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Parents are central to keeping children safe when receiving healthcare. National scrutiny of failures to recognise and respond to clinical deterioration in children led to the introduction of Martha's Rule by National Health Service (NHS) England, which formalises families' rights to request an urgent clinical review for children. Given rising paediatric emergency department (ED) attendances and evidence of healthcare-associated harm within EDs, we examined how parents contribute to and mitigate unsafe care in this care context. This was an exploratory multi-method analysis of anonymised paediatric safety incidents from EDs. We sought reports reported by EDs between 2014 and 2020. 4000 reports were reviewed to identify whether a patient safety incident had occurred and whether there was parental involvement to mitigate or contribute to the harm. Reports were categorised by incident type (what happened), contributory (why it happened), mitigatory factors (actions taken to reduce or prevent harm), outcome (patient impact) and harm severity. Of 658 reports that met the definition of a patient safety incident and included parental involvement, 591 (90.0%) described parents mitigating harm and 67 (10.0%) described inadvertent contribution to incidents. Parents most commonly mitigated harms by advocating for their children, prompting reassessments where necessary and supporting care. However, poor communication involving clinical information, particularly allergies or pertinent medical history, contributed to harm, leading to multiple safety incidents, including the administration of contraindicated medication within EDs. Parents are important participants in paediatric safety within EDs, and we have identified diverse ways in which they prevent harm. As policy initiatives formalise escalation pathways, healthcare systems must strengthen mechanisms to support partnership working with families across healthcare settings, while addressing paediatric vulnerabilities that contribute to harm.

Group VIA calcium-independent phospholipaseA2 (iPLA2β or PLA2G6) is a homeostatic enzyme involved in basal glycerophospholipid metabolism. The mutations in the PLA2G6 gene lead to heterogenous neurodegenerative disorders. Global PLA2G6 inactivation in iPLA2β-null mice exhibited liver fibrosis and intestinal atrophy when they reached an advanced age at 20-22 months old. Here, we analyzed the phenotypes of iPLA2β-null mice which happened to be exposed to natural pathogens in our animal facility. Compared with wild-type, male iPLA2β-null mice at 9-14 months of age exhibited reduced body, liver, and subcutaneous fat weights concomitant with decreased hepatic triacylglycerol and decreased expression of de novo lipogenesis genes. Hepatocytes from male mutants were sensitive to apoptosis induced by palmitic acid. Male but not female mutants displayed attenuation of hepatic lipid synthesis; however hepatic fibrosis was increased in mutants of both sexes. Hepatic apoptosis was also increased in mutants of both sexes, and they were susceptible to endotoxin-induced liver injury. Hence, global PLA2G6 inactivation combined with natural infection accelerates progression of chronic liver disease in both male and female mice with male-biased alteration of hepatocellular glycerolipid metabolism.

Perceptual distortions are widely observed in various psychiatric diseases, including Autism Spectrum Disorder (ASD). Recent Bayesian models of psychiatric disorders and learning disabilities propose a general theory grounded on the concept of "aberrant precision." However, these models have yet to be used as phenomenological models for visual distortions because previous models usually only deal with a low-dimensional input with Laplace approximation. Such assumptions are necessary for precision to be well-defined; otherwise, the explanation based on aberrant precision was hardly applicable. This study addresses these limitations using the predictive coding-based deep neural network PredNet and a new analysis method inspired by the precision account using the Hilbert-Schmidt Independence Criterion (HSIC). We found that the visual distortion happened when trained with more extended temporal contexts, which was mitigated when we increased the weight of the prediction error of the top layer. From HSIC analysis, we showed that this weight increase enhanced the top-down information flow in prediction, which led to an enhanced ability to capture global features of the visual input, such as rotation and average brightness and hue.

