Isolated lung perfusion for targeted therapies: applications in acute respiratory distress syndrome, acute lung injury, and transplantation

Isolated lung perfusion (ILP) is a platform equipped for localized delivery, assessment, and optimization of lung-targeted therapies to manage acute respiratory distress syndrome (ARDS), acute lung injury, and transplantation. Here we review platform capabilities, therapeutic potential, and translational pathways with particular focus on ARDS. A systematic search was performed in the PubMed database to identify relevant works. From this comprehensive review, we discuss the historical application of ILP in lung transplantation and thoracic oncology, and its progression to treating acute lung injury. Recent preclinical studies have demonstrated the efficacy of pharmacological interventions, gene therapy, and cell-based approaches delivered via ILP. Molecular investigations have revealed mechanisms underlying ILP effects, including modulation of inflammatory pathways, enhancement of cellular repair processes, and activation of tissue protection mechanisms. Significant technical refinements have extended perfusion durations, improved monitoring capabilities, and enhanced delivery systems. ILP has surfaced as the ideal platform for precision medicine approaches to ARDS management. Despite significant advances, challenges to clinical translation persist. Issues of standardization, cost analysis, and minimally invasive techniques need to be addressed to continue expanding in diagnostic utility and therapeutic benefit with a focus on personalized approaches based on ARDS etiology and patient-specific biomarkers.

Evaluation of drug-drug interactions associated with metamizole in clinical practice

Metamizole, a non-steroidal anti-inflammatory drug and moderate inducer of cytochrome P450 enzymes (CYP3A4, CYP2B6, CYP2C19), has gained increased use in clinical practice. This retrospective study evaluates the number of drug-drug interactions (DDIs) associated with metamizole when prescribed for ≥24 h. Data were collected from the electronic healthcare records of adult patients prescribed metamizole at Tergooi Medical Center between June 2017 and May 2024. Relevant DDIs with metamizole were identified using the Metamizole DDI Manager developed by Global DDI Solutions. Only clinically relevant, i.e. orange (action may be needed) and red (contra-indicated), DDIs that occurred during or within seven after discontinuation of metamizole treatment in a hospital setting were considered. A total of 37,110 unique patients received at least one metamizole prescription of which 2.6% (n = 968) were treated for ≥24 h. Of these, 98.6% (n = 954) were prescribed at least one interacting medication. In total, 3680 DDIs were identified, corresponding to an average of 3.8 DDIs per metamizole prescription. Of the 98 interacting medications identified, 95% were classified as orange, and 5% as red. In conclusion, metamizole is associated with a many DDIs in clinical practice. This highlights the need for careful monitoring when prescribed.

Crisis Reporting and Professionalism in Journalism: An Analysis of Reporting Practices in Cameroon and Nigeria

This study examines the dynamics of journalistic professionalism in crisis reporting in Nigeria and Cameroon: countries which have experienced sustained violent secessionist crises since 2015 and 2016 respectively. These crises have led to new approaches to crisis reporting, in which local journalists cover events amid severe violence and the strong nationalist ideologies typical of secessionist movements. Using an innovative mixed method that combines regression analysis and fuzzy set qualitative comparative analysis (fsQCA), the article explores the nuances of journalistic professionalism in the reporting of these crises through a survey of 302 journalists from the secessionist regions in these countries. With professionalism operationalized through objectivity, the regression analysis revealed the use of emotions , the inclusion of ideologies on nationalism/secessionism, the freedom of journalists, their use of multiple/variety sources in reporting, and the inclusion of opposing views as factors affecting journalistic objectivity in crisis reporting in Cameroon and Nigeria. The FsQCA results further stress the nuances in the independence of these factors and the complex circumstances where their presence or absence could enhance objectivity in reporting. In this way, the study reveals the dialectics of existing literature on media systems using an innovative methodological approach.

The effect of incentives and procedure simplification in policy implementation: evidence from a survey experiment on waste sorting

To encourage residents to sort their waste, governments can use incentives such as cash rewards or social reinforcement. The effect of such incentives remains unclear, and residents often are deterred by the complexity of procedures to obtain their rewards. Based on positive reinforcement theory and using a survey experiment, we study the effect of types and procedures of incentives on waste sorting behavioural intentions in a large Chinese city. We find that cash incentives have a stronger effect on waste sorting behavioural intentions than incentives based on social reinforcement such as a certificate of merit. Cash-based incentives also have a stronger effect on perceived probability to obtain the incentive and on perceptions of procedure difficulty. More simple procedures to obtain the incentive does not seem to have an effect on waste sorting behavioural intentions, neither direct nor in an interaction. However, the simplification of the procedure through which an incentive can be obtained is positively correlated with perceived probability to obtain the incentive.

‘We do in the spirit of togetherness’: stories of collective resilience, wellbeing and climate (im)mobility in the Pacific

Collectivity is at the heart of resilience and wellbeing in the lived experience of those navigating climate (im)mobility in Oceania. The implications of collective resilience and wellbeing for development policy and practice, however, are still little understood given the under-representation of research drawing on the perspective and experience of those from places most disproportionately impacted by climate change. This article presents findings from a qualitative multigenerational family stories study amongst Pacific peoples – Moana or Indigenous peoples of Oceania – on their experiences of climate (im)mobility, resilience and wellbeing. This Pacific-led research involved researchers engaging with their own places, family or kin groups across six Pacific countries (Kiribati, PNG, Solomon Islands, Tokelau, Tonga, Tuvalu). The findings illustrate collective resilience and wellbeing through connection to past generations, cultural ways of working together, practical adaptation, spirituality/faith and dealing with cultural erosion. Based on this study, it is recommended that, in addition to environmental sustainability, development policy and practice focus on cultural sustainability as well as ‘commoning’ through a relational ethics of care, in order to address future climate (im)mobility and to strengthen collective resilience and wellbeing across the Pacific.

Addition of pulsed electric field ablation to SBRT for lung tumors: effect on health-related quality of life

Treatment indications for oligometastatic/oligoprogressive lung tumors are growing. Safety and lack of detrimental effect on patients’ quality of life are critical for novel local therapies. We tested that the additive effect of pulsed electric field (PEF) ablation with lower-dose stereotactic body radiation therapy (SBRT) on health-related quality of life (HRQoL) as a secondary endpoint in a prospective clinical trial. FACT-Lung Cancer Subscale (FACT-LCS) and FACT-General domain surveys were collected at screening, 3 months, and 12 months. Functional clinical data included forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and diffusing capacity of the lung for carbon monoxide (DLCO). Six patients with eight tumors were enrolled. Baseline well-being domain scores were: Physical 25.9 (Std Dev 2.3), Social 21.0 (Std Dev 6.9), Emotional 17.3 (Std Dev 4.7), Functional 21.2 (Std Dev 5.8), and LCS 19.4 (Std Dev 5.3). There were no significant changes following combined modality treatment in HRQoL domain scores or pulmonary function metrics after treatment. Lower EWB and SWB were associated with worse FVC and FEV1. In this small pilot study, no clinically meaningful declines in pulmonary function or patient-reported quality of life were observed at 3 months following combination therapy.

Doug Burleigh

Effective prompt design for large language models in clinical practice

Large language models (LLMs) have emerged as transformative healthcare tools for clinical documentation, diagnostic reasoning, and medical education. However, effective utilization requires understanding prompt engineering principles—the strategic design of inputs to optimize performance while mitigating hallucination, bias, and outdated information. This narrative review synthesizes evidence from a structured PubMed search through December 2025 using terms including “large language models,” “prompt engineering,” “clinical decision support,” and “retrieval-augmented generation.” We included peer-reviewed studies and systematic reviews from 2023 onwards, supplemented by manufacturer benchmarks (acknowledged as non-peer-reviewed), informed by a Belgian Society of Internal Medicine symposium (December 2025). Effective clinical prompt engineering requires four elements: role definition, context provision, task formulation, and output specification. Structured frameworks—RTF (Role–Task–Format) for routine tasks and BRAIN (Background, Role, Aim, Instructions, Next steps) for complex scenarios—provide systematic approaches. Advanced techniques including chain-of-thought reasoning, few-shot prompting, and retrieval-augmented generation (RAG) enhance performance. RAG improves accuracy by 9.8–16.3% while reducing hallucinations by 11.8–18%. A meta-analysis of 36 studies found pooled LLM accuracy of 72% on medical licensing examinations. Critical limitations persist: studies demonstrate an inverse correlation between model confidence and accuracy, with lower-performing models paradoxically exhibiting higher confidence. Independent clinical validation remains limited. LLMs offer efficiency gains while requiring careful implementation. Physicians must develop prompt engineering competency, combining structured frameworks, RAG grounding strategies, and persistent human oversight for safe clinical integration. Prompt engineering literacy represents an essential emerging clinical skill.

The nature and limits of policy design against athlete maltreatment

Athlete maltreatment has drawn significant attention from governing bodies, stakeholders and the global public. While a number of policies have been introduced to address maltreatment, their effectiveness calls for an analytical approach to policy design incorporating three considerations: an acknowledgement of policy and political goals, an understanding of path-dependence and adaptation, and an anticipation for conflict. Focusing on South Korea’s responses to scandals, this study draws from 18 interviews with government officials, sport organisation managers and athletes. Findings first suggest that while revised rules have led to heightened political legitimacy, they have also generated conflicting perspectives on punishments and ambiguities in the management of training camps. Second, data suggests that the Korea Sport Ethics Centre (KSEC), the new agency tasked with investigating maltreatment, lacks independence, adequate staff and professionals, sufficient authority to investigate and punish, and trust amongst athletes. Third, stakeholders reported the limitations of educational programmes, including incomplete coverage in a one-hour compulsory programme, repetitive content and a disproportionate focus on sexual abuse. Consequently, this article suggests that when policy makers neglect design considerations (such as the inertia of previous policies or stakeholder conflict), countermeasures for addressing maltreatment may be prone to ambiguity and failure.

Detecting the Olympic tourism legacy: a data-driven approach

This research applies a data-driven approach for identifying changes in time series to model the Olympic tourism legacy. Measuring potential legacy effects from mega-sporting events has been problematic in prior research. Issues revolve around how to measure tourism, how to control for pre-existing trends, and how to account for extraneous events affecting tourism unrelated to the Olympics. Most problematic for analytical models is determining when the tourism legacy begins and what is the functional form of the tourism legacy. Many of these issues interact and can confound results leading to erroneous conclusions. The seminal methodology developed by Tsay [(1988). Outliers, level shifts, and variance changes in time series. Journal of Forecasting , 7 (1), 1–20] requires no prior assumption about the timing or functional forms of the outliers, therefore solving these issues and provides a framework that can be used when analysing mega-sporting event legacies. Using this methodology, the research finds limited support for a short-term Olympic tourism legacy and no support for a long-term tourism legacy.