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BackgroundCapnocytophaga is a bacterium frequently found in the oral flora of dogs and cats (e.g. Capnocytophaga canimorsus) and humans (e.g. Capnocytophaga gingivalis). Among Capnocytophaga related ocular infections, fulminant endophthalmitis is a rare but sight-threatening clinical manifestation.Case presentationA 35-year-old previously healthy patient presented after a cat bite into the left upper and lower eyelid and nasal part of the conjunctiva of the left eye. At initial consultation, the corrected visual acuity was 0.8 in decimal scale and a detailed clinical examination revealed no evidence of ocular penetration. However, daily follow-up examinations under local therapy revealed a progressive intraocular inflammation, therefore the decision was made to perform a diagnostic vitrectomy with intravitreal and systemic antibiotic treatment. Capnocytophaga felis was detected as the cause of endophthalmitis and the initiated treatment resulted in quick morphological and functional recovery of the left eye. After surgery of secondary cataract, visual acuity improved from hand motion preoperatively to 1.0 postoperatively.ConclusionsEarly recognition as well as prompt and effective treatment of animal bite associated endophthalmitis is essential for good visual recovery and functional outcome. Furthermore, this case highlights the importance of daily follow-up examinations, even in the absence of signs of ocular penetration and intraocular inflammation, to enable prompt and effective treatment initiation. Given the negative results in bacterial culture, we additionally emphasize the value of sequencing-based microbiological diagnostics in unclear cases.

This essay invites a dialogue between Henry James’s “The Aspern Papers” and Cynthia Ozick’s The Messiah of Stockholm through the notion of literary speculation. In both texts, the relations between the experiential and the literary are explored via Paul Ricouer’s theory of “threefold mimesis .” Jacques Derrida’s account of hauntology and secular messianism, moreover, underscores failures of justice, ethics, and hope. James’s poised tragi-comic narrative is juxtaposed with Ozick’s critique of imaginative self-indulgence. Both works culminate in the burning of manuscripts, figuring in turn the demise of personal or editorial yearnings, then the Holocaust’s merciless incineration of Jewish life and creativity.

One of the common tasks required for designing new plasma scenarios or evaluating capabilities of a tokamak is to design the desired equilibria using a Grad-Shafranov (GS) equilibrium solver. However, most standard equilibrium solvers are time-independent and do not include dynamic effects such as plasma current flux consumption, induced vessel currents, or voltage constraints. Another class of tools, plasma equilibrium evolution simulators, do include time-dependent effects. These are generally structured to solve the forward problem of evolving the plasma equilibrium given feedback-controlled voltages. In this work, we introduce GSPulse, a novel algorithm for equilibrium trajectory optimization, that is more akin to a pulse planner than a pulse simulator. GSPulse includes time-dependent effects and solves the inverse problem: given a user-specified set of target equilibrium shapes, as well as limits on the coil currents and voltages, the optimizer returns trajectories of the voltages, currents, and achievable equilibria. This task is useful for scoping performance of a tokamak and exploring the space of achievable pulses. The computed equilibria satisfy both Grad-Shafranov force balance and axisymmetric circuit dynamics. The optimization is performed by restructuring the free-boundary equilibrium evolution equations into a form where it is computationally efficient to optimize the entire dynamic sequence. GSPulse can solve for hundreds of equilibria simultaneously within a few minutes. GSPulse has been validated against NSTX-U and MAST-U experiments and against SPARC feedback control simulations, and is being used to perform scenario design for SPARC. The computed trajectories can be used as feedforward inputs that are connected to the feedback controller to inform and improve feedback performance. The code for GSPulse is available open-source at github.com/jwai-cfs/GSPulse_public.

Advances in artificial intelligence (AI) promise to reshape the landscape of scientific inquiry. Amidst all these, OpenAI’s latest tool, Deep Research, stands out for its potential to revolutionize how researchers engage with the literature. However, this leap forward presents a paradox; while AI-generated reviews offer speed and accessibility with minimal effort, they raise fundamental concerns about citation integrity, critical appraisal, and the erosion of deep scientific thinking. These concerns are particularly problematic in the context of biomedical research, where evidence quality may influence clinical practice and decision-making. In this piece, we present an empirical evaluation of Deep Research and explore both its remarkable capabilities and inherent limitations. Through structured experimentation, we assess its effectiveness in synthesizing literature, highlight key shortcomings, and reflect on the broader implications of these tools for research training, and the integrity of evidence-based practice. With AI tools increasingly blurring the lines between knowledge generation and critical inquiry, we argue that while AI democratizes access to knowledge, wisdom remains distinctly human.

Deep research agents are autonomous large language model–based systems capable of iterative web search, retrieval, and synthesis. They are increasingly positioned as the next major leap in medical artificial intelligence. In this viewpoint, we argue that while these agents mark progress in information access and workflow automation, they represent an incremental evolution rather than a paradigm shift. We review current applications of deep research agents in biomedical scenarios, including literature review generation, clinical evidence synthesis, guideline comparison, and patient education. Across these early use cases, the tools demonstrate the ability to rapidly gather and structure up-to-date information, often producing outputs that appear comprehensive and well-referenced. However, these strengths coexist with unresolved and clinically significant limitations. Citation fidelity remains inconsistent across models, with subtle misinterpretations or unreliable references still common. Their retrieval processes and evidence-ranking mechanisms remain opaque, raising concerns about reproducibility and hidden biases. Moreover, overreliance on artificial intelligence–generated syntheses risks eroding clinicians’ critical appraisal skills and may introduce automation bias at a time when medicine increasingly requires deeper scrutiny of information sources. Safety constraints are also less predictable within multistep research pipelines, increasing the risk of harmful or inappropriate outputs. Finally, current evidence is largely limited to proof-of-concept evaluations, with little evidence from real-life clinical deployment. We contend that deep research agents should be embraced as assistive research tools rather than pseudoexperts. Their value lies in accelerating information gathering, not replacing rigorous human judgment. Realizing their potential will require transparent retrieval architectures, robust benchmarking, and explicit educational integration to preserve clinicians’ evaluative reasoning. Used judiciously, these systems could enrich medical research and practice; used uncritically, they risk amplifying errors at scale. We contend that deep research agents should be embraced as assistive research tools rather than pseudoexperts. Their value lies in accelerating information gathering, not replacing rigorous human judgment. Realizing their potential will require transparent retrieval architectures, robust benchmarking, and explicit educational integration to preserve clinicians’ evaluative reasoning. Used judiciously, these systems could enrich medical research and practice; used uncritically, they risk amplifying errors at scale.

Little is known about the experience of caring for a son with anorexia nervosa (AN). Prior research with parents of primarily daughters with AN indicate that they experience significant distress. Ten mothers participated in semi-structured interviews regarding their experiences taking care of a son (between the ages of 11 and 18) who had inpatient treatment for AN within 2 years of the interview and was residing at home. Consensual qualitative research methods were used to analyze the data. Mothers reported challenges accessing and navigating treatment, noting that front-line providers missed their sons’ AN because of their gender. Once their sons were diagnosed, mothers continued to experience distress and described negative changes in family relationships, including increased conflict with the diagnosed son, strained sibling relationships, and marital stress. The gender-atypical nature of AN negatively impacted perceived social support. Despite these negative findings, living with AN also offered an opportunity for growth, with some mothers reporting increased closeness with the diagnosed son, greater family unification, and strengthening of the marital bond. Based on these findings, it is recommended that treatment professionals provide greater psychological support and resources to mothers, who often assume primary caregiver responsibilities, and make treatment settings and approaches more gender inclusive. Highlights Mothers experienced psychological distress, shame, guilt, isolation, self-doubt, and felt blamed by others. Obtaining an accurate diagnosis and appropriate treatment were perceived to be more difficult, due to their son’s gender. Mothers described receiving less social support, which they ascribed to their sons’ gender-atypical illness. Mothers reported challenges with healthcare professionals, including pediatricians, who minimized and dismissed their concerns. Validating mothers’ concerns and helping them find support may enhance their functioning as caregivers.

Background. Cryptococcal meningitis (CM) is the proximate cause of death in 20%–30% of persons with acquired immunodeficiency syndrome in Africa. Methods. Two prospective, observational cohorts enrolled human immunodeficiency virus (HIV)—infected, antiretroviral-naive persons with CM in Kampala, Uganda. The first cohort was enrolled in 2001–2002 (n=92), prior to the availability of highly active antiretroviral therapy (HAART), and the second was enrolled in 2006–2007 (n=44), when HAART was available. Results. Ugandans presented with prolonged CM symptoms (median duration, 14 days; interquartile range, 7–21 days). The 14-day survival rates were 49% in 2001–2002 and 80% in 2006 (P<.001). HAART was started 35±13 days after CM diagnosis and does not explain the improved 14-day survival rate in 2006. In 2006–2007, the survival rate continued to decrease after hospitalization, with only 55% surviving to initiate HAART as an outpatient. Probable cryptococcal-related immune reconstitution inflammatory syndrome occurred in 42% of patients, with 4 deaths. At 6 months after CM diagnosis, 18 persons (41%) were alive and receiving HAART in 2007. The median cerebral spinal fluid (CSF) opening pressure was 330 mm H2O; 81% of patients had elevated pressure (>200 mm H2O). Only 5 patients consented to therapeutic lumbar puncture. There was a trend for higher mortality for pressures >250 mm H2O (odds ratio [OR], 2.1; 95% confidence interval [CI], 0.9–5.2; P=.09). Initial CSF WBC counts of <5 cells/mL were associated with failure of CSF sterilization (OR, 17.3; 95% CI, 3.1–94.3; P<.001), and protein levels <35 mg/dL were associated with higher mortality (OR, 2.0; 95% CI, 1.2–3.3; P=.007). Conclusions. Significant CM-associated mortality persists, despite the administration of amphotericin B and HIV therapy, because of the high mortality rate before receipt of HAART and because of immune reconstitution inflammatory syndrome—related complications after HAART initiation. Approaches to increase acceptance of therapeutic lumbar punctures are needed.