Beyond its efficacy on atrial fibrillation, pulsed field ablation (PFA) presents potential advantages in ventricular arrhythmia. This study sought to investigate the feasibility of PFA for ventricular tachycardia (VT) and premature ventricular complexes (PVC). A systematic search (Scopus, PubMed, and Science Direct) with citation searching was performed on 9 January 2026. Studies evaluating the feasibility of PFA in VT and PVC were included. This study included seven studies (74 patients with VT and 86 with PVC). Pooled acute procedural success rate in VT was 0.92 (95% CI: 0.86-0.99) and in the PVC was 0.93 (95% CI: 0.86-1.00). During follow-up, VT recurrence rates ranged from 20% to 54%. PVC ablation demonstrated a significant burden reduction (MD: 86.54%; 95% CI: 59.21-113.86; p = 0.005) with long-term success rates ranging from 50% to 85%. Safety evaluation demonstrated satisfactory outcomes, with major adverse cardiovascular events (MACE) during follow-up occurring in four patients with high-risk comorbidity. Major adverse events (AEs) occurred in 11 patients and were preventable; minor AEs consisted solely of vascular access site AEs. PFA was feasible for VT and PVC ablation. Larger long-term studies and standardized protocol were urgently necessary to ensure efficacy with minimal AEs. www.crd.york.ac.uk/prospero identifier is CRD420251272352. Pulsed field ablation (PFA) is a newer technology for abnormal heart rhythms. It uses electrical pulses to treat parts of the heart tissue that cause abnormal rhythms. Unlike older treatments, it does not use heat or freezing. In the world, doctors are already used to treating atrial fibrillation. However, less is known about its use for ventricular arrhythmias. These include ventricular tachycardia and premature ventricular complexes. This study reviewed data from seven studies involving 158 patients. The study found that new technology worked well during the procedure in most patients. However, some patients later had the abnormal heart rhythm return, especially those with ventricular tachycardia. In patients with premature ventricular complexes, the treatment lowered the number of extra heartbeats. Serious complications were rare and mostly happened in patients who already had severe health problems. We found that most complications are also preventable by the doctors, although more research needs to be done in this area. Overall, PFA appears to be a promising and feasible technology for these types of heart rhythm disorders.

The recently introduced ROBUST-RCT tool aims to reconcile ease of application with methodological rigor in risk-of-bias assessments for systematic reviews. The tool is structured in two steps: first, evaluating what happened; second, judging the risk of bias related to the assessed aspect of the study. Its straightforward design aims to avoid overly complex workflows. Thus, its usability testing included junior reviewers to ensure accessibility and ease of use. No data regarding its inter-rater reliability are currently available. This study aims to assess the inter-rater reliability of the ratings between junior researchers using the ROBUST-RCT. An inter-rater reliability study. Four junior researchers screened and rated a random sample of 115 articles from a systematic search on PubMed. An additional phase beyond the prospectively defined research phases was introduced to exclude articles in which the two raters assessed different outcomes, resulting in a sample of 85 articles. As pre-specified in the protocol, the primary statistical analysis employed Gwet's AC2 at each step for each core item ("step-level") and at aggregated step 2 ratings ("judgment set") to provide an overview of the final judgment in the tool. Exploratory analyses include Fleiss' Kappa and a block-level approach. Universidade Federal do Rio Grande do Sul, a university in southern Brazil. In the primary analysis, the aggregated data with the step 2 ratings ("judgment set") yielded a Gwet's AC2 agreement coefficient of 0.59 (95% CI: 0.53, 0.65); its inter-rater reliability was classified in Gwet's benchmarking as "moderate or higher". The AC2 agreement coefficient for specific steps was, in some instances, higher in the first step of the tool than in the second. Results on step-level ranged from 0.43 (95% CI: 0.24, 0.62, classified as "fair or higher") in the core item 3 step 2 to 0.78 (95% CI: 0.79, 0.92, classified as "almost perfect") in the core item 1 step 1. The results support the perspective that the ROBUST-RCT is a reliable and straightforward tool for assessing the risk of bias in systematic reviews. Taken together with previous findings, the higher agreement on some items in the first step may support the view that authors of future systematic reviews should transparently report both steps, enabling readers to build their own reasoning from ratings in step 1. Risk of bias tools are instruments used in the synthesis of medical scientific literature to assess whether specific characteristics of clinical trials could affect their results. The ROBUST-RCT is one of these tools and was recently introduced with characteristics that may enable junior researchers to conduct those assessments. This study evaluates the tool's inter-rater reliability, the extent to which users agree in their assessments. A result of 0.00 would mean no better agreement than random data, while 1.00 would suggest perfect agreement - an ideal not often met. In this study, the junior researchers had an inter-rater reliability of 0.59 for the most relevant step of the tool, which is interpreted as at least moderate agreement. Therefore, it supports that the risk of bias could be assessed by junior scientists using the ROBUST-RCT tool.

