Consciousness science is fragmented, and empirical investigations are largely confined within the framework of each theory of consciousness (ToC). Proliferating ToCs accumulate anomalies without progress, operating orthogonally. The principle of recurrency, functional and architectural, specifies a unifying, mechanistic scaffold for consciousness to arise. We show that all theories tacitly invoke feedback loops and can be re-expressed along a single axis of recursion. Four nested levels, viz., cellular, local inter-areal, global, and lateral, map onto state consciousness, phenomenal (P) content, conscious access (A), and phenomenal character, respectively, thus tying evolved anatomy to phenomenality. The classical P-A distinction dissolves into a graded cascade wherein deeper recursion expands the set of reportable, behaviour-driving variables. Recurrency, defined as structural, causal, and/or functional feedforward and feedback connections between elements within a system, is favoured in biological architectures, and supports the closed-loop interactions between brain, body, and environment that underlie adaptive behaviour and self-related processing. Disparities in the explanatory mechanisms across theories of consciousness can thus be resolved by converging onto this shared principle on the implementation axis, rather than deal with phenomenal-first or functional-first ontologies. The field urgently requires this implementation-first distillation that is biologically plausible, mechanistic, and empirically testable.

Socioemotional competencies (SEC) are essential for nurses to provide quality care and to maintain their own health. Historically underrepresented, nursing programs are changing their curricula to incorporate SEC development more strongly. Although it is recommended to practice SEC during clinical placement, studies on how to support nursing students in developing these competencies are lacking.

Our study explores second-year nursing students' perceived and actual use of a reflection tool during their first 20-week clinical placement. Designed to support SEC development, the study focuses on how students incorporate the application in their learning process for SEC development.

An embedded mixed method study was conducted with 15 students from a nursing program in the Netherlands. Qualitative surveys and semistructured interviews were used to capture students' experiences with the application both during and at the end of the clinical placement. Log data from the application provided insight into how the app was used. The mixed methods data were analyzed using warranted assertion analysis.

The app helped students relate learning goals to clinical experiences, identify learning opportunities, and experience a sense of growth. Features that removed practical barriers to reflecting were experienced as most beneficial. Although SEC-focused use was limited (n=7), involved students used the app over a longer period of time and reported greater benefits. Nevertheless, 13 students stopped using the app halfway through their clinical placement, as their attitude shifted from learning to working.

This study gives a rich description of how nursing students used a reflection app to structure their learning process during clinical placement. It reveals that smartphone-based reflection supports students in clinical placement learning. Specifically, the app lowers barriers to engaging in structural reflection and decreases the mental burden of self-regulated learning. However, more guidance and a multimodal intervention approach seem necessary for SEC development. Further research into how to account for students' shifting attitudes toward learning is needed.

The burden of mental disorders is high in conflict-affected populations. In Palestine, we piloted Inuka Coaching, a digital intervention adapted from the Friendship Bench delivered by trained and supervised lay coaches. This paper documents the implementation of the intervention in this highly volatile context after October 7, 2023.

This study aimed to describe the implementation of Inuka Coaching, a digital mental health tool based on task shifting, in Palestine and examine contextual challenges, fidelity to the coaching model, and lessons learned regarding recruitment, retention, and delivery during escalating ethnic cleansing.

Two Palestinian mental health professionals were trained and certified in the Inuka method as head coaches, and subsequently trained 5 lay coaches. Palestinian adults in Gaza and the West Bank were recruited primarily through social media and received up to 4 structured, text-based coaching sessions typically delivered over 4 weeks depending on participant availability and preference. Standardized mental health screening questionnaires (Self-Reporting Questionnaire-20 [SRQ-20] and Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [PCL-5]) were collected at baseline, immediately after the first coaching session, and 3 months after the final session. Session transcripts were reviewed to assess coaches' fidelity to the Inuka method, and a focus group discussion explored coaches' experiences with training, delivery, and contextual challenges.

