Ambulatory oxygen therapy (AOT), defined as the use of oxygen during activities of daily living and exercise, may be prescribed to optimise quality of life and physical activity in people with fibrotic interstitial lung disease (fILD) with exertional hypoxaemia. The aim of this study was to compare patient experiences of ambulatory therapy with oxygen or air delivered via an identical portable oxygen concentrator (POC) in order to understand perceptions of therapy in both active and sham conditions.

A qualitative study using semistructured interviews with open-ended questions was conducted over the telephone.

Participants data were used from a 6-month clinical trial of AOT (NCT03737409) in three hospitals in Australia.

Included participants were randomised 1:1 to receive AOT using a POC (oxygen group) or sham therapy using an identical POC delivering air (air group). Participants were instructed to use the POC whenever they were physically active over 6 months. Participants were blind to group allocation. Interviews were conducted after the intervention period and were recorded and transcribed verbatim, and thematic analysis was used to report on experiences.

23 participants with fILD agreed to be interviewed (12 oxygen group, 11 air group). Participants presented with moderate to severe fILD. Four major themes with subthemes were identified in both groups: benefits of POC use, negative aspects of POC use, equipment features, personal decisions about POC use. Themes and experiences did not differ between oxygen and air groups.

POC use provides benefits and challenges. Shared decision-making and consideration of the balance between perceived benefits and harms are required when prescribing this therapy.

NCT03737409.

Self-care self-efficacy is a key determinant of treatment adherence and long-term disease management among adolescents with cystic fibrosis (CF). However, to the best of our knowledge, no culturally specific and psychometrically validated instrument currently exists to assess this construct among Iranian adolescents with CF. This study aims to develop and validate a theory-informed and culturally appropriate scale to measure self-care self-efficacy in this population.

This protocol describes a sequential exploratory mixed-methods study conducted in two phases. Phase I involves qualitative concept development guided by the Hybrid Model of Concept Development and includes an integrative literature review, semistructured interviews with approximately 15-20 adolescents with CF, and analytical integration to refine the conceptual definition and identify measurable indicators. Phase II focuses on scale development and psychometric evaluation. Items derived from qualitative findings will be assessed for face and content validity. Construct validity will be examined using exploratory factor analysis with about 200 adolescents consecutively recruited from two specialised CF referral clinics located in Mashhad and Ahvaz. Reliability will be evaluated using Cronbach's alpha and test-retest intraclass correlation coefficients. Quantitative analyses will be conducted using SPSS V 29.

Ethical approval has been obtained from the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.NURSE.REC.1403.093). Written informed assent and parental consent will be obtained from all participants. Findings will be disseminated through peer-reviewed publications and conference presentations to inform clinical assessment and intervention planning for adolescents with CF.

This article describes modern strategies for treating acute respiratory distress syndrome (ARDS), with a focus on extracorporeal gas exchange procedures, weaning concepts, and new phenotype-based therapeutic approaches. It highlights key aspects of ARDS treatment based on current recommendations, in particular the new German S3 guideline "Invasive ventilation and use of extracorporeal gas exchange procedures in acute respiratory failure", the American Thoracic Society (ATS) and the European Society of Intensive Care Medicine (ESICM). Venovenous extracorporeal membrane oxygenation (vvECMO) is discussed as a key option for severe ARDS, including indications, complications, technical requirements, and prognostic factors. In addition, the role of ECCO₂R in severe hypercapnia is explained. The second part focuses on a structured weaning process from invasive ventilation, including prerequisites, spontaneous breathing trials, and the management of prolonged weaning. Finally, new developments in the individualization of ARDS therapy are discussed, as biological and radiological subphenotypes demonstrating different responses to therapies may enable future personalized treatment concepts.

Adherence to chronic obstructive pulmonary disease (COPD) self-management plans can improve health outcomes, yet access to pulmonary rehabilitation remains limited. Digital self-management interventions, such as myCOPD, offer a potential means to extend support across care pathways. However, little is known about how these tools are delivered in routine practice or how delivery influences patient engagement across different clinical settings.

This study explored perceived barriers and facilitators to the delivery of and engagement with myCOPD by examining the perspectives of both patients and health care professionals (HCPs) across 2 National Health Service settings.