Acute kidney injury (AKI) commonly occurs after pediatric hematopoietic stem cell transplantation (HSCT) and may lead to increased mortality and long-term kidney complications. However, observational data on the clinical determinants of HSCT-associated AKI remain heterogeneous. This retrospective cohort study included pediatric patients who received HSCT between March 2019 and March 2023 with a minimum follow-up of 6 months. AKI was defined according to KDIGO criteria using serum creatinine. Results were analyzed at both the patient level (incidence, risk factors, and chronic kidney disease outcomes) and the episode level (timing, triggers, KDIGO severity). Multivariable analysis was performed using Firth penalized logistic regression to identify independent predictors of AKI. Of 88 patients screened, 68 were included in the study, with a median follow-up of 23.7 months. AKI developed in 18 patients (26%). Older age (median 151.5 vs. 50 months, p = 0.001), having a malignant indication (OR = 8.00, 95% CI 2.41-26.57, p = 0.001), and using peripheral blood stem cells (OR = 3.56, p = 0.027) were significant predictors in univariate analysis. In Firth penalized logistic regression, only older age remained an independent predictor (adjusted OR = 1.40 per year, 95% CI 1.15-1.69, p = 0.001; C-statistic = 0.912). There were 36 AKI episodes among the 18 patients, with 66.7% of these occurring within the first 100 days. Two episodes occurred on the day of transplantation in patients who received cryopreserved products. Infection/antibiotic exposure was the most common trigger (44%). Most episodes (91.7%) were KDIGO stage 1, while all stage 2-3 episodes happened in patients with GVHD and were always fatal. Four patients developed new CKD, all of whom had previous AKI. No CKD was found in patients without AKI. Hypertension was seen early after transplant in 31% of patients and continued in 9%. In this group, AKI after pediatric HSCT showed a bimodal risk pattern: frequent mild cases triggered by infection within the first 100 days, and rare but always fatal severe cases linked to GVHD. Older age was the only independent predictor in multivariable analysis. All patients who developed CKD had a history of AKI, supporting the link between AKI and CKD in this population. These results suggest that high-risk HSCT patients should have risk-based monitoring, early involvement of nephrology, and use of biomarkers for better surveillance.

On 15 August 2025, a fatal train crash happened in Southern Denmark following a collision with a truck at an unsecured railway crossing, resulting in derailment and one overturned carriage. One person was killed, and 29 people were injured. This case report aims to give a detailed description of the response of emergency medical services to evaluate cross-border and inter-authority cooperation as well as adherence to major incident guidelines and established communication pathways. Initial calls indicated several critical patients and numerous school children on the train. Nineteen Danish and German units, including four helicopters, were dispatched to the scene. Access to the site was restricted to a single narrow countryside road, requiring careful organization of staging areas, access/egress routes, and casualty clearing stations. A Joint Incident Command was formed, and patients were triaged, treated, and registered using an electronic prehospital system allowing for continuous coordination with the dispatch center for hospital allocation. Two critically injured patients were transported by helicopter to two trauma centers in Denmark and Germany, and the remaining patients were distributed across three regional hospitals. The response to this incident largely aligned with national guidelines and cross-border cooperation agreements. However, delays in incident management were identified, and responders criticized infrequent training opportunities for major incidents. The rate of unauthorized radio shifts was lower than previously described. This report describes the response to a major incident, characterized by effective inter-authority cooperation and successful cross-border collaboration between Danish and German emergency services. Routine collaboration during everyday responses proved crucial to ensure efficient collaboration during crises. While adherence to major incident protocols was generally high, challenges remained regarding the site organization and timely establishment of command structures. The observed delays may reflect limited experience with major incident management among regular responders, prompting the need for comprehensive incident command training of prehospital physicians. Compared to previous incidents, communication consistency was notably improved, likely due to dedicated training efforts after prior communication failure. The incident underscored the importance of joint inter-authority response concepts and the central coordinating role of the dispatch center. Enhanced training accessibility and continued evaluation of real-life incidents are recommended to further improve preparedness for future incidents.

