Data were collected prospectively from 60 Veterans at risk for suicide at multiple time points over a one year period to identify predictors of suicidal events in the next 90 days. This outcome included suicide attempts, interrupted/aborted attempts, preparatory behaviors, or suicide-related hospitalizations. Entry criteria included prior year suicidal behavior or prior week severe suicidal ideation. At each time point, participants completed neurocognitive testing and self-report measures of suicidality, and reported suicide-related events since the previous time point. Available data include suicide-related outcomes, question-level data for clinical interviews and self-report measures (including assessments of suicidal thoughts and behaviors, suicidal ideation severity, as well as the Beck Depression Inventory-II (BDI-II), Beck Hopelessness Scale (BHS), Holmes-Rahe Stress Inventory, Automatic Thoughts Questionnaire (ATQ-30), and Acquired Capacity for Suicide Scale (ACSS)), and trial-level data for neurocognitive testing (including go-no/go task, a reward- and punishment-based learning task, death/suicide version of the Implicit Association Task, a memory recognition test), as well as latent cognitive variables extracted from computational modeling of the neurocognitive tests. This data may be used in secondary analyses for identification of predictors of multiple suicide-related outcomes over different time frames.

Individuals with bipolar disorder spend significantly more time depressed than manic, and treatment alternatives for treatment-resistant patients are greatly needed. Although the Stanford Accelerated Intelligent Neuromodulation Therapy (SAINT) intermittent theta-burst stimulation (iTBS) protocol has shown efficacy in unipolar depression, its utility in bipolar depression remains largely unexplored. This study aims to assess the feasibility and safety of SAINT in patients with bipolar I depression that have failed to respond to a first-line treatment and examine underlying neural mechanisms of treatment response.

Ten participants with bipolar I disorder underwent a modified SAINT protocol in this open-label study. Depressive and manic symptoms were assessed throughout. Personalized left dorsolateral prefrontal cortex (DLPFC) stimulation targets exhibiting negative resting-state connectivity with the subgenual anterior cingulate cortex (sgACC) were generated using resting-state functional MRI. We then investigated changes in resting-state (DLPFC and sgACC) seed-to-whole brain connectivity, and its relationship to treatment response.

Immediately post-treatment, depressive symptoms decreased by an average of 56.7 (SD=19.7%)%. Following treatment, participants exhibited increased connectivity between sgACC and two bilateral frontal pole clusters. Greater reductions in depressive severity were significantly associated with increased negative connectivity between left DLPFC target seed and four clusters in prefrontal and temporal cortices.

SAINT iTBS was well-tolerated in a bipolar I depression sample and associated with sgACC functional connectivity changes. Increased negative connectivity between the DLPFC target and prefrontal/temporal cortex was associated with treatment response. Larger, sham-controlled studies are needed to confirm these findings and explore predictors of treatment response in bipolar depression.

Health professionals play a critical role in tobacco prevention and cessation, but limited training during education often leaves their knowledge, attitudes, behaviors, and organizational support insufficient. Our aim was to assess the effect of an online brief smoking cessation training program on knowledge, attitudes, behaviors, and organizational factors among health professions students in Spain and the United Kingdom.

A pre-post study was conducted among 756 undergraduate health professions students (652 from Spain and 104 from the UK) from four universities. Participants completed the validated Knowledge, Attitudes, Behaviors, and Organizational factors self-reported questionnaire for health professions Students (KABO_S) before and one month after the training. Generalized linear mixed models analyzed pre-post changes, adjusting for gender, age, and tobacco use.

Significant increases were observed in the overall KABO_S score from 4.82 (SD=1.34) to 6.69 (SD=1.26) at one month (p<0.01). All dimensions increased in both countries (all p<0.01), with the greatest gains in individual knowledge/skills and attitudes/beliefs (median improvements ranging from 38.5% to 69.1%). Organizational resources showed the lowest gains (median improvement of 5.7% to 15.2%). Linear mixed models confirmed a significant increase in overall KABO_S scores (Spain: β=1.78; 95% CI: 1.67-1.90; UK: β=2.44; 95% CI: 2.13-2.74) and in each individual dimension (all p<0.001).