Background Although regulatory agencies require hospitals to engage in peer review to maintain accreditation, quality assurance review processes are not standardized, and well-structured peer review of clinical cases involving medical errors and adverse events governed by Just Culture principles is not widespread. We implemented such an emergency department (ED) physician peer review process and performed an analysis of cases that underwent review. Methods We formed an ED physician peer review committee at our institution guided by Just Culture principles, including promotion of a culture of safety to encourage open reporting of errors and near misses, and top-down leadership commitment to focus on identifying systemic factors contributing to human error, thereby creating opportunities for shared learning, rather than punishment and retribution. Using an existing database, we conducted a retrospective analysis of 282 clinical cases reviewed by the committee between July 2019 and June 2022, describing the sources of case referrals, case management attribution determinations, identified opportunities for improvement, post-review actions taken, and systems-related contributing factors. Results 282 clinical cases were reviewed between July 2019 and June 2022. The most common sources of case referral were ED faculty ( n  = 108, 38.3%), external hospital departments ( n  = 51, 18.1%), event reporting system ( n  = 39, 13.8%), mortality chart reviews ( n  = 15, 5.3%), and ED nursing ( n  = 8, 2.8%). The committee determined that “most practitioners would have managed care similarly” in 142 cases (50.4%), “similarly, with opportunity to improve” in 99 cases (35.1%), and “differently” in 39 cases (13.8%). Attribution determinations and their distribution were similar between calendar years. Conclusions This study demonstrates that physicians can engage in a structured peer review process guided by Just Culture principles that promotes physician learning and faculty development, while also identifying competency and systems-related contributions to clinical care that enhance patient safety.

The efficacy of anthracycline-based chemotherapeutics, which include doxorubicin and its structural relatives daunorubicin and idarubicin, remains almost unmatched in oncology, despite a side effect profile including cumulative dose-dependent cardiotoxicity, therapy-related malignancies and infertility. Detoxifying anthracyclines while preserving their anti-neoplastic effects is arguably a major unmet need in modern oncology, as cardiovascular complications that limit anti-cancer treatment are a leading cause of morbidity and mortality among the 17 million cancer survivors in the U.S. In this study, we examined different clinically relevant anthracycline drugs for a series of features including mode of action (chromatin and DNA damage), bio-distribution, anti-tumor efficacy and cardiotoxicity in pre-clinical models and patients. The different anthracycline drugs have surprisingly individual efficacy and toxicity profiles. In particular, aclarubicin stands out in pre-clinical models and clinical studies, as it potently kills cancer cells, lacks cardiotoxicity, and can be safely administered even after the maximum cumulative dose of either doxorubicin or idarubicin has been reached. Retrospective analysis of aclarubicin used as second-line treatment for relapsed/refractory AML patients showed survival effects similar to its use in first line, leading to a notable 23% increase in 5-year overall survival compared to other intensive chemotherapies. Considering individual anthracyclines as distinct entities unveils new treatment options, such as the identification of aclarubicin, which significantly improves the survival outcomes of AML patients while mitigating the treatment-limiting side-effects. Building upon these findings, an international multicenter Phase III prospective study is prepared, to integrate aclarubicin into the treatment of relapsed/refractory AML patients. Graphical abstract

A better understanding of the physics of tokamak breakdown has the potential to ensure reliable operation and increase confidence in the startup scenarios of future tokamak devices. This article presents an experimental validation of 0D Townsend breakdown theory in a toroidal geometry using the TCV tokamak and two separate time-dependent 2D torodally-symmetric electromagnetic field reconstruction techniques. Breakdown parameters have been scanned along three experimental axes: neutral pressure, toroidal loop voltage, and—for the first time—poloidal magnetic field null gradient. The magnetic null gradient is observed to have a direct influence on the effective connection length: a smaller magnetic null gradient leads to a larger effective connection length and hence a lower loop voltage required for breakdown. 0D Townsend theory successfully predicts whether a breakdown would occur within 1σ error bars in over 96% of cases only when a minimum number of ionizing collisions per unit connection length between 8 and 13 is considered. Secondary electron emission from the high-field-side (HFS) wall is hypothesized to explain both the observed proximity of early radiation to the HFS wall and the empirically inferred minimum number of ionizing collisions required per connection length to achieve the onset of breakdown. There could be, however, additional physics at play.