Communication about housing, care, and end of life often happens in reaction to, rather than in anticipation of, critical life periods. As such, it is mostly studied in critical situations and clinical contexts, although anticipatory and repeated communication in close relationships may come with unique benefits. We aimed at providing a better understanding of the frequency of anticipatory communication about housing, care, and end of life in romantic partnerships and its immediate behavioral, cognitive, and affective benefits. In this study, 118 individuals, among them 55 couples, aged 63 years on average were surveyed on their anticipatory communication, preparatory behavior, feelings of preparedness, and topic-specific anxiety via questionnaires. For analyses, we applied multilevel modeling. Anticipatory communication happened rarely but was associated with behavioral, cognitive, and affective benefits. More frequent communication about housing was most strongly associated with preparatory behavior. More frequent communication about the end of life was most strongly associated with feelings of preparedness and reduced anxiety. The context of the romantic relationship is particularly promising for anticipatory communication. Anticipatory communication should be enabled and supported. HINTERGRUND: Kommunikation zu den Themen Wohnen, Pflege und Lebensende findet häufig in Reaktion auf statt in Antizipation kritischer Lebensphasen statt. Entsprechend wird sie zumeist in kritischen Situationen und klinischen Kontexten untersucht, obwohl eine antizipative und wiederholte Kommunikation in engen Beziehungen besondere Vorteile hat. Das Ziel war, zu einem besseren Verständnis der Häufigkeit antizipativer Kommunikation zu Wohnen, Pflege und Lebensende in romantischen Beziehungen beitragen und dabei unmittelbare behaviorale, kognitive und affektive Vorteile untersuchen. Insgesamt 118 Personen, darunter 55 romantische Paare, wurden im Alter von durchschnittlich 63 Jahren mit Fragebögen zu ihrer antizipativen Kommunikation, Vorsorgeverhalten, dem Gefühl, vorbereitet zu sein, sowie themenspezifischen Ängsten befragt. Die statistischen Analysen wurden mit Mehrebenenmodellierung durchgeführt. Antizipative Kommunikation fand selten statt, war aber mit behavioralen, kognitiven und affektiven Vorteilen verbunden. Häufigere Kommunikation über Wohnen war am klarsten mit Vorsorgeverhalten assoziiert. Häufigere Kommunikation über das Lebensende war am stärksten mit dem Gefühl, vorbereitet zu sein, und niedrigeren Ängsten verknüpft. Der Kontext romantischer Beziehungen ist besonders vielversprechend für alternsbezogene Kommunikation. Antizipative Kommunikation sollte ermöglicht und unterstützt werden.

Offline reinforcement learning constrains policy optimization within a given dataset, avoiding the high costs and unpredictable risks associated with online sampling in the real world. Model-based approaches provide a promising direction for offline reinforcement learning, as extensive policy explorations and evaluations can happen within the data-driven dynamics model, transcending the limitations imposed by the dataset boundaries. However, accurately predicting long-horizon sequential steps in the learned dynamics model remains a significant challenge. Model roll-out in previous methods relies on bootstrapping prediction, which attributes the next state to the prediction of the current state, leading to error accumulation over time steps. In this paper, we introduce the Any-step Dynamics Model (ADM) that allows for the use of variable-length plans as inputs for predicting future states. Based on ADM, we propose the Hierarchical Roll-out (HiRo) to mitigate the compounding error by reducing bootstrapping prediction to direct prediction. Theoretical and empirical evidence demonstrate that HiRo has stronger long-horizon prediction capabilities than the widely used step-by-step roll-outs based on the single-step dynamics model. Furthermore, leveraging the inherent diverse predictions of ADM, HiRo can offer a better estimation of model uncertainty compared to the ensemble. Ultimately, offline reinforcement learning with HiRo demonstrates superior performance compared to recent state-of-the-art offline algorithms.