Knowledge, attitudes, behaviors, and organizational factors improved significantly among health professions students in both countries. These findings suggest that this online training program may represent a promising addition to health professions curricula in Europe.

The COVID-19 pandemic had a profound impact on nurses in Long Term Care settings, who are responsible for resident care, clinical leadership, and staff training. These nurses face challenges such as supporting residents with complex health conditions, high workloads, and staffing shortages- challenges that intensified during the pandemic. Research suggests that these factors have affected nurses' well-being, and the quality of care provided to residents.

This study aimed to compare nurses' (RNs/LPNs) quality of work life before and after the pandemic, focusing on changes in work-related stress, burnout, and well-being.

We conducted a repeated cross-sectional analysis of data from a stratified random sample of 39 urban Long Term Care homes in Anonymized and Anonymized that are part of the Translating Research into Elder Care Program. Data were collected pre pandemic (February 2020) and during the pandemic (December 2021), with only homes participating in both waves included. Two-level random-intercept regression models were used, adjusting for demographics and Long Term Care home characteristics. A total of 389 and 430 nurses completed surveys in 2020 and 2021, respectively.

The 2021 sample reported working significantly more hours (B = .04, p<.001), with increased emotional exhaustion (B = 0.17, p = .038, 95% CI: 0.09, 0.32), a key component of burnout, and a small but significant decline in mental health (B = -0.03, p = .007, 95% CI: -0.05, -0.01). Another component of burnout, cynicism, was significantly lower during the pandemic (B = -0.28, p<.001, 95% CI: -0.42, -0.14). No significant changes were observed in job satisfaction, professional efficacy, or physical health.

Despite rising emotional exhaustion and declining mental health, cynicism did not follow the pattern expected under crisis conditions, suggesting that components of burnout may respond differently to pandemic stressors. Our findings have implications for supporting Long Term Care nurses through targeted interventions, particularly in managing workloads and mental health.

Antipsychotic-induced extrapyramidal symptoms (EPS), including drug-induced parkinsonism, akathisia, dystonia, and tardive dyskinesia, remain major limitations of long-term antipsychotic therapy and negatively affect treatment adherence and quality of life. Traditional Chinese Medicine (TCM) has increasingly been explored as an adjunctive strategy for EPS management; however, evidence regarding prescription patterns, clinical effectiveness, and mechanistic rationale remains fragmented.

To conduct an integrative review of TCM interventions for antipsychotic-induced EPS through synthesis of clinical evidence and quantitative analysis of prescription patterns.

A systematic search of English- and Chinese-language databases identified 31 eligible studies, including randomized controlled trials, non-randomized studies, and cohort investigations. Clinical characteristics, EPS subtypes, outcome measures, safety data, and herbal prescription components were extracted. Narrative evidence synthesis was combined with frequency analysis, association rule mining, clustering, and network mapping to identify recurrent herbal combinations and therapeutic structures.

Included studies involved patients with schizophrenia-spectrum disorders receiving first- or second-generation antipsychotics. Drug-induced parkinsonism and tardive dyskinesia were the most frequently evaluated EPS subtypes. Frequently prescribed herbs included Gastrodia elata, Uncaria rhynchophylla, Angelica sinensis, and Paeonia lactiflora. Data mining identified reproducible prescription patterns centered on wind-extinguishing, blood-nourishing, and phlegm-resolving therapeutic principles. Across comparative studies, adjunctive TCM interventions were associated with reductions in EPS severity scores and generally mild adverse events. Mechanistic findings suggested potential roles in dopaminergic modulation, neuroprotection, anti-inflammatory activity, and oxidative stress reduction. However, methodological heterogeneity, inconsistent reporting standards, limited blinding, and short follow-up durations reduced certainty of evidence.

Current evidence suggests that adjunctive TCM interventions may provide symptomatic benefit for antipsychotic-induced EPS, particularly drug-induced parkinsonism and tardive dyskinesia. Nevertheless, existing evidence remains preliminary and geographically concentrated, and higher-quality multicenter studies with standardized reporting and long-term safety evaluation are required before broader clinical implementation can be recommended.

The Body Project is a dissonance-based body image intervention that was originally developed to prevent the onset of eating disorders. The aim of this review is to provide an overview of the key scientific Body Project findings along with a discussion of implementation successes and approaches as well as ongoing questions.

This is an invited narrative review.

The Body Project is backed by significant efficacy and effectiveness research and has been found to reduce internalization of the appearance-ideal, body dissatisfaction, negative mood, dieting, and continuous measures of eating disorder pathology. Some variants have also been found to reduce onset of eating disorders, thus making the Body Project a true eating disorders prevention program. Despite this, many communities choose to implement the Body Project primarily for its effectiveness at improving body image under a wide range of circumstances.

Although the mental health field broadly has struggled to translate efficacy and effectiveness research into widespread adoption of evidence-based programs, an informal global village comprised of researchers, community partners, and clinicians has collectively worked together to successfully implement the Body Project on a very large scale. It offers numerous lessons about the importance of theory and research in intervention development as well as the potential of community participatory research. Future directions include novel and cultural adaptations to allow flexible Body Project implementation in new contexts.

Impaired microcirculation contributes to delayed healing in venous, arterial, diabetic and mixed-aetiology ulcers. Activation of the leg muscle pump by intermittent neuromuscular electrostimulation of the common peroneal nerve has been proposed to improve microvascular perfusion. This review examines current evidence for neuromuscular electrostimulation effecting changes in microvascular flux in chronic lower-limb ulcers of all aetiologies, as measured by Laser Speckle Contrast Imaging. Eligible studies were limited to human research evaluating the effects on chronic lower-limb ulcers of any aetiology. Four eligible studies (total n = 44) were identified. In venous ulcers, neuromuscular electrostimulation increased wound bed flux by 28.5% (p < 0.05), and pulsatility by 126% (p < 0.05). In arterial leg ulcers, flux increased by 60.9% (p < 0.02) and pulsatility by 161% (p < 0.02). In mixed aetiology ulcers, wound bed flux increased by 38.2% (p < 0.05) and pulsatility by 214% (p < 0.05). In diabetic foot ulcers, flux increased by 40.2% (p < 0.01) and pulsatility by 406% (p < 0.01). Across all ulcer types combined, wound-bed flux increased by 37.6% (p < 0.001) and pulsatility by 198% (p < 0.001). There is compelling evidence that intermittent neuromuscular stimulation of the common peroneal nerve enhances microcirculatory perfusion in the wound bed of chronic leg and foot ulcers. These consistent physiological improvements support its potential as an adjunctive therapy.

Annexin A5 (ANXA5) is a Ca²⁺-dependent phosphatidylserine (PS)-binding protein classically employed as an apoptosis biomarker. Accumulating evidence now positions ANXA5 as a multifunctional regulator of membrane homeostasis, immunometabolism, and cellular adaptation to metabolic stress across the spectrum of diabetes mellitus (DM). This review synthesizes current mechanistic and translational insights identifying ANXA5 as a candidate molecular determinant of diabetic pathophysiology. Its conserved α-helical architecture and dual-promoter transcriptional regulation enable reversible, high-affinity PS binding and assembly of a two-dimensional (2D) crystalline lattice that underpins its diverse biological functions. In the pancreas, ANXA5 has been shown to inhibit islet amyloid polypeptide (IAPP) aggregation and shields β-cell membranes from amyloid-induced injury; it has also been proposed to modulate mitochondrial Ca²⁺ homeostasis via VDAC1-associated pathways. In insulin-responsive peripheral tissues, ANXA5 has been hypothesized to modulate insulin signaling fidelity and facilitate glucose uptake through putative IRS-1 interactions and lipid raft stabilization, although direct in vivo validation remains outstanding. In the diabetic endothelium, hyperglycemia-induced dysfunction of acid sphingomyelinase impairs ANXA5-mediated membrane resealing, thereby precipitating Ca²⁺ overload, inflammasome activation, and a prothrombotic state. Experimental studies further suggest that ANXA5 may promote M2 macrophage polarization and suppress TGF-β/Smad2/3 signaling, indicating potential roles in immunomodulation and fibrosis attenuation. Importantly, distinct disease contexts shape ANXA5 biology: in T2D, glucolipotoxic stress and IAPP aggregation drive ANXA5-dependent protective responses, whereas in T1D, circulating anti-ANXA5 autoantibodies may neutralize membrane-protective functions and amplify vascular injury risk. Emerging translational applications include recombinant ANXA5 (NEXUS) and Diannexin, although prospective clinical validation remains limited. To facilitate interpretation of the literature, we introduce an evidence-grading framework that distinguishes diabetes-validated mechanisms from biologically supported, incompletely validated, and speculative pathways.

Diabetes mellitus severely impair fracture healing due to a pathological microenvironment characterized by persistent hyperglycemia, excessive reactive oxygen species (ROS), tissue hypoxia, and chronic inflammation, which together suppress angiogenesis and osteogenesis. Most current biomaterial strategies target only a single pathological factor and therefore fail to disrupt the interconnected metabolic cascade that perpetuates tissue dysfunction. Here, we developed a pathology-driven catalytic nanozyme-integrated adhesive hydrogel (Gel-FQG) to simultaneously regulate hyperglycemia, oxidative stress, hypoxia, and immune imbalance in diabetic fractures. Gel-FQG incorporates glucose oxidase (GOx)-loaded Fe³⁺-quercetin nanozymes into a dynamic Schiff-base hydrogel network, providing strong tissue adhesion, injectability, and sustained catalytic activity. Through sequential glucose oxidation and H₂O₂ decomposition, Gel-FQG consumes excess glucose, scavenges ROS, and generates oxygen, thereby disrupting the hyperglycemia-ROS-hypoxia feedback loop. In vitro, Gel-FQG alleviates oxidative stress and hypoxia, promotes macrophage polarization toward the pro-regenerative M2 phenotype via suppression of the TNF-α/NF-κB/HIF-1α signaling, and enhances osteogenic and angiogenic responses under hyperglycemic conditions. In a diabetic rat femoral fracture model, local implantation of Gel-FQG significantly accelerates vascularized bone regeneration and fracture healing. These findings demonstrate that Gel-FQG actively remodels the diabetic fracture microenvironment and offers a promising strategy for diabetic bone repair.

Type 1 diabetes (T1D) is a chronic autoimmune disease that requires intensive lifelong self-care, often beginning in childhood or adolescence, with daily demands such as blood glucose monitoring, a balanced diet, and insulin administration. Grounded in the Common-Sense Model of Self-Regulation, this study examined the predictive role of illness perceptions in self-care behaviors among Brazilian adults with T1D. Participants were 107 adults with T1D who completed an online survey including sociodemographic and clinical questions, the Summary of Diabetes Self-Care Activities Questionnaire, and the Brief Illness Perception Questionnaire. The sample was predominantly female, with a mean age of about 31 years and a mean age at diagnosis in adolescence, and showed, on average, moderately adequate glycemic outcomes. Multiple stepwise linear regression analyses indicated that personal control was retained in several exploratory models and was the most consistent predictor of self-care behaviors, including general diet, physical activity, blood glucose monitoring, and medication engagement. Other illness perception dimensions showed behavior-specific associations, such as concern predicting greater engagement in foot care and treatment control contributing to more frequent blood glucose testing, while older age and earlier diagnosis were also related to better care. These findings underscore personal control as a central psychological factor influencing diabetes self-management, reflecting the progressive internalization of responsibility that begins in adolescence and extends into adulthood. Early interventions targeting illness perceptions, particularly personal control, may help strengthen long-term self-care skills and treatment adherence across the lifespan in people with T1D.