Care homes in England experienced disproportionate harm during the COVID-19 pandemic, yet existing policy analyses offer limited explanation of the structural and positional vulnerabilities faced by care home managers. This conceptual paper applies systems-led setbacks and social positioning theory to examine how pandemic policies shaped care home management across macro, meso and micro contexts.

Qualitative research evidence relating to care home management during the pandemic was examined using a multi-level thematic analysis. Evidence was organised across six policy domains: hospital discharge, communication with families, personal protective equipment, end-of-life care, testing and surveillance, and vaccine roll-out. Recurring patterns were interpreted through the combined theoretical framework.

Five overarching themes were identified: liminal positioning, accountability displacement, rights erosion, information asymmetries and temporal misalignments. Across all six domains, managers were required to implement complex and frequently contradictory directives while operating with limited authority, incomplete information and insufficient institutional support. System-level decisions therefore interacted with managers' marginal organisational position, amplifying risk for both staff and residents.

Systems-led setbacks and social positioning theory provide greater explanatory depth than conventional policy analysis by showing how structural inequities and positional vulnerabilities compounded pandemic harms. Future preparedness frameworks should explicitly recognise the authority, information needs and institutional position of care home leaders, and involve them directly in policy design and implementation to reduce avoidable harm to people living and working in care homes.

Despite decades of evidence supporting methadone as a life-saving treatment for opioid use disorder, its delivery in the US has been stymied by stigmatizing dispensation policies that are neither evidence-based nor person-centered. Implementation failures and regulatory challenges have resulted in a significant treatment gap in the US and less than 30% of people with OUD enter and remain in treatment. In this article, we provide a historical overview of the methadone treatment (MT) system in the US and outline why it requires de-implementation. We present the COVID-19 public health emergency as a naturalistic experiment in de-implementation, outline evidence from this period on how COVID-19 related flexibilities influenced treatment outcomes and patient experiences and present a de-implementation framework to contextualize these changes while imagining further expansion of de-implementation efforts to support sustained change. We highlight how patient advocacy can shape further de-implementation while noting current threats to progress.

Short-term ambient air pollution is a known trigger for acute cardiovascular and respiratory events. Biochemical markers help reveal pollution-induced physiological changes during emergency presentations, though evidence remains fragmented.

This scoping review mapped existing literature on short-term biochemical responses to air pollution in patients presenting acutely with cardiorespiratory conditions.

Eligible studies were human studies assessing at least one biochemical marker in people presenting to emergency departments after short-term exposure to outdoor air pollution.

Five databases (PubMed, Scopus, Web of Science, Embase, CINAHL) were searched from 2000 to 2025.

Data were extracted using the PCC framework and summarized in structured tables.

Twelve studies met criteria. PM_2.5, PM10, and NO₂ were most frequently linked to inflammatory and coagulative markers such as CRP, IL-6, D-dimer, and troponins, often with effects seen within hours to days.

The mapped evidence suggests that short-term air pollution exposure is associated with acute biochemical alterations. Standardized exposure windows, harmonized biomarker panels, and more detailed subgroup analyses are needed before these markers can support emergency-care pathways and environmental health policy.

Bacterial pneumonia remains a major cause of infectious mortality, and antimicrobial resistance has intensified interest in host-directed therapy (HDT). Recent bronchoalveolar lavage fluid (BALF) and peripheral blood atlases (2024-2025) provide single-cell evidence from human disease, but the main translational gap is prioritization rather than catalog expansion. In this review, we reorganize published datasets from bacterial pneumonia and related lung infection cohorts (>500,000 cells; 2020-2026) into a state-prioritization scheme termed "treatable cell states." Evidence is currently strongest for severity-linked expansion of indoleamine 2,3-dioxygenase 1-positive/programmed death-ligand 1-positive (IDO1+/PD-L1+) macrophages and pathological neutrophils; exhausted-like CD8+ T-cell states show emerging human transcriptomic and translational support but still require protein-level, functional, and longitudinal validation, whereas evidence for injured epithelium and repair-failed stromal states in bacterial pneumonia remains partly inferential and draws on adjacent lung-injury literature. We therefore treat the six proposed state categories as a ranked hypothesis set for macrophage-, neutrophil-, T-cell-, epithelial-, and stromal-directed interventions, not as validated clinical targets. Most proposed interventions still require longitudinal and functional validation before routine bedside use.

Septic shock complicated by acute respiratory distress syndrome (ARDS) and multiple organ dysfunction syndrome (MODS) presents a fundamental therapeutic conflict: shock demands aggressive fluid resuscitation, whereas lung protection requires fluid restriction and a negative fluid balance. We report the precision nursing management of a 79-year-old patient with septic shock, ARDS and MODS who received invasive mechanical ventilation and continuous renal replacement therapy (CRRT). A closed-loop 'monitoring-decision-intervention' strategy was built around electrical impedance tomography (EIT): EIT-guided positive end-expiratory pressure (PEEP) titration optimised respiratory support; during CRRT fluid management, continuous EIT monitoring of ventilation distribution provided early safety warnings regarding lung ventilation; EIT-based position titration established the 45° left lateral decubitus as the optimal ventilation position; real-time EIT imaging localised airway secretions to guide targeted postural drainage; and a prevention protocol for EIT electrode belt-related pressure injuries was implemented. After 10 days of intervention, the PaO₂/FiO₂ ratio increased from 150 to 356 mmHg, and the patient was successfully weaned and extubated. This case suggests that EIT-guided precision nursing may help balance fluid management with lung protection and provide visual guidance for airway clearance and position management; its effectiveness warrants validation in prospective studies. This case provides a reproducible, nurse-led framework that integrates EIT ventilation monitoring to reconcile competing treatment goals in septic shock complicated by ARDS, offering a practical reference for complex critical care nursing.

Pulmonary fibrosis (PF) secondary to Echinococcus granulosus infection is a severe complication with limited therapeutic options. Harmine (HM) exhibits antifibrotic potential but is restricted by significant neurotoxicity. This study aimed to evaluate the therapeutic efficacy and underlying mechanism of HM derivative H-2-104 in a clinically relevant E. granulosus-induced PF mouse model, and to clarify its advantages over parent compound HM.

A mouse model of E. granulosus-induced PF was established, and treated with H-2-104 (25 or 50 mg/kg) or nintedanib for 21 days. Lung function, histopathology, hydroxyproline (HYP), inflammatory cytokines, and fibrosis-related protein expression were assessed. In vitro, human embryonic lung fibroblasts (MRC-5) were activated with TGF-β1 and treated with H-2-104. Cell viability, migration, apoptosis, differentiation, DNA damage, and related gene expression were evaluated.

H-2-104 significantly improved lung function, alleviated pathological damage, and collagen deposition, decreased HYP, TGF-β1, TNF-α, IL-6, and IL-1β, elevated IL-10, and downregulated α-smooth muscle actin (α-SMA), collagen I, and fibronectin. Importantly, H-2-104 showed no obvious neurotoxicity and exhibited better safety than HM. In vitro, H-2-104 inhibited TGF-β1-induced MRC-5 cell viability (IC₅₀ = 13.49 µg/mL), migration, and fibroblast-to-myofibroblast differentiation, while promoting apoptosis along with increased DNA damage in a dose-dependent manner. Additionally, H-2-104 downregulated the expression of fibrosis-related genes and upregulated DNA damage-related genes (H2AX, ATR, and RAD51) in TGF-β1-induced MRC-5 cells.

This study establishes H-2-104 as a promising antifibrotic candidate for E. granulosus-induced PF, using a clinically meaningful parasitic infection-associated fibrosis model. H-2-104 retains strong antifibrotic efficacy while overcoming the neurotoxicity limitation of HM. Mechanistically, the activation of DNA damage response is correlated with the antifibrotic activities of H-2-104, providing a new perspective for targeting fibroblast activation in PF therapy.

International college students in the United States experience unique academic, cultural, financial, and immigration-related challenges that place them at increased risk of adverse mental health outcomes, including stress, anxiety, depression, and suicidal ideation. The COVID-19 pandemic further intensified these challenges through disruptions in education, travel restrictions, social isolation, and uncertainty regarding immigration and visa policies. Although numerous studies have examined international students' mental health during this period, the available evidence has not been comprehensively mapped to characterize the extent, nature, and methodological characteristics of the literature or to identify gaps requiring further investigation.

The objective of this scoping review is to systematically map the available evidence on stress, anxiety, depression, and suicidal ideation among international college students enrolled in US institutions during and following the COVID-19 pandemic, describe the characteristics of the existing literature, and identify knowledge gaps to inform future research, policy, and practice.

This protocol follows the Joanna Briggs Institute methodology for scoping reviews and the methodological frameworks. The completed review will be reported in accordance with the PRISMA-ScR, and the search strategy will be developed and reported following the PRISMA-S recommendations. Electronic searches will be conducted in PubMed (MEDLINE), PsycINFO, CINAHL Complete, Scopus, ERIC, and Web of Science Core Collection for peer-reviewed English-language studies published between January 1, 2020, and December 31, 2025. Eligible studies will include quantitative, qualitative, and mixed methods research examining stress, anxiety, depression, or suicidal ideation among international college students enrolled in US institutions. The 2 independent reviewers will screen studies, extract data on study characteristics, participant demographics, mental health outcomes, measurement instruments, COVID-19-related contextual factors, and key findings, and synthesize the evidence using descriptive and narrative approaches. Consistent with scoping review methodology, no formal risk of bias assessment will be conducted.

The a priori protocol for this unfunded scoping review was registered with the Open Science Framework. We conducted the review from December 25, 2025, through April 17, 2026. After protocol registration, we added 2 additional reviewers to assist with study screening and data abstraction. After screening, 253 records underwent further eligibility assessment, and 16 studies met the eligibility criteria for inclusion. Data analysis and synthesis are complete, and the findings and discussion are being revised and formatted for manuscript submission. Publication of the completed review is tentatively anticipated by December 31, 2026.

This scoping review will provide the first comprehensive evidence map of stress, anxiety, depression, and suicidal ideation among international college students enrolled in US institutions during and following the COVID-19 pandemic. The completed review will identify research gaps, summarize methodological trends, and provide evidence to inform future investigations, institutional initiatives, and policies aimed at improving mental health support for international college students.

Avian influenza viruses (AIVs) continue to circulate in live poultry markets (LPMs), posing potential risks for zoonotic exposure. This study investigated the environmental circulation of AIVs and their potential epidemiological associations with human infection in Henan Province, China.

We analyzed 7,956 environmental samples collected from poultry-associated settings in Henan Province between 2020 and 2025. Multivariable logistic regression was used to identify factors associated with AIV detection. Serological surveillance was conducted among occupationally exposed individuals, and phylogenetic analyses were performed to characterize the genetic relationships between human-derived and environmental AIVs.

A total of 1,460 samples (18.35%) tested positive for AIVs. LPMs were significantly associated with higher odds of AIV detection (OR = 7.211, 95% CI: 5.039-10.319, P < 0.001), and the odds of AIV detection increased over the surveillance period (OR = 1.254, 95% CI: 1.210-1.301, P < 0.001). Multiple AIV subtypes were detected, with H9N2 remaining predominant throughout the study period. Five human infections were identified, including H5N6 and H3N8 infections in 2022 and three H9N2 infections in 2025. Serological surveillance identified H9N2-seropositive and H3N8-reactive samples among occupationally exposed individuals. Phylogenetic analyses revealed genetic similarities between human-derived and environmental viruses. Three H3N8 viruses, including one isolated from a human case, formed a distinct phylogenetic cluster, with their internal genes closely related to co-circulating H9N2 viruses.

These findings demonstrate sustained circulation of multiple AIV subtypes in poultry-associated environments and highlight the importance of integrated environmental and human surveillance for the early detection of viruses with zoonotic potential.

To analyze the association between fatigue, self-care, and sociodemographic and clinical variables in patients with heart failure.

A cross-sectional and correlational study, conducted at a university hospital in the Northeast region of Brazil. The Brazilian versions of the Dutch Fatigue Scale, Dutch Exertion Fatigue Scale, and the European Heart Failure Self-care Behavior Scale were used. The analysis included descriptive statistics and Spearman correlation.

Ninety-nine patients with heart failure participated. Substantial fatigue was observed in 71.7% and fatigue on exertion in 66.7% of the sample. The mean self-care score was 28.41 ± 7.98. There was no significant association between fatigue and self-care. A negative correlation was found between age and exertional and substantial fatigue, and a positive correlation was found between the duration of treatment and age. There was a positive correlation between functional capacity, exertional fatigue, and substantial fatigue.

The findings reinforce the importance of symptom awareness and management in self-care. Health interventions are timely for promoting the quality of life of this population.

Transition of care (TOC) is a high-risk period for medication errors as patients move between multiple health care professionals, settings, and changing medication regimens. Ineffective communication systems further increase the likelihood of medication harm and hospital readmission. A TOC service with tailored, patient-specific support may help reduce these risks. Cardiovascular medicines significantly contribute to medication harm, and patients recovering from acute myocardial infarction (AMI) or cardiothoracic surgery (CS) are vulnerable due to complex regimens and frequent medication changes. Pharmacists, as medication experts embedded within cardiology teams, are well positioned to support these high-risk patients, facilitate safer transitions from hospital to home, and provide coordinated postdischarge follow-up.

This study aims to evaluate the impact of a pharmacist-led interdisciplinary TOC service on reducing medication harm for cardiology patients post-AMI or CS.

The study will be conducted in two phases: phase 1-intervention development will combine scoping review findings with stakeholder input to design an evidence-based, cocreated, culturally relevant intervention, underpinned by implementation science. A risk prediction model will be developed and validated to identify AMI/CS patients at high risk of medication-related unplanned readmission within 30 days. Phase 2: the RECARD (Reduce Hospital Readmissions for High-Risk Cardiology Patients) trial will use a pre-post design across 3 Australian tertiary hospitals (2 metropolitan and 1 regional) to compare a retrospective usual care patient cohort (referred to as "pre") with a different prospective patient cohort (referred to as "post") that includes both usual care and intervention AMI/CS patients receiving the TOC service. Only high-risk poststudy patients will receive the intervention TOC service, consisting of an individualized bundle of TOC activities to optimize medication management, while the remaining poststudy patients will receive usual care. A unique feature of the service is its capacity for hospital clinicians to conduct postdischarge home visits for patients needing additional support. The primary outcome for this study is medication-related 30-day hospital readmission. The analysis will consist of multivariable logistic regression. An economic analysis will be conducted to evaluate the costs associated with the intervention and medication-related readmissions. A comprehensive process evaluation will be conducted using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to enable learnings from the trial to inform sustainable improvements in this field. A patient survey will be administered at the end of the trial to assess patient experience and elicit patient preferences using a discrete choice experiment.

The predata are currently being collected for patients discharged from the 3 hospital sites during the 12-month prestudy period. The postdata intervention began on December 10, 2025. As of May 27, 2026, a total of 343 patients have been recruited at the 3 study sites.

The findings of this study will inform future implementation of a sustainable cardiac TOC model within the Australian health care setting.