The study of causal relationships is central to scientific inquiry. Understanding what disease is, why it arises, and how it can be treated are a set of fundamentally causal questions. In this article, an overview of causal inference is provided for the applied researcher, with an emphasis placed on intuition and the use of examples from periodontology to support understanding. Causal reasoning goes beyond the description of associations, with a focus instead placed on questions of the form: what would happen to an outcome if a particular exposure were changed? Directed acyclic graphs are introduced as tools through which assumptions can be made explicit and structures that may threaten valid causal inference can be identified, including confounding, mediation, and collider pathways. Randomized controlled trials are highlighted as the gold standard of causal evidence, primarily because they ensure that, on average, comparisons are made between like-with-like groups. However, observational data must often be relied upon due to ethical, practical, and logistical constraints. A three-step framework to answering causal questions is presented, based on (i) asking a causal question, (ii) identifying the causal effect, and (iii) carrying out the analysis. Within this context, two principal strategies for causal identification are outlined: design-based identification and adjustment-based identification. It is illustrated that each approach relies on different sets of assumptions to connect observed data to causal effects. The analysis stage carries out a pre-defined associational comparison that is taken to have a causal interpretation under the proposed assumptions. Across all approaches, a central theme is that causal inference is inherently driven by assumptions. The credibility of a causal claim is determined not primarily by the statistical method, but by whether the underlying assumptions are considered plausible within the context of the scientific question.

Black Liberation work focuses on the flourishing of people of African descent across interconnected life components-community, health, education, employment, nutrition, and housing. Because these components are porous, connected systems, Black Liberation and social justice work are projects of system Futures. Yet what justice workers can or cannot imagine is deeply entangled with our experience as parts of these wounded systems. The resilience of systems of injustice has produced a future orientation of Afropessimism and Afronihilism within the African diaspora. White or Eurocentric Futures and design employ an ethics of hope that does not work for communities without hope, making these dominant paradigms exclusive. Futures has always been practiced by communities since the beginning of human and ecological life, especially by oppressed and decolonial movements. Viewing Futures as a spiritual practice, this paper uses a Black Liberation theology lens, informed by intersectional liberation theologies, to critique White Futures practice and its ethics of hope. This paper then presents how Black and underutilized communities that include people without hope practice futurism through an ethics of hopelessness founded in Impossible Futures. Rather than using impossibility as a euphemism or temporary state, Black Liberation and social justice workers mean it literally-a future that will never happen. This practice is called Black Liberation Futures Design, one contextualized glimpse of pluriversal Futures practices. This paper also makes a methodological argument for sociological research on race. Dominant Futures methodologies embed epistemological assumptions-about hope, agency, and linear temporality-that function as hidden scholastic bias, reproducing the racial hierarchies they claim to study or disrupt. Drawing on standpoint theory, Black Liberation theology, and lived experience, this paper shows how researcher positionality and the categories embedded in research practice shape what knowledge about race and racialization becomes possible. Black Liberation Futures Design offers sociology a reflexive, community-rooted methodological alternative for studying race, temporality, and structural oppression.

The rapid expansion of theranostics has increased the stress felt by many nuclear medicine departments. One significant challenge relates to the training of nuclear medicine technology students in new therapy procedures during a time when protocols and expectations are in flux. Nuclear medicine technologist education programs are being asked to graduate fully functional theranostics technologists before the resources for such training are available in the clinical sphere. This article describes the basic parameters under which education programs operate, namely the national scope of practice, programmatic accreditation standards, and credentialing examination content. The approaches and limitations of several programs around the country are presented. Despite considerable variability in the extent of student participation in theranostic procedures, the foundational elements of their nuclear medicine education remain firmly in place and reliable. Graduates will learn the specifics of each procedure in the workplace, as happens with already-credentialed nuclear medicine technologists.