Between August 2023 and February 2024, a total of 70 participants were enrolled. Baseline assessments indicated high levels of psychological distress: 95.7% (67/70) scored above the PCL-5 threshold of 31, suggesting likely posttraumatic stress disorder, and 69.4% (43/62) scored in the "at risk" range on the SRQ-20. The effectiveness of the method could not be determined as retention was low, with only 7.1% (5/70) completing the program. Coach fidelity was high, with 94.6% (35/37) of transcripts adhering to all 5 steps of the intervention. Coaches reported positive experiences with the method but identified challenges related to recruitment, session continuity, platform usability, and the need for flexibility during acute crises. Key implementation learnings included the importance of early in-person collaboration and training, culturally sensitive framing, flexible delivery and session structures, and robust support for lay coaches.

While digital, task-shifted mental health interventions can be delivered with fidelity in conflict settings, sustaining engagement during escalating violence remains challenging. Future implementations require flexible design, context-sensitive recruitment and retention strategies, adaptive delivery models, and strong support for lay coaches.

Continuity of care is essential in psychiatric services due to the chronic, relapsing nature of mental health conditions, yet care pathways remain heavily fragmented at critical transition points. Although advancements in AI and machine learning (ML) offer powerful capabilities to track longitudinal data and automate clinical decision-making, a structured appraisal of their efficacy in supporting continuity of psychiatric care is lacking. This protocol outlines a mixed methods systematic review to evaluate how AI-driven workflows can proactively enhance monitoring, optimize triage and care resource allocation, and address systemic coordination gaps.

The primary objective of this systematic review is to evaluate the effectiveness of AI and ML interventions in psychiatric care settings in improving the continuity of patient care. Secondary objectives include stratifying the types of AI architectures used and identifying implementation barriers and facilitators.

A systematic literature search of MEDLINE, Embase, CENTRAL, CINAHL, and APA PsycInfo will be conducted to identify peer-reviewed randomized controlled trials, nonrandomized interventional studies, and qualitative or mixed methods evaluations published between January 1, 2016, and December 31, 2025. Two independent reviewers will perform study screening, data extraction, and quality assessment. A mixed methods convergent synthesis using the Joanna Briggs Institute (JBI) convergent segregated approach will be carried out to synthesize quantitative evidence on effectiveness and qualitative data on implementation.

This review is self-funded and was officially registered with PROSPERO on January 24, 2026 (CRD420251245352). Comprehensive database searches have commenced, with full-text screening and transcript reviews projected to conclude by late August 2026, followed by data analysis and submission of the systematic review manuscript targeted for early spring 2027.

By systematically mapping interventions across patient, institutional, and health system levels, this review will clarify the clinical effectiveness, ethical boundaries, and logistical implementation factors of psychiatric AI tools. Ultimately, these consolidated insights will provide an evidence-based foundation to inform clinical guidelines; governance frameworks; and the design of proactive, learning mental health systems.

PROSPERO CRD420251245352; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251245352.

PRR1-10.2196/95931.

There is an urgent and critical need to support the mental health of health care providers, given high rates of stress and burnout. Although the issues are complex, digital access to information and support can help address the needs, as technology can facilitate on-demand links to private, customized resources, including peer support. Beyond Silence (McMaster University) is an evidence-informed mobile health platform co-designed with health care workers and grounded in prior evidence that mental health literacy and peer support can reduce stigma and facilitate earlier help-seeking.

This study aimed to (1) explore how health care workers across diverse health care settings use the app and (2) identify opportunities and barriers to implementation.

A multiple-case study framework, informed by the Consolidated Framework for Implementation Research (CFIR), was applied to capture 4 months of implementation across a purposive sample of 7 diverse Canadian health care organizations. Implementation within each organization was led by designated organizational champions who leveraged existing communication channels and standardized promotional materials to invite employees to voluntarily download and use the app. Implementation outcomes were assessed using app analytics (downloads and feature use) and semistructured baseline and follow-up interviews with organizational champions to explore contextual influences on uptake.

Approximately 1066 employees downloaded the app over the 4-month period, ranging from <2% to >45% of employees across the 7 organizations. Interviews with 28 organizational champions noted that there was good leadership support for the technology, aligning with their mission to address employee mental health. Barriers to use, however, included workplace culture surrounding mental health and help-seeking, lack of awareness about when and how to use the app, and infrastructure-related challenges, such as limited time and a lack of private spaces to download and use the technology.