This qualitative study was conducted between November 2023 and April 2024 across 2 contrasting clinical pathways: community pulmonary rehabilitation and a hospital discharge service following acute exacerbation of COPD. Semistructured interviews were conducted with patients using myCOPD and HCPs involved in its delivery. Topic guides covered health background, digital technology use, and experiences of engaging with the intervention. A convenience sampling approach, with elements of purposive sampling, ensured representation across settings. Clinical data were obtained from health records with consent, and usage data were provided by my mhealth Ltd. Data were analyzed using abductive thematic analysis informed by the Medical Research Council's process evaluation framework.

Thirty interviews were completed (16 patients and 14 HCPs). Patients described how multimorbidity, perceived digital ability, and socioeconomic context shaped their engagement with myCOPD, operating as "layers of vulnerability" that influenced whether COPD self-management could be prioritized. HCPs highlighted organizational and workflow constraints that shaped how the intervention was introduced and supported. Delivery approaches differed markedly between settings: community teams adopted proactive, relationship-based support that enabled iterative discussion, tailored recommendations, and continuity, whereas hospital teams described passive, onboarding-focused delivery shaped by time pressures, staffing constraints, and discharge priorities. These contrasting delivery models influenced engagement patterns, with proactive support associated with more multifaceted engagement (characterized as routine and sustained) and passive onboarding associated with single-aspect engagement (characterized as short-term and transactional). Participants also identified perceived barriers (eg, usability concerns, limited integration with in-person care) and perceived benefits (eg, improved inhaler technique, increased confidence, lifestyle adjustments).

Delivery context and local workflows play a central role in shaping how patients engage with digital self-management tools. Proactive, relational support appears to facilitate deeper and more sustained engagement, whereas passive onboarding may limit the intervention's potential. Implementation strategies should align digital tools with local capacities, staffing structures, and patient characteristics, attending to layered vulnerabilities such as multimorbidity and digital confidence. Further work is needed to understand how proactive delivery models can be resourced and integrated within routine COPD care.

Foodborne diseases remain a significant global public health concern, imposing substantial health and economic burdens. The COVID-19 pandemic altered health care-seeking behaviors, infection control practices, and infectious disease epidemiology; however, its association with microbial foodborne pathogens remains incompletely characterized.

This single-center retrospective study aimed to analyze changes in bacterial and viral foodborne pathogen detection using clinical and etiological data from patients at an infectious diarrhea clinic in a tertiary Beijing hospital over 6 years and to inform prevention strategies in the postpandemic era.

We collected data from patients presenting to the Infectious Diarrhea Clinic of Peking University Third Hospital (a grade A tertiary care center serving the Haidian District and surrounding areas of Beijing) from January 2018 to December 2019 (prepandemic) and from January 2022 to December 2023 (postpandemic). The years 2020 and 2021 were excluded due to major disruptions in clinical services and surveillance during the peak pandemic period. Etiological results were obtained from the Beijing Haidian District Center for Disease Control and Prevention. Diagnostic methods, laboratory protocols, specimen collection procedures, reagent kits, instrumentation, and testing criteria remained consistent throughout the study period. Cases were divided into 2 groups based on time period, and χ2 tests were used for comparisons. The positivity rate was calculated as patients with at least 1 target pathogen detected divided by all patients who provided stool specimens.

In total, 1064 patients were included (561 in group A and 503 in group B). From 2018 to 2019, 155/561 specimens tested positive for foodborne pathogens (27.6%, 95% CI 23.9%-31.3%), including 22 Salmonella, 24 Vibrio parahaemolyticus, 66 diarrheagenic Escherichia coli (DEC), and 43 Norovirus cases. From 2022 to 2023, 82/503 specimens tested positive (16.3%, 95% CI 13.1%-19.5%), including 13 Salmonella, 7 V parahaemolyticus, 45 DEC, and 17 Norovirus cases. The overall positivity rate was significantly lower in the postpandemic period than in the prepandemic period (27.6% vs 16.3%, P<.05). Students and males aged 16-25 years were the most represented demographic groups. DEC remained the predominant pathogen in both periods. The detection rates of V parahaemolyticus, from 24/561 (4.3%) to 7/503 (1.4%) (P=.005), and Norovirus, from 43/561 (7.7%) to 17/503 (3.4%) (P=.002), were significantly lower in the postpandemic period.

Among patients attending a single infectious diarrhea clinic in Beijing, the detection rates of microbial foodborne pathogens were significantly lower in the postpandemic period compared with the prepandemic period. These findings may reflect changes in health care-seeking behavior, infection control practices, food consumption patterns, and/or testing practices during this period; however, this observational study cannot establish causation. Targeted surveillance and health education for students and young adults remain important. These results may not be generalizable to community-level incidence or other settings; further multicenter studies are warranted.