HSK21542 is a novel, peripherally selective kappa opioid receptor (KOR) agonist under development for the treatment of pain and pruritus. This study aimed to develop a liquid chromatography-tandem mass spectrometry (LC-MS/MS) method for quantifying HSK21542 in rat plasma and tissue homogenate. A sensitive LC-MS/MS method using d4-HSK21542 as the internal standard was developed and validated in rat plasma and tissue homogenates. Sprague Dawley (SD) rats received single intravenous doses of HSK21542 at 0.1, 0.3, or 1.0 mg/kg, or repeated intravenous doses of 0.3 mg/kg twice daily for 7 days. Tissue distribution was evaluated after a single intravenous dose of 0.3 mg/kg. The method was fully validated and demonstrated good linearity for rat plasma (0.500 - 500 ng/mL) and rat liver homogenate (2.50 - 2500 ng/g). HSK21542 exhibited high clearance (mean CL 36.0 - 44.7 mL/min/kg), a short terminal half-life (2-3 h), multi-exponential pharmacokinetic characteristics, and dose-proportional exposure, with no pharmacologically significant accumulation after multiple doses. Tissue distribution studies indicated rapid and wide distribution, with the highest concentrations found in the kidney, bladder, and liver. The validated LC-MS/MS method was suitable for preclinical HSK21542 analysis. These pharmacokinetic and tissue distribution profiles provided essential data supporting its further clinical development. HSK21542 is a new medicine being studied for the treatment of pain and itching. Some pain medicines can cause unwanted effects because they act in the brain. HSK21542 is designed to work mainly outside the brain, which may help reduce these unwanted effects. In this study, we first developed a reliable test to measure the amount of HSK21542 in blood and body tissues. We then used this test to study what happens to HSK21542 after it is given to rats through a vein. The results showed that HSK21542 left the blood quickly and moved into different body tissues. Higher levels were found in the kidney and liver. Only very small amounts were found in the brain, suggesting that little of the drug entered the brain. When the drug was given more than once, it did not appear to build up in the body. These findings help us better understand how HSK21542 moves through the body. They also support further study of HSK21542 as a possible treatment for pain and itching with limited effects in the brain.

Theoretical physics shaped much of what eventually strengthened the domain of physics. Will large language models (LLMs), and artificial intelligence (AI) emerge as the primary accelerators for the development of theoretical medicine. The window of opportunity for this to happen is now.

Bacterial translation initiation is a highly regulated process essential for accurate start codon selection and the assembly of an elongation-competent ribosome. Two initiation factors, 1 (IF1) and 3 (IF3), contribute to quality control for formation of 30S preinitiation complex (30S PIC), while the GTPase IF2 facilitates stable initiator tRNA binding and promotes subunit association. However, the molecular mechanism of IF1 action and the regulatory role of IF2-mediated GTP hydrolysis and inorganic phosphate (Pi) release remain poorly understood. Using ensemble cryo-EM integrated with fast-kinetics, we delineate the translation initiation pathway involving IF1 and IF2. We show that IF1 transiently associates with the 30S subunit and interferes with the formation of multiple inter-subunit bridges. IF2 promotes subunit association by stabilizing the 30S PIC through interactions mediated by its N-terminal domains. IF1 departure happens after or concomitant with GTP hydrolysis, following which the inter-subunit bridges establish. Then Pi release triggers remodeling of IF2 followed by its departure from the 70S initiation complex. These findings reveal how the coordinated interplay of IF1 and IF2 with the ribosome ensures translational fidelity and plays crucial role for formation of elongation-competent 70S.