Effective implementation is a precondition for positive outcomes; therefore, strategies are needed to optimize technology implementation. Recommendations include evaluating organizational readiness, building mental health literacy, creating a multimodal communication and implementation plan, addressing technology requirements, and embedding the technology into organizational policies and practices. This study highlights key challenges in the implementation of the Beyond Silence peer support platform for health care workers, including slow adoption linked to mental health stigma, competing demands, and limited frontline engagement. Addressing these barriers will require innovative, trust-building strategies to support meaningful uptake and sustained use.

Video-based psychotherapy (VBT) is increasingly used to expand access to mental health care. Review studies generally report symptom outcomes similar to those achieved with face-to-face (F2F) psychotherapy. However, these studies often analyze VBT alongside other remote modalities, and it remains unclear what portion of the effects can be attributed to the video-based setting itself.

The objective of this systematic review is to compare VBT and F2F psychotherapy in terms of symptom reduction, using strict methodological inclusion criteria, to maximize comparability between the delivery formats while also considering therapy duration.

We searched bibliographic databases (MEDLINE via PubMed, PsycINFO, and Embase) from inception to May 20, 2025, supplemented by reference checking. The search was updated on March 10, 2026. We conducted a systematic review of randomized controlled trials (RCTs) comparing synchronous VBT with F2F psychotherapy in adults and reporting symptom severity. Trials had to meet a minimum treatment dose (≥500 min) and limited hybrid exposure (≤1/3 of sessions delivered F2F). Interventions had to be delivered by health professionals. We excluded interventions delivered solely via telephone or asynchronous platforms, blended formats, or unstructured counseling or group settings. Risk of bias was assessed following Metapsy (RoB2) guidelines, and certainty of evidence was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Standardized mean differences (Hedges g) of posttreatment symptom severity were synthesized using a 3-level correlated and hierarchical effects (CHE) random-effects model to account for dependent outcomes.

Out of 11,386 identified records, 87 articles underwent full-text review; 12 RCTs (465/900, 51.7% female; mean age 40.21, SD 14.52 y) met the inclusion criteria. Diagnoses included posttraumatic stress disorder, depression, obsessive-compulsive disorder, bulimia nervosa, generalized anxiety disorder, and somatoform pain. Across 41 effect sizes, no significant differences in symptom reduction emerged between VBT and F2F psychotherapy (Hedges g=-0.09, 95% CI -0.52 to 0.33; SE=0.19; P>.99). Between-study heterogeneity was substantial; the 95% prediction interval was -1.65 to 1.46. No moderating effects were detected. The Akaike information criterion favored the 3-level model over conventional approaches.

The evidence base was limited in size and scope (predominantly Western settings, posttraumatic stress disorder diagnoses, and cognitive behavioral interventions). Study limitations, heterogeneity, and few noninferiority trials reduced the certainty of the evidence. This review is innovative in isolating synchronous VBT from other remote delivery formats to understand the specific impact of the setting. Unlike previous reviews, this one provides a more specific estimate of the effects of the delivery setting. This is achieved by isolating synchronous video delivery, applying dose/setting restrictions, and focusing on RCTs. Results refine the current evidence base and support offering VBT as a pragmatic delivery option to extend access to mental health care. Adequately powered noninferiority trials across diverse diagnoses, cultures, and longer-term treatments are needed.

This manuscript describes the (1) development of the "DiscoverU" afterschool mentoring program and (2) formative evaluation of its feasibility, acceptability, and initial impact on adolescents' physical activity (PA), interpersonal skills, and social connectedness. We used a convergent mixed-methods design with quantitative data from adolescents (n = 32) and qualitative data from adolescents (n = 14), mentors (n = 14), facilitators (n = 3), and school staff (n = 3). We assessed pre-post changes physical activity, mindful eating, and social-emotional skills with paired Wilcoxon tests and used content analysis to identify themes. DiscoverU was highly acceptable and demonstrated initial impacts on PA days/week, peer cooperation, and social connection. Qualitative data indicated adolescents' experience with mentors was important to these outcomes. However, feasibility was limited by inconsistent attendance with 44%-52% of adolescents receiving the intended dose. DiscoverU's novel use of mentoring to integrate physical and mental health promotion was well-liked by all involved parties. Strategies to enhance consistent adolescent attendance are needed to increase program feasibility.

