Conventional segmented phase contrast (PC) MRI is the clinical reference standard for cardiovascular hemodynamic quantification, but prolonged acquisition times, mandatory breath-holding, and susceptibility to arrhythmia limit its utility in vulnerable populations.

To validate the clinical performance of compressed sensing-accelerated real-time (CSRT) PC MRI with shared velocity encoding (SVE) for fast, free-breathing cardiac flow assessment.

Prospective.

63 patients (46 male/17 female, mean age 51.5 ± 15.1 years) with diverse cardiac disease.

3.0 T; single-shot RF-spoiled gradient echo sequence with SVE (free-breathing CSRT PC MRI) and velocity encoded segmented gradient echo sequence (breath-hold routine segmented (RS) PC MRI).

Hemodynamic parameters-peak velocity, peak flow rate, net flow rate, and peak mean velocity-were measured at the sinotubular junction plane for both CSRT and RS datasets. Scan time of the two sequences was recorded.

Pearson/Spearman correlation analysis, intraclass correlation coefficient (ICC), Bland-Altman analysis, paired t-test/Wilcoxon test. A p value < 0.05 was considered significant.

RS acquisition time was 16.0 ± 2.3 s; total imaging time including breath-hold instructions was 26.0 ± 2.3 s, whereas CSRT acquisition time was 10.0 s, yielding a statistically significant difference in scan duration. All hemodynamic parameters demonstrated strong significant correlation between CSRT PC and RS PC MRI (r ≥ 0.89) and good-to-excellent inter-method agreement (ICC ≥ 0.87). CSRT PC yielded significantly lower values for peak velocity (bias = -16.72 ± 11.48 cm/s [-13.31% ± 9.68%]), peak flow rate (bias = -36.28 ± 35.06 mL/s [-9.18% ± 8.98%]), and peak mean velocity (bias = -6.49 ± 7.06 cm/s [-11.02% ± 13.14%]) relative to the RS, but net flow rate was not significantly different between methods (bias = 0.15% ± 0.60 L/min [4.16% ± 17.28%, p = 0.058]).

CSRT PC provided satisfactory agreement with conventional RS PC while shortening scan time and enabling free-breathing acquisition.

1.

Stage 1.

Ferroptosis is essential for the occurrence and development of myocardial infarction. The aim of the study is to elucidate the molecular mechanism of Ginkgolide Injection against ischemic cerebral infarction (ICI), focusing on its multi-target regulation of ferroptosis via the AKT1 and NFE2L2.

Human primary neurons and astrocytes were subjected to oxygen-glucose deprivation/reoxygenation (OGD/R) to mimic cerebral ischemia. Cells were treated with Ginkgolide Injection or transfected with AKT1-targeting siRNA. Targets of Ginkgolide Injection components against ICI-associated genes were retrieved from TCMSP, CTD, HERB, OMIM, and DisGeNET databases. A compound-target-disease network was constructed using Cytoscape, followed by PPI, GO, and KEGG analyses. Cell viability (CCK-8), lipid peroxidation assessment (C11-BODIPY581/591 staining), redox markers (GSH, ROS, MDA), and AKT1/Nrf2 signaling (RT-qPCR, Western blot) were analyzed.

Ginkgolide Injection restored viability in OGD/R-injured neurons and astrocytes. Bilobalide in Ginkgolide Injection targeted 22 genes; Ginkgolide A targeted 32 genes; Ginkgolide B targeted 48 genes; Ginkgolide C targeted 30 genes; Ginkgolide J targeted 7 genes. A total of 55 targets for Ginkgolide Injection were common with ICI-associated genes. Network pharmacology identified AKT1 and NFE2L2 as core targets of Ginkgolide Injection against ICI. Ginkgolide Injection suppressed ferroptosis (reduced PTGS2 mRNA and lipid peroxidation) and activated AKT1 signalling in OGD/R-injured neurons and astrocytes. AKT1 knockdown abolished Ginkgolide's anti-ferroptotic effects, confirming AKT1's regulatory role.

Ginkgolide Injection mitigates cerebral infarction by co-activating AKT1 and NFE2L2 to suppress ferroptosis, highlighting its potential as a multi-target therapy for ischemic ICI.

Extended reality technologies, including virtual reality (VR), augmented reality, and mixed reality, are increasingly used in medical education to create immersive and interactive learning environments. As these modalities expand, validated instruments are needed to measure learners' experiences accurately. The Immersive Technology Evaluation Measure (ITEM) is a multidomain questionnaire assessing immersion, motivation, cognitive load, usability, and debriefing. Although cognitive interviewing informed its original development, less is known about how ITEM questions function when used in a different linguistic and educational context.