Hematopoietic stem cells are traditionally cryopreserved (CP) until transfusion. Melphalan's half-life is 75&#x202f;min and allows transplantation of fresh non-CP hematopoietic stem cells (HSCs). There are a few studies in lymphoma and myeloma focusing on the role of autologous stem cell transplantation (ASCT) with fresh HSCs. In this single-center study, we aimed to compare the engraftment kinetics of non-CP versus conventional ASCT. Of 125 transplants performed among 121 myeloma patients, 44 were with conventional CP, while 81 were using non-CP products. Four patients with high-risk myeloma received tandem ASCT with non-CP followed by CP products. Non-CP patients compared to CP received similar induction regimens but more frequent Plerixafor (50.6% vs. 19%, p&#x202f;<&#x202f;0.001) resulting in higher CD34 cell mobilization and transfusion (8.32 vs. 5.2&#x202f;&#xd7;10&#x2076;/kg, p&#x202f;<&#x202f;0.001). Neutrophil and platelet engraftments between CP vs. non-CP groups were 11 (9-17) vs. 11.5 (10-19) days (p&#x202f;<&#x202f;0.001) and 11 days (p&#x202f;=&#x202f;0.31) in both, respectively. Complications such as mucositis and diarrhea of all grades were similar, but infusion-related reactions (15.9% vs 2.5%, p&#x202f;=&#x202f;0.009) were more frequent with longer hospital stays (15 vs 14 days, p&#x202f;=&#x202f;0.019) among CP compared to non-CP ASCTs. In conclusion, a statistically significant but clinically not meaningful faster neutrophil engraftment, fewer infusion-related reactions, and one day shorter duration of hospitalization were observed, all in favor of non-CP products, which also happens to coincide with more frequent use of plerixafor in our experience.

Atopic dermatitis (AD) and alopecia areata (AA) are chronic immune-mediated disorders that frequently coexist in the same patient, an observation noted in both pediatric and adult populations. The clinical implications of a patient experiencing both disease states simultaneously underscores the need for a deeper understanding of pathophysiology of both disease states, how to optimally utilize specific therapeutic options to achieve synergistic outcomes, suggest simplified rational approaches to treatment selection, how to integrate care with other specialists when needed, and hopefully reach the ultimate goal of clinicians incorporating more personalized treatment selection through immunophenotype-guided therapy. This article , based primarily on emerging case reports and off-label data, reviews all the above implications when encountering a patient with both AD and AA. Continued research and real-world clinical evidence are needed in this important area that affects many individuals that clinicians encounter in their practice, including within the pediatric population.

In high-stakes domains like medicine, it may be generally desirable for models to faithfully adhere to the context provided. But what happens if the context does not align with model priors or safety protocols? In this paper, we investigate how LLMs behave and reason when presented with counterfactual (or even adversarial) medical evidence. We first construct MedCounterFact, a counterfactual medical QA dataset that requires the models to answer clinical comparison questions (i.e., judge the efficacy of certain treatments, with evidence consisting of randomized controlled trials provided as context). In MedCounterFact, real-world medical interventions within the questions and evidence are systematically replaced with four types of counterfactual stimuli, ranging from unknown words to toxic substances. Our evaluation across multiple frontier LLMs on MedCounterFact reveals that in the presence of counterfactual evidence, existing models overwhelmingly accept such "evidence" at face value even when it is dangerous or implausible, and provide confident and uncaveated answers. While it may be prudent to draw a boundary between faithfulness and safety, our findings suggest that models arguably overemphasize the former.

At times, the psychiatric inpatient system pathologizes patient perspectives as 'lack of insight', framing survival strategies as DSM symptoms. In these moments, power imbalances emerge that risk silencing patients' experiential knowledge. This autoethnography reflects on my journey from invalidated patient to 'knower' to underscore the need for curiosity-driven, person-centred practices that validate lived wisdom in mental health recovery. A first-person autoethnographic narrative draws on lived experience of inpatient care, including periods of compulsory treatment during severe anorexia and post-ECT amnesia, combined with retrospective reflection and critical engagement with psychiatric literature and power dynamics. When patients' voices are ignored, recovery stalls, risking internalized illness identities. Reclaiming narrative through writing enables 'double recovery'-from suffering and systemic marginalization. This fosters equality through questions like 'How do you understand your experience?'-a stark contrast to DSM's symptom-focused framing. Drawing on my experience of inpatient care, mental health nursing can help shift psychiatric practice towards a more collaborative approach that actively incorporates patients' own explanations into assessment, documentation and care planning. This can begin by asking how patients understand what is happening, recording their own explanations alongside clinical observations and co-designing goals that align with patients' priorities. In doing so, staff can better recognize survival strategies as meaningful responses to distress and strengthen trust through more person-centred practice.