Background and objectives Large-scale studies on the prevalence of substance use disorder among people in prisons from developing countries such as India are limited, despite a sizeable number of individuals lodged in prisons. The present study aimed to assess the prevalence of various psychoactive substance use among people in prisons in India, and to assess factors associated with psychoactive substance use in prison. Methods Seventeen prisons from 9 States representing different geographical regions of the country were selected. 7004 incarcerated people selected by systematic sampling were interviewed using a structured questionnaire. Results Majority were incarcerated for the first time (n=5372, 77%) and were under remand awaiting trial or sentencing (n=4537, 65%). The proportion of incarcerated persons with lifetime use of alcohol, cannabis, and opioids was 51% (n=3579), 20% (n=1383), and 11% (n=758), respectively. 21% (n=752) of alcohol users, 30% (n=411) of cannabis users, and 45% (n=340) of opioid users used alcohol, cannabis, and opioids respectively daily in the one month before their current imprisonment. 5.9% (n=412) used a psychoactive substance (including alcohol and illicit drugs) during their current imprisonment, most commonly, cannabis (3.9%, n=273). Multivariable regression showed that psychoactive substance use in prison was significantly associated with younger age [odds ratio (OR): 1.4, 95% confidence interval (CI): 1.1, 1.8], multiple imprisonment (OR: 1.6, 95% CI: 1.3, 2.0), cannabis use before imprisonment (OR: 5.5, 95% CI: 4.1, 7.4), and substance withdrawals inside prison (alcohol OR: 1.8, 95% CI: 1.4, 2.4, cannabis OR: 2.9, 95% CI: 2.1, 4.1, opioids OR: 3.1; 95% CI: 2.3, 4.2). Interpretations and conclusions The study documents high lifetime substance use among individuals in prisons in India and identifies various factors associated with substance use during current imprisonment.

Many medical students incorporate music in their daily lives, however opportunities to engage with music within the curriculum are rare. This mixed-methods study explores the experiences of medical students who participated in a semester-long, performance-focused 'Music for Health' elective at an Australian University, including benefits and challenges perceived by students.

Data were collected over a three-year period, from six cohorts (2018-2023) of students who participated in the elective during the second year of their medical degree. Twenty-one (21) students who participated in the elective between 2021 and 2023 completed an online survey, from which data were analysed using descriptive statistics and deductive content analysis. Meanwhile, eleven (11) students who participated between 2018 and 2020 granted access to written reflections, which formed the basis for an Interpretative Phenomenological Analysis (IPA).

Survey data suggested that most students (>80%) perceived benefits to their mental health and communication and teamwork skills from participating in the elective. Content analysis of 'benefits' and 'challenges' described in survey data supported the validity of six themes identified through the IPA: Therapeutic potential of music; Personal well-being and mental health; Emotions and human connection; Transferable skills; My relationship with music; and Camaraderie through musical collaboration. From themes identified two Global Meaning Units were constructed: (1) Music supports personal and social well-being and (2) Emotional connection through music enhances relationships.

The results of this study suggest that medical students' participation in curricular music ensemble performance can serve as a medium for teamwork and collaborative problem-solving, developing 'performance skills' such as adaptability and dealing with nerves in a context of peer support. Facilitating student-patient interaction through music can also support students to recognise and value the social and emotional dimensions of medicine practice.

The protracted conflict in Yemen has led to profound disruptions in the health system, fundamentally reshaping patterns of healthcare access and utilization. This commentary engages with a recent study that conceptualizes self-medication and informal antibiotic use as forms of coping and agency in constrained settings, and re-examines this interpretation within the context of systemic collapse. Drawing on a structural perspective, the analysis argues that self-directed care practices in Yemen are not temporary responses to episodic constraints but are embedded within enduring structural conditions shaped by infrastructure destruction, workforce depletion, and disruptions in medical supply chains. These conditions have produced overlapping physical, financial, and sociocultural barriers to healthcare access, contributing to the normalization of informal care practices, including self-prescription and reliance on community-based networks. The commentary also examines the role of psychological distress in shaping health-seeking behaviour, highlighting how the absence of accessible mental health services reinforces reliance on self-directed care. By reframing self-medication as an outcome of structural conditions rather than individual choice, this analysis contributes to debates on health system collapse in conflict settings and underscores the limitations of behaviour-focused interventions while emphasizing the need to address structural determinants of healthcare access.