micro-Bioengineering Laboratory to interrogate single cells. They can also observe how the cancer responds to chimeric antigen receptor T-cell therapy in real time—within a patient’s unique immune system.

The chips are constructed using a leukemia patient’s own cells. Meaning, Chen said, the observed therapeutic response is not only more accurate than it would be in an animal model but also patient-specific.

“We can help to identify responders, non-responders, or we can help screen out more efficient combination therapy for the specific patient for precision medicine purposes,” Chen said.

He acknowledged that the process is imperfect, yet strong enough to swiftly guide treatment. The chips take just half a day to build and yield results within weeks.

“We can fill the gap, providing a high throughput and also accelerated screening in three weeks,” Chen said. “We can screen many drugs at the same time.”

Chen pointed out that some patients have a weeks-long window in between chemotherapy and immunotherapy—a time crunch the leukemia-on-a-chip can accommodate.

The lab is also exploring other immunologic uses for organs-on-a-chip, including a lymph node-on-a-chip that can help validate new vaccines. In addition, in March, the NYU Grossman School of Medicine and Sage Bionetworks received a $25-million grant to launch the data hub and coordinating center for the National Institutes of Health’s (NIH) Complement-Animal Research in Experimentation program.

Though Chen will leave NYU in June to become the dean of the new School of Biomedical Engineering at Nanjing University in China, the work continues.

“It’s exciting for us to expand our research in the future to make a real impact,” Chen said.

Bone-deep discoveries, millimeters thin

Nearly 3,000 miles to the west, Avathamsa Athirasala, PhD, an assistant staff scientist at the Oregon Health and Science University (OHSU) in Portland, is studying other aspects of the bone in miniature.

“The bone is different from other tissues in how it feels and what it’s made up of,” she said. “It’s highly mineralized, it’s mechanically stiff, and it’s constantly being remodeled. It has a lot more forces being put on it.”

Avathamsa Athirasala
Avathamsa Athirasala, PhD
Assistant Staff Scientist
Oregon Health and Science University

Athirasala works in the Precision Biofabrication Hub, part of the OHSU Knight Cancer Institute, under founding director Luiz Bertassoni, DDS, PhD. Through their bone-on-a-chip, hub researchers are studying cancer metastasis.

For example, more than 80% of people with advanced prostate cancer experience bone tumors. A $2.5-million NIH grant awarded in April will help Athirasala’s team discover how.

“Some of these tumor cells—why are they attracted to bone? And why do they thrive in bone?” she asked. “Because they have never experienced an environment like bone.”

She added, “Using this model, we are able to try and maybe even understand how cancer progresses, or how it changes as it goes to a new environment.”

Athirasala is also investigating potential uses for the bone-on-a-chip in regenerative therapies. Soldiers, for instance, may have debilitating bone injuries that heal differently from fractures. A scaffold designed to regenerate bone may be a better treatment than a metal implant, and the chip could help evaluate patient reaction.

“What are the first things that the body starts doing in response to a foreign object? There will be inflammatory signals, there will be host stem cells that want to infiltrate in there and start remodeling it,” Athirasala said. “You can actually recreate the temporal aspects of this—what comes first, what comes later—in a chip.”

Problem and promise of precision

Athirasala delights in seeing solutions to biological problems play out before her. Within organs-on-a-chip, cells hold answers. Still, the devices’ possibilities aren’t endless—yet.

Precision medicine applications, in particular, face logistical roadblocks, she said.

“You have to get all the pipelines in place to be able to get patient cells, preserve them long enough, and get them to where the engineers are making these chips and incorporate them in the devices,” Athirasala said.

Preclinical drug testing that replaces animals with organs-on-a-chip is projected to curtail costs in the long run. Emulate, for example, expects its Liver-Chip alone to increase annual research and development productivity in the small-molecule drug development industry by $3 billion. But as with any new technology, for now, the chips themselves and the infrastructure required to sustain them aren’t cheap.

Market intelligence platform IndexBox estimates that in the U.S., single-chip readers cost about $10,000 each, while comprehensive systems that manage microfluidics run as high as $200,000. Chips are priced between $50 and $2,000, with assay kits and reagents hovering around $100 to $500.

Ewart, of Emulate, said the company doesn’t typically publish costs, which vary depending on customer needs.

What’s more, with each institution that builds its own organ-on-a-chip, standardization becomes harder to attain.

“Each one may have their own advantages, but no one can convince each other which one’s better,” said Chen, of NYU. “Without standards, we cannot really push this technology into practical use.”

Andrei Georgescu
Andrei Georgescu, PhD
CEO and Co-founder
Vivodyne

In the absence of device uniformity, Vivodyne, the Penn Engineering spinoff with offices in Philadelphia and outside San Francisco, is tackling the issue of reproducibility. CEO and co-founder Andrei Georgescu, PhD, saw a solution in end-to-end automation.

“If it is possible to scale up the production of these lab-grown tissues, then we have ourselves a substrate for solving what is the most challenging problem now in medicine,” he said, “which is, we don’t know how human biology responds very well to the perturbations that we make on it.”

The result not only eliminates human variation in lab technique but also allows Vivodyne to test more than 10,000 lab-grown tissues at once.

“We shrink what is like a state-of-the-art biotech lab into the footprint of a large desk,” Georgescu said. “Within each of these systems, we have complex confocal microscopy and a fridge and freezer and a robot arm with multiple tools for liquid handling, dispensing, and dosing these tissues, and we grow them within this platform.”

Vivodyne pairs its automated labs with artificial intelligence to create a feedback loop in experimental design, Georgescu said. The idea is to quickly identify druggable targets and pinpoint which drug candidates are most likely to succeed.

While complete bodies-on-a-chip remain a pipe dream, Vivodyne is among the companies investigating how different organs-on-a-chip interact with one another. Orlando-based Hesperos, for one, manufactures a Human-on-a-Chip® that can replicate several organs on a single device. TissUse, of Berlin, is developing multi-organ chips to mirror male and female environments: the HUMIMIC ChipXY and HUMIMIC ChipXX.

The burgeoning field of organ-on-a-chip drug testing lies at the intersection of bioengineering, pharmaceutical regulation, and data science. To Georgescu, at its heart, it’s also reassuringly straightforward.

“Just because biology is complex,” he said, “does not mean it is not already as simple as can be.”

 

Lindsey Leake is an award-winning, independent health reporter based outside Washington, D.C. She spent 15 years as a staff journalist at outlets including Fortune, the USA TODAY Network and Sinclair Broadcast Group. She holds an MA in Science Writing from Johns Hopkins University, an MA in Journalism and Digital Storytelling from American University, and a BA from Princeton University.

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