Highly pathogenic avian influenza (HPAI) H5N1 was confirmed in a dairy cows in Texas March 2024 and milk was identified as a critical source of virus spread within and between dairy herds. This study demonstrates that calves fed infected unpasteurized milk from infected cows became infected, showed clinical signs including nasal discharge and increased respiratory effort, and seroconverted. Live virus was persistently detected in nasal swabs, even after calves were transitioned to milk from non-infected cows. This study also demonstrates the presence of neutralizing antibodies in milk provides from protection from infection as an additional group of calves fed milk from infected cows also shedding neutralizing antibodies did not become infected, show clinical signs, or seroconvert. These data demonstrate that milk diverted from the human food supply in H5N1 positive dairy herds or suspect cows should not be fed to calves without pasteurization, as H5N1 may further adapt to the bovine respiratory tract and the risk of calves as a source of farm to farm transmission has not yet been evaluated. As characterization of HPAI in the dairy community continues the determination of routes of transmission is an essential step to inform subsequent research on intervention and vaccination strategies.

We assessed the association between cardiovascular disease (CVD) and cognitive decline in adults aged 50 years or older using pooled data from five multinational cohorts, quantified heterogeneity, and explored its potential sources.

Individual-level data from China Health and Retirement Longitudinal Study (CHARLS), Health and Retirement Study, Survey of Health, Ageing and Retirement in Europe, English Longitudinal Study of Ageing, and Mexican Health and Aging Study (83,159 adults ≥50 years) were pooled. Linear mixed models were used to estimate CVD-cognitive decline associations, followed by random-effects meta-analysis. Heterogeneity was explored via descriptive stratification analyses, subgroup analyses, and sensitivity analyses. In supplementary analyses, we fitted time-varying CVD models, mutually adjusted models for stroke and heart disease, and separate time-varying models for stroke and heart disease as sensitivity analyses.

Substantial heterogeneity across cohorts in the association between CVD and cognitive decline (I² = 97.5%, p < 0.001) was observed. The stratification analyses revealed that CHARLS differed from the other four cohorts across multiple characteristics (region, sex, body mass index, and education). Subgroup and sensitivity analyses generally supported the main findings, although the association reversed in CHARLS when analyses were restricted to participants with CVD not taking medication. Additionally, heart disease correlated with accelerated cognitive decline across four Western cohorts, with heart disease-to-stroke ratios between 1.8:1 and 5.2:1, while stroke alone showed no significant link in any cohort.

The association between CVD and cognitive decline varies markedly across populations, with opposite directions observed between Chinese and Western cohorts. This heterogeneity may be partially explained by variations in the composition of heart disease and the use of medication across five cohorts.

Ischemic stroke is a leading cause of disability and death, and early identification of carotid atherosclerotic plaques is critical for stroke prevention in primary care and community settings. We examined whether artificial intelligence (AI)-enhanced handheld ultrasound (HHUS) could improve carotid plaque detection and stenosis assessment in community-based primary care screening.

We developed a super-resolution reconstruction model (Hyper-CycleGAN) and validated it in a clinical cohort of 127 patients with 198 plaques. The validated model was then applied in a community screening setting with 117 participants and 153 plaques, using portable ultrasound as the reference standard. We evaluated agreement with the reference standard (Bland-Altman, intraclass correlation coefficient) and community diagnostic performance (detection rates, quadratic-weighted Cohen κ, confusion matrices, and standard metrics).

In community screening, AI-enhanced HHUS identified 94.8% of carotid plaques compared with 87.6% using standard HHUS. Agreement in stenosis grading with the reference standard improved, with weighted κ increasing from 0.492 to 0.836. Sensitivity for identifying ultrasound-defined vulnerable plaques increased from 47.4% to 63.2%, and specificity remained high.

AI-enhanced HHUS improved carotid plaque detection and stenosis assessment in community screening, supporting more accurate risk stratification and referral decisions in primary care. This approach could expand access to low-cost stroke prevention strategies in underserved communities.Abstract available in: يبرع (Arabic); (Chinese); Francais (French); Deutsch (German); हिन्दी (Hindi); Indonesian (Indonesian); (Japanese); Portugues (Portuguese); Español (Spanish).

No validated Serbian-language patient-reported outcome measure exists for wrist and hand conditions. The Patient-Rated Wrist/Hand Evaluation (PRWHE) demonstrates superior responsiveness over broader instruments such as the Disabilities of the Arm, Shoulder, and Hand (DASH) for pathology confined to the wrist and hand.

To translate, culturally adapt, and validate the PRWHE for Serbian-speaking patients with hand and wrist disorders.

Clinical measurement, cross-sectional validation study.

One hundred sixty-three patients (52.1% male; mean age 52.4 ± 15.8 years) with hand and wrist conditions were enrolled. Translation adhered to internationally accepted cross-cultural adaptation guidelines. Participants completed the Serbian PRWHE, DASH, and SF-12. Internal consistency (Cronbach's α), test-retest reliability (ICC; n = 15, 2-week interval), confirmatory factor analysis, and convergent validity (Pearson/Spearman correlations) were assessed.

Internal consistency was excellent for the Pain (α = 0.90) and Function (α = 0.94) subscales. Test-retest reliability was excellent (ICC = 0.96; 95% CI: 0.92-0.98; p < 0.001), with no systematic bias on Bland-Altman analysis (p = 0.550). Confirmatory factor analysis confirmed the two-factor structure with satisfactory loadings (range: 0.73-0.93; RMSEA = 0.09; CFI = 0.95). Convergent validity was supported by significant correlations with the DASH (r = 0.23, p < 0.001) and moderate negative correlations with the SF-12 Physical Component Summary (r = -0.33 to -0.43, p < 0.001).

The Serbian PRWHE demonstrates strong psychometric properties and is a valid, reliable instrument for assessing pain and functional disability in wrist and hand conditions. Its availability enables standardized, patient-centered assessment in Serbian-speaking populations and supports cross-cultural research in hand therapy.

Congenital heart disease (CHD) remains a leading cause of neonatal morbidity and mortality worldwide, with a significant proportion of cases remaining undetected before birth. While pediatric cardiologist-performed echocardiography represents the diagnostic gold standard, access to specialist services is limited across many neonatal care settings globally. Neonatologist-performed point-of-care echocardiography has emerged as a bedside diagnostic tool; however, the evidence supporting its diagnostic performance and clinical impact requires systematic evaluation.

To systematically review the diagnostic performance and clinical impact of point-of-care echocardiography performed by neonatologists or trained non-cardiologist clinicians for the early detection of cardiac lesions in neonates across diverse clinical settings.

A systematic search of PubMed and Google Scholar was conducted in April 2026, supplemented by reference list screening of all included studies (198 additional records screened), forward citation searches (32 additional records), and a supplementary Embase search conducted in August 2026 in response to peer review. Studies evaluating neonatologist-performed echocardiography in neonates aged 0-28 days, reporting diagnostic performance metrics or clinical impact outcomes with a cardiologist comparator or confirmed diagnosis as reference standard, were included. Methodological quality was assessed using the QUADAS-2 tool. Due to substantial clinical and methodological heterogeneity, findings were synthesized narratively in accordance with PRISMA 2020.

Thirteen primary studies (2008-2026, including two ahead-of-print articles) from eleven countries encompassing over 31 800 neonates were included and synthesized across three domains: diagnostic performance and agreement, CHD detection capability, and clinical impact. Concordance between neonatologist and cardiologist echocardiography ranged from 91.15% to 97.9% (kappa 0.68-0.862). One population-based screening study reported sensitivity of 92% and specificity of 99.6%. No cases of missed major or critical CHD were reported in the included studies, although evidence remains limited and predominantly retrospective. Neonatologist-performed echocardiography was associated with management changes in 48%-66% of consultations involving structural or mixed cardiac assessment, and in up to 79% of consultations addressing hemodynamic indications alone (patent ductus arteriosus, pulmonary hypertension, systemic hypotension). Formal diagnostic accuracy data were limited to one study, and heterogeneity precluded meta-analysis.

Current evidence supports moderate-to-high diagnostic agreement and potential clinical utility of neonatologist-performed point-of-care echocardiography for identifying major and critical neonatal cardiac lesions. Evidence suggests this modality may be most appropriately utilized as an initial bedside triage and rule-in tool in settings where immediate pediatric cardiology access is limited. However, robust diagnostic accuracy data remain limited, and high-quality prospective multicenter validation studies are urgently required before definitive conclusions can be drawn.