This study aimed to evaluate the clarity, comprehensibility, and response processes of ITEM among native Arabic-speaking medical students enrolled in an English-medium medical program. We also sought to identify linguistic, referential, and contextual sources of comprehension difficulty and use these findings to inform proposed item-level refinements.

We conducted a qualitative cognitive interviewing study with 10 third-year and fourth-year medical students at United Arab Emirates University following VR-based clinical skills activities. Using concurrent think-aloud and verbal probing techniques, participants explained how they interpreted each ITEM question and arrived at their responses. Interview transcripts, recordings, and interviewer notes were independently reviewed using a descriptive, item-focused approach. Participant feedback was examined for recurring comprehension problems, and proposed item-level decisions were reviewed through research team consensus. Item-level saturation was reached after 8 interviews and confirmed with 2 additional interviews.

Participants identified comprehension or response-process problems in 47.5% (19/40) of ITEM questions. Difficulties occurred across all 5 domains and were most frequent in immersion (6/9, 66.7%) and usability (6/10, 60%), followed by debriefing (4/5, 80%), motivation (2/10, 20%), and cognitive load (1/6, 16.7%). Common difficulties involved nonspecific references such as "activity" and "technology," unfamiliar or abstract terminology, negative wording, and unclear temporal or contextual framing. For example, "concern" was interpreted by some participants as worry rather than focus, and "mentally demanding" was interpreted in relation to mental health rather than cognitive effort. Cognitive interviewing informed different item-level decisions rather than a uniform revision: 11 problematic questions received proposed wording or contextual revisions, 2 received presentation-only modifications, and 6 were retained unchanged where clarification could introduce a meaning not clearly established in the original item. Six additional questions received limited contextual or terminology-standardizing changes for consistency. No items were removed, and the original 5-domain structure was retained.

Cognitive interviewing identified response-process difficulties that were not apparent from the questionnaire wording alone and provided a systematic basis for determining when clarification was warranted and when the original wording should be preserved. The findings extend response-process evidence for ITEM and illustrate the value of examining established educational measures in new linguistic and educational settings. The proposed refinements provide a foundation for further cognitive testing and psychometric evaluation across immersive learning contexts.

BackgroundBlack populations have deep ancestral ties to Canada, yet little research examines what shapes access to mental healthcare for Black immigrant youth of African descent (BIYAD), defined here as first-generation African-born Black young adults aged 18 to 34. Almost none of these studies examine how race, immigration status and young adulthood intersect to shape that access.PurposeTo argue that persistent underutilisation of mental health services by BIYAD is structurally produced rather than a failure of individual help-seeking or resilience, and to identify the structural drivers that clinic-centred models obscure by treating distress as personal deficit.Research DesignConceptual and critical policy analysis integrating Levesque and colleagues' multidimensional model of access with intersectionality theory. No empirical study was undertaken.Study SampleNot applicable. The analytic focus is BIYAD in Canada. No primary data were collected.Data Collection and/or AnalysisPeer-reviewed and grey literature on anti-Black racism, immigration and settlement, socio-economic position and Black mental health in Canada was assembled purposively and analysed against the five access dimensions and these intersecting axes.ResultsAccess narrows at every dimension: outreach that misses African-born communities and mistrust after racist encounters (approachability); stigma and few providers sharing language, faith or race (acceptability); thin Black-led provision and long waits (availability); precarious work and uninsured psychotherapy (affordability); and clinic-centred care that misreads spiritually grounded distress (appropriateness). These constraints compound rather than add. Framing resilience as the remedy recasts structural failure as personal attribute.ConclusionHealth equity for BIYAD requires structural and community-grounded reform rather than individual remediation: accountable anti-racism and cultural safety measures, culturally responsive community-based care, and sustained investment in Black-led services.

Sleep health in adolescence is a global public health concern. However, limited studies on adolescent sleep health in Africa exist, and the extent of the available literature on the African continent has not been previously mapped. This review aimed to map the studies on adolescent sleep health in Africa with a focus on the geographical distribution, publication trends, pattern of sleep health measures, prevalence of sleep disorders, the barriers and facilitators to good sleep health, rural-urban disparities, as well as the associations of sleep health with mental health, school schedule and cardio-metabolic risk among the adolescents. All published articles on adolescent sleep health in Africa in English, French, Spanish, Portuguese, and Italian languages were to be included. We conducted a scoping review by searching five databases: MEDLINE (via PubMed), CINAHL (via EBSCOHost), PsycINFO (via EBSCOHost), Scopus, and the African Journal Online (AJOL), from the inception of the databases to January 2025. As previously highlighted in our published protocol, we used the JBI methodology for the scoping review. After screening 921 titles and abstracts and 78 full-text articles, we included 43 articles. There has been an increasing number of studies on adolescent sleep in Africa in the past 25 years. Cross-sectional studies were the most frequent design (67.4%). Most studies focused on sleep quantity and quality, with small sample sizes and scanty evidence on other aspects of sleep health. Inadequate weekday sleep duration was common among adolescents, often compensated by longer weekend sleep durations. Screen use at bedtime, sleeping environment, school schedules, and chronic medical conditions were the major risk factors for sleep disturbances. Poor sleep was associated with poor academic performance, depression, anxiety, and adverse cardiometabolic risk. This review shows a lack of studies on the multidimensional aspects of sleep health and the need for more objective sleep measures to better characterise the sleep health of adolescents in Africa. Larger studies with longitudinal and mixed-method designs are needed to drive the planning and execution of interventions to improve sleep health among African adolescents.

This article offers a critical reworking of ecological and social-ecological models as applied to intellectual and developmental disabilities, autism, and severe mental illness. Drawing on a qualitative synthesis of 18 studies, we show that ecological frameworks are predominantly used as descriptive mapping devices, that power and inequalities enter analyses in partial and fragmented ways, and that intersystemic connections often generate formally inclusive yet experientially exclusionary arrangements. To address these limitations, we propose an Integrated Ecological Model for Mental Disability, which retains Bronfenbrenner's multilevel architecture but introduces four structural extensions: asymmetry of reciprocity in the microsystem, the defensive mesosystem, capital-modulated exosystemic permeability, and the performative and normalizing exosystem. These concepts integrate Bourdieu's theory of capital and field, Foucault's genealogy of dispositifs,¹ and group psychoanalysis, and they are grounded in recurrent patterns observed across school transitions, family-service relations, residential services, and autism employment programs. The framework has implications for research designs that move beyond barriers and facilitators for multilevel clinical and educational interventions, and for normative debates on relational justice and psychopolitical validity in mental-disability policy.

The inflammatory response mediates the primary pain pathway in animals assigned female at birth, whereas sex hormones are cited as the primary mediator of the pain pathway in animals assigned male at birth. It is unclear if these sex-based pain mediators are also present within humans in cases of musculoskeletal pain.

This study investigates the association of self-reported pain in the neck, back, arms, and breasts in physically active, full-busted women with their hormonal levels, anthropometry measures, and indicators of overall mental health.

Twenty (20) healthy, full-busted women who were assigned female at birth and performed regular physical activity were recruited to participate in this cross-sectional observational study.

University-research center in Houston, TX, USA.

Patients completed a series of surveys and questionnaires regarding their medical health history, physical activity, and history of pain-including neck, back, and arm pain as well as mastalgia. The patients also underwent anthropomorphic measurements and a blood draw.

Patients demonstrated significant musculoskeletal pain, anxiety, and depression (P < 0.005). Estradiol, progesterone, and glycated hemoglobin levels were significantly associated with self-reported musculoskeletal pain in the neck, back, and arms, as was mastalgia. Additional covariates, including anxiety, number of children borne, and trunk anthropometry, were found to clarify hormonal and metabolic contributions to the patients' pain presentation.

Limitations of this initial project include the small sample size (n = 20) of physically active women without current metabolic health complications (glycated hemoglobin values of less than 5.7%).

These data indicate significant influences of hormonal levels and metabolic health on musculoskeletal pain and mastalgia perceived in physically active women. The data also suggest that several control covariates, including self-reported anxiety, should be considered to clarify potential mechanistic pathways in pain presentation in women who were assigned female at birth.

Background: Posttraumatic stress disorder (PTSD) and substance use disorders (SUD) commonly co-occur. Several treatments for co-occurring PTSD and SUD (PTSD + SUD) exist, yet evidence for comparative treatment effectiveness is restricted by a historical emphasis on symptom severity and substance consumption endpoints instead of recovery-oriented outcomes. Moreover, extant syntheses relied on conventional analytic approaches prioritizing standardized mean group differences, instead of clinically significant change (CSC), and included few pharmacological randomized clinical trials (RCTs).Objective: In an extension of Project Harmony (R01AA025853), this study (R01DA061338) will apply novel quantitative approaches addressing limitations of prior work to elucidate which PTSD + SUD treatments work best overall and at the individual level.Method: This study will harmonize data from over 60 RCTs (N > 8,000) and use meta-analysis of individual patient data, integrative data analysis, and propensity score weighting to assess the comparative effectiveness of pharmacological, behavioral, and combination treatments for PTSD + SUD. Clinical severity outcomes will be measured as latent PTSD symptom severity, alcohol consumption, and other drug consumption. Recovery outcomes will be estimated from indicators of psychosocial functioning and substance use consequences. State-of-the-art CSC methodologies will be used in analyses of the original Project Harmony dataset (36 RCTs; N = 4,046), which will evaluate the proportion of patients in each treatment class that showed (non)significant improvement or worsening along clinical and recovery outcomes. Analyses of the expanded Project Harmony dataset will assess comparative effectiveness of active PTSD + SUD treatment classes, compared to treatment as usual, on clinical severity and recovery outcomes.Conclusions: By applying modernized quantitative methodologies to patient-level data from at least 60 RCTs, this study will advance the field's understanding of which PTSD + SUD treatment approaches are most effective across multiple indicators (i.e. clinical severity and recovery outcomes). This study is registered in the International Prospective Register of Systematic Reviews (PROSPERO identifier CRD420251250349).

Gun, knife, or other weapon involvement in intimate partner violence (IPV) may indicate heightened actual and perceived lethality and coercive control, but its mental health impacts on survivors are poorly understood after accounting for other IPV and prior mental health symptoms.

To estimate the adjusted association between gun and other weapon-involved IPV and symptoms of major depressive disorder (MDD), panic disorder (PD), posttraumatic stress disorder (PTSD), and adult separation anxiety disorder (ASAD), accounting for concurrent and past nonweapon physical IPV, psychological abuse, and prior symptom levels.

This prospective, longitudinal cohort study with 6 waves at 12- to 18-month intervals recruited participants from January 1, 2015, to March 31, 2016, from public antenatal clinics in Sydney and Melbourne, Australia. Women with exposure and outcome data from at least 2 waves were eligible for the study. Data analysis was conducted in February 2025.

Past-year gun and other weapon-involved IPV, nonweapon physical IPV, and psychological abuse.

Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders [Fourth Edition]) symptom counts for MDD, PD, PTSD, and ASAD at each wave. β-Binomial (β̂) mixed-effects models with random intercepts modeled bounded symptom counts, adjusting for survey wave, lagged symptoms, and covariates. Pooled marginal and within-person transition contrasts were estimated using parametric simulation.

Among 1114 women (mean [SD] age at wave 1, 29.48 [5.42] years), 585 (52.5%) were migrants; median birth year was 1987 (range, 1969-1999). Across follow-up, 43 women (3.9%) reported gun or other weapon-involved IPV, 171 (15.4%) nonweapon physical IPV, and 726 (65.2%) psychological abuse. In fully adjusted models, weapon-involved IPV remained associated with PD (β̂ = 0.79; 95% CI, 0.08-1.50) and PTSD (β̂ = 1.07; 95% CI, 0.38-1.76) but not MDD (β̂ = 0.12; 95% CI, -0.55 to 0.79) or ASAD (β̂ = -0.12; 95% CI, -0.81 to 0.57). Adjusted pooled marginal differences were 0.57 (95% CI, 0.04-1.44) for PD and 0.69 (95% CI, 0.17-1.59) for PTSD; within-person transition effects were 1.12 (95% CI, 0.08-2.24) for PD and 1.14 (95% CI, 0.26-2.02) for PTSD.

In this cohort study, gun and other weapon-involved IPV was independently associated with higher PD and PTSD symptom counts after controlling for other IPV types and prior mental health. Identifying weapon-involved IPV should alert clinicians to fear-related presentations and prompt safety-focused interventions.

ObjectivesThis study investigated the prevalence of adverse social determinants of health (SDOH) and health-related social needs (HRSN) and their associations with physical and mental distress among U.S. adults with Chronic Obstructive Pulmonary disease (COPD).MethodsData from the 2022 Behavioral Risk Factor Surveillance System (BRFSS) was analyzed for respondents across 37 U.S. states who self-reported COPD and completed the Social Determinants and Health Equity module. Weighted prevalence estimates and logistic regression models evaluated associations between SDOH, HRSN, and self-reported physical/mental health, controlling for demographics.ResultsAmong 32,962 respondents with COPD, social isolation (23.08%) and mental stress (24.80%) were common. Females experienced high rates of food insecurity (65.59%) and housing insecurity (65.90%). Social isolation (OR = 1.84, 95% CI: 1.83-1.85) and life dissatisfaction (OR = 2.10, 95% CI: 2.09-2.11) were associated with increased odds of frequent physical distress. For mental distress, life dissatisfaction (OR = 5.07, 95% CI: 5.04-5.10), stress (OR = 7.11, 95% CI: 7.07-7.14), and transportation barriers (OR = 2.15, 95% CI: 2.14-2.16) were associated with increased odds.DiscussionSocial isolation, life dissatisfaction, stress, and transportation barriers were associated with increased physical and mental distress in COPD.