Many medical professionals and trainees do not feel comfortable providing care for obesity. Therefore, there is a need to improve the standards of obesity education and medical curriculum in Canada. Our study aims to determine how obesity care is currently taught and to identify the perceived most effective teaching methods for improving obesity care education in Canadian medical schools.

Our study employs a cross-sectional design and is guided by constructivist grounded theory, which posits that the interpretation of study results is shaped by the researcher. Attempts to recruit participants were made at 8 of 14 English-speaking medical schools across Canada. A total of n = