Rapid and accurate identification of respiratory pathogens and antimicrobial resistance is essential for optimizing antimicrobial therapy in pneumonia. Conventional culture-based diagnostics are limited by delayed turnaround times and reduced sensitivity, particularly after prior antibiotic exposure. The BioFire FilmArray Pneumonia Panel enables rapid multiplex detection of respiratory pathogens and antimicrobial resistance genes directly from clinical specimens.

To evaluate the diagnostic performance and clinical impact of the BioFire FilmArray Pneumonia Panel in hospitalized patients with pneumonia.

We conducted a retrospective observational study comparing the diagnostic performance of the FilmArray Pneumonia Panel with conventional culture using 558 bronchoalveolar lavage and sputum specimens collected between December 2022 and December 2023. Diagnostic performance, pathogen detection, antimicrobial resistance genes, and polymicrobial detection patterns were evaluated. The clinical impact of FilmArray implementation was also assessed in 494 hospitalized patients by comparing antibiotic management and clinical outcomes between the FilmArray period and pre-implementation period (January to November 2022). Multivariable regression analyses were performed to adjust for baseline differences.

The FilmArray panel detected a broad spectrum of bacterial pathogens, respiratory viruses, and antimicrobial resistance genes, with a substantial proportion of specimens being culture-negative but FilmArray-positive, particularly sputum specimens. Compared with the pre-implementation period, the FilmArray period showed a significantly higher frequency of result-driven antibiotic actions (40.5% vs. 26.5%; adjusted odds ratio, 1.86; 95% confidence interval [CI], 1.24-2.79; P = 0.003) and a shorter time from microbiological result reporting to antibiotic action (adjusted mean difference, -0.59 days; 95% CI, -1.07 to -0.10; P = 0.019). Measured from specimen sampling, the interval to the antibiotic action was more than three days shorter (adjusted mean difference, -3.53 days; 95% CI, -4.08 to -2.99; P < 0.001), reflecting the faster turnaround of the panel (median, 0 vs. 3 days). Hospital length of stay was also shorter (adjusted mean difference, -1.61 days; 95% CI, -3.07 to -0.15; P = 0.031). However, total antibiotic exposure was modestly longer (adjusted mean difference, 1.86 days; 95% CI, 0.29-3.44; P = 0.021), and antibiotic de-escalation rates did not differ significantly between the two periods.

The BioFire FilmArray Pneumonia Panel improved pathogen detection and facilitated earlier and more frequent microbiology-guided antibiotic management, and was associated with a modest reduction in hospital length of stay. However, it modestly increased overall antibiotic exposure and did not increase antibiotic de-escalation. Rapid molecular diagnostics may improve the timeliness and precision of antimicrobial therapy, but their full clinical benefit is likely to be realized only when they are used as a complementary tool alongside conventional microbiological methods and integrated within a structured antimicrobial stewardship program.

Breaking bad news is a core component of emergency care, but the emergency department (ED) environment of urgency, crowding, and limited privacy presents challenges for sensitive communication. Many communication frameworks originate from other specialities, but the ED has limited evidence and guidance tailored to its context.

This scoping review aimed to map the extent, nature, and characteristics of the literature on delivery of bad news in EDs, including terminology, frameworks, stakeholder perspectives, barriers and facilitators, educational resources, reported metrics, and evidence gaps.

The review followed Joanna Briggs Institute (JBI) methodology and was prospectively registered on the Open Science Framework (OSF https://osf.io/f6q59/overview). Four databases (MEDLINE, EMBASE, EMCARE, CINAHL) and grey literature sources were searched in July 2025. Eligible sources included empirical studies, training evaluations, reviews, guidelines, consensus statements, editorials, commentaries, opinion pieces, educational articles, conference abstracts, and relevant grey literature reporting on adult patients, relatives, or clinicians in ED contexts. Data were charted and synthesised narratively.

From 7985 records, 156 publications were included. Studies originated from 26 countries, though the United States of America (USA) (n = 85) and United Kingdom (UK) (n = 18) dominated the literature. There was a rise in publications from 2010, particularly post-COVID-19. Twenty-five communication frameworks were identified; most were adapted from oncology (with SPIKES most frequently cited). Three frameworks developed specifically for ED practice (GRIEV_ING, 8S, EMTalk) were identified. Stakeholder perspectives were unevenly represented, with a predominance of healthcare professional perspectives. Reported metrics centred on clinician confidence; patient- and family-centred studies were uncommon. Barriers to effective communication consistently included time scarcity, lack of privacy, and insufficient training.

Research on delivering bad news in EDs is dominated by educational and simulation-based studies, and is largely clinician-centred, with limited evidence of patient and family perspectives, with no studies examining long-term outcomes. Reliance on frameworks from other specialties risks overlooking the contextual specifics of emergency care. Future research should prioritise ED-centred frameworks, patient outcomes, and systemic enablers to support compassionate, effective communication in this demanding environment.

Many acute respiratory failure (ARF) survivors develop psychiatric sequelae. Inpatient psychologic distress is an important risk factor.

Evaluate ARF survivors' perspectives on patient-centered communication and its relationship to the inpatient psychologic experience.

A mixed methods prospective observational study involving one survey and a semi-structured interview administered within 6 weeks of discharge to ARF survivors from two hospitals in the same system (August 2024 to December 2025). ARF was defined as greater than or equal to 24 hours of mechanical ventilation, high-flow nasal cannula, or noninvasive positive pressure ventilation. Fifty-six survivors were enrolled; 20 participated in interviews. Twenty-four survivors (43%) were male, 28 survivors (50%) were identified as Black or African American, 25 survivors (45%) were White, and three survivors (5%) were Hispanic. ARF was most commonly due to respiratory (50%), cardiovascular (23%), or gastrointestinal (7%) disease. Forty-three participants (77%) were mechanically ventilated.

Qualitative interviews were analyzed using grounded theory. Quantitative measures included the "Heard and Understood" (H&U) measure, the Hospital Anxiety and Depression Scale, the Impact of Events-6 Scale, a 0-100 visual analog scale measuring perceived health, and the EuroQol-5 dimension quality of life measure. Associations between H&U measure responses and mental health outcomes were tested using the Wilcoxon rank-sum and chi-square tests.

Patient-centered communication was characterized by meaningful interpersonal relationships, transparent and responsive communication, effective healthcare dynamics, and timely care. Communication perceived as patient-centered improved psychologic well-being, uncertainty tolerance, and engaged shared decision-making. Twenty-one of 56 (38%) participants felt "completely" H&U. Those who did had lower anxiety (4 [1-6] vs. 7 [5-10]; p < 0.01) and depression (6 [5-10] vs. 10 [7-13]; p = 0.02) scores, greater perceived health (80 [70-90] vs. 60 [43-78]; p < 0.01), and greater health-related quality of life (0.84 [0.62-0.94] vs. 0.55 [0.29-0.72]; p < 0.01).

Patient-centered communication may improve psychologic well-being in ARF survivors while admitted and after discharge.

Rural hospital closures in the US have accelerated since 2010, with Texas experiencing more rural closures than any other state. Whether closures are associated with population-level mortality remains unclear, and rural hospital closures in Texas have not been examined.

To examine the association between rural hospital closures in Texas and county-level mortality from 4 time-sensitive conditions: acute myocardial infarction, stroke, sepsis, and asthma or chronic obstructive pulmonary disease.

This county-year cohort study of Texas counties used 2 complementary difference-in-difference study designs with data from January 1, 2006, to December 31, 2019. Statistical analyses were performed from November 2025 to June 2026.

Residence in a county where a rural hospital closed or in the nearby affected area, assessed using 2 designs: adjacent-county exposure (a closure county or a county bordering a closure county) and Hospital Service Area (HSA)-based exposure (a county being within an HSA where a closure occurred).

The main outcome was annual deaths per 100 000 residents from time-sensitive conditions (acute myocardial infarction, stroke, sepsis, and asthma or chronic obstructive pulmonary disease). County-level mortality rates were compared for treated and control counties for 3 to 5 years before and after closure. Regressions were adjusted for county fixed effects, year fixed effects, and time-varying sociodemographic county characteristics.

In the sample of 175 counties (71 treated and 104 control counties in the adjacent-county design and 53 treated and 122 control counties in the HSA treatment design), 14 rural hospitals (approximately 8% of rural hospitals in Texas) closed during the study period. Closures were associated with 12 additional annual time-sensitive deaths per 100 000 residents in an affected county (adjacent-county treatment: average treatment effect on the treated [ATT], 11.60 [95% CI, 4.62-18.58]; P = .001; HSA treatment: ATT, 11.52 [95% CI, 0.46-22.58]; P = .04). This represented a 5.4% increase compared with the baseline mortality rate in affected counties. Estimates were robust to several sensitivity analyses. Supplementary analyses suggested that mortality associations were concentrated in acute emergencies, persisting under an alternate definition of time-sensitive conditions (adjacent-county ATT, 8.21 [95% CI, 2.08-14.34] per 100 000 residents) but not under a broader definition (adjacent-county ATT, 6.85 [95% CI, -2.31 to 16.01] per 100 000 residents).

In this cohort study, rural hospital closures in Texas were associated with increased population-level mortality from time-sensitive conditions. The findings suggest that there were adverse patient outcomes in the aftermath of rural hospital closures, emphasizing a need to manage the emergency response and the progressive deterioration of clinical infrastructure and patient health.

Thyroid eye disease (TED) is an autoimmune disorder commonly associated with hyperthyroidism of Graves' disease. The global outbreak of SARS-CoV-2 resulted in an unparalleled public health emergency. The rapid development and widespread administration of COVID-19 vaccines were instrumental in controlling viral transmission and decreasing severe disease outcomes and deaths. Although these vaccines have demonstrated strong safety and effective prevention, isolated cases of uncommon adverse events have been reported. Notably, instances of new-onset or worsening autoimmune disorders, including TED, after vaccination have drawn considerable research interest. In this review, we describe the common risk factors (age, sex, genetics, ethnicity, dysthyroid status, high serum cholesterol, oxidative stress, pregnancy, psychological stress, radioiodine therapy, trauma, systemic disease, and virus) of TED and outline the constituents of COVID-19 vaccines and the current global vaccination scenario. We further explain autoimmune mechanisms as central drivers of classical TED, particularly through the activation of autoreactive T-cells and the production of autoantibodies targeting shared antigens in orbital fibroblasts, leading to inflammation, tissue remodeling, and orbital expansion. Besides, we discuss molecular signaling (MAPK, PI3K/Akt, NF-κB, and JAK/STAT) implicated in TED. Moreover, we critically examine published case reports (n = 30) to identify shared features and potential factors associated with the onset of this autoimmune condition. We delineate the autoimmune-mediated molecular mechanisms in the development of COVID-19 vaccine-associated TED. The therapeutic management approaches and clinical outcomes related to COVID-19 vaccine-associated TED are also thoroughly examined and discussed. Improved understanding of these mechanisms may refine patient risk stratification, optimize clinical management, and inform vaccination strategies.

ObjectiveMachine learning is increasingly integrated into safety-critical domains such as medical applications. In this context, regulatory frameworks require the assessment and minimization of risks associated with incorrect model predictions. However, classical evaluation methods often focus on quantifying error frequencies, which do not reflect the heterogeneous impact of different types of errors. To address this deficiency, we elaborate an approach for assessing machine learning-based multiclass classification models that conforms to regulatory requirements in the field of medical devices. Additionally, we aim to demonstrate its applicability in a concrete application scenario as an exemplary reference.MethodsHerein, we provide weighted balanced accuracy WBAn as a risk-based approach for assessing machine learning models for multiclass classification. WBAn is systematically based on regulatory requirements for medical devices. It incorporates core properties such as the representation of risks as a multiplicative combination of likelihood and severity and the relationship between development and real-world scenarios. We demonstrate the application of WBAn using X-ray based detection of lung diseases as a reference scenario.ResultsOur analysis shows that WBAn achieves a risk-based assessment in the lung disease scenario as a reference. WBAn systematically operationalizes the definition of risk from corresponding regulatory requirements and allows the assessment to be adapted according to risk levels that have to be elaborated in the context of the risk-management process.ConclusionAlthough this study uses only a single use case to demonstrate the practical applicability of our approach, it shows the impact of a risk-based approach when assessing the performance of machine learning multiclass classification models in medical applications. Without such an approach, regulatory requirements cannot be implemented in a fully comprehensive way. Consequently, the clinical impact cannot be adequately assessed when applying the model in real-world scenarios.

To better understand the palliative care needs of people with serious and/or chronic conditions, and their families, in humanitarian settings in low-and middle-income countries between 2012 and 2022.

A systematic scoping review methodology was employed to enable a wide-ranging search of this under-researched area. Databases and websites were systematically searched, in addition to correspondence to key experts.

Eighty-eight documents were included, comprising 63 publications in peer-reviewed journals, 5 conference abstracts, 4 conference posters, 7 case reports, 5 reports, 2 research snapshots, 1 survey report, and 1 master's thesis. The majority of literature was from the Public Health Emergency setting including 42 documents related to COVID and 30 to Ebola. Significantly less literature was identified from other settings: refugee populations (n = 10), multiple settings (n = 3), natural disaster contexts (n = 2), and conflict settings (n = 1). Sixty-four documents considered patient needs, 17 considered combined patient/family needs and 7 focused on family needs. Forty-six documents focused on adults, 25 on adults/children, 6 on children with 11 having no age specification. Findings from individual humanitarian contexts were mapped to palliative care domains and themes presented narratively.

The literature from Public Health Emergencies (Ebola and COVID) overshadowed other humanitarian contexts, demonstrating the comparative paucity of research in refugee, natural disaster, and conflict settings. The voice of children appeared under-represented, as did the perspective of family/caregivers. While there was strong research on pain and physical symptoms, holistic needs were also identified, highlighting the diversity of palliative care needs in humanitarian settings.

Involving individuals with lived experience in the evaluation process is essential. Little research or evaluation to date has assessed member perceptions of their participation in this process over time, and how those findings were used to adjust community engagement activities. In July 2020, a philanthropic funder collaborative funded the implementation of a racial equity and COVID-19 initiative in Chicago. A community engagement model was implemented to incorporate community voice and assist in guiding the evaluation of the initiative. The model included a community advisory council composed of members living and working in Black and Brown communities experiencing the highest rates of COVID-19 mortality in Chicago.

A longitudinal mixed-methods evaluation was conducted to understand implementation of the community engagement model.

Data were collected from community advisory council members in a biannual online survey and quality improvement and evaluation interviews from December 2020 to July 2023.

Evaluation interviews revealed that members felt a sense of connectivity with others, but also noted a need for more inclusion of community voice in dissemination efforts and opportunities to engage with initiative funders.

This evaluation of a community advisory council highlights the importance of monitoring individual community members' experiences for short-term quality improvements and multiple evaluation approaches to build a long-term, sustainable community engagement model.

Allergic rhinitis is a common chronic inflammatory disease affecting millions of people worldwide and substantially impairing quality of life. This study aimed to investigate the association of the IL-4 rs2243250 polymorphism with allergic rhinitis, inflammatory markers, and leukocyte profiles.

A total of 182 participants were included, comprising 91 patients with allergic rhinitis and 91 healthy controls. Peripheral blood samples were collected for complete blood count, DNA extraction, and measurement of IL-4, IL-13, and IgE levels using enzyme-linked immunosorbent assays. Skin prick testing for weed, grass, tree, and mite allergens was performed to confirm IgE-mediated sensitization. The IL-4 rs2243250 polymorphism was detected by polymerase chain reaction followed by restriction fragment length polymorphism analysis using the AvaII restriction enzyme.

Significant differences (P < 0.001) between patients and controls were observed for all investigated immunological markers and differential white blood cell counts. For rs2243250, the CC genotype was associated with a reduced likelihood of allergic rhinitis (OR = 0.25; 95% CI: 0.11-0.55), whereas the TT genotype was associated with an increased likelihood (OR = 3.8; 95% CI: 1.82-8.17). Similarly, the C allele was associated with reduced disease likelihood (OR = 0.35; 95% CI: 0.23-0.53), while the T allele was associated with increased likelihood (OR = 2.88; 95% CI: 1.88-4.41; P < 0.001). Significant positive correlations among several white blood cell types were also observed.

The findings demonstrate an association between the IL-4 rs2243250 polymorphism and allergic rhinitis. The C allele and CC genotype were associated with reduced disease likelihood, whereas the T allele and TT genotype were associated with increased likelihood. These genetic associations, together with alterations in inflammatory markers and leukocyte profiles, may contribute to understanding susceptibility to allergic rhinitis.

:Alpha-1 antitrypsin deficiency (AATD) is a rare genetic disorder mainly affecting the lungs and liver, but its psychological, functional, and relational burden remains insufficiently characterizedcharacterised.

To describe emotional distress, health-related quality of life, interpersonal and sexual difficulties, and daily functional limitations in individuals with AATD.

We conducted a cross-sectional online survey in Italy between October and December 2025 among individuals with AATD. Socio-demographic, clinical, and psychosocial data were collected using an ad hoc questionnaire, the Hospital Anxiety and Depression Scale (HADS), and the 12-item Short Form Health Survey (SF-12). HADS subscales were reconstructed from item-level responses, applying reverse scoring where appropriate.

The study included 130 participants (mean age 56.3 ± 13.5 years; 53.8% female). Pulmonary involvement was the most frequent manifestation (68.5%). Disease-related limitations were reported in daily functioning by 57.7% and in social participation by 53.1%. Clinically significant symptoms were present in 46.2% for anxiety and 17.7% for depression. The SF-12-derived ad hoc unweighted physical and mental descriptive composites were 56.68 ± 27.47 and 54.53 ± 26.91. Women reported higher anxiety and poorer mental-composite scores, while participants receiving augmentation therapy showed worse depressive and perceived-health burden. Sexual-life changes were reported by 37/96 partnered participants (38.5%). Fifteen of 128 respondents (11.7%; two preferred not to answer) reported current psychological support. In exploratory covariate-adjusted models, functional and perceived-health correlates remained associated with clinically significant anxiety.

In this cross-sectional survey, respondents with AATD reported substantial emotional, functional, and relational burden, while few were receiving psychological support. The self-selected sample and absence of a non-AATD comparison group preclude causal or disease-specific inference; the findings support evaluation of brief psychological screening and defined referral pathways in multidisciplinary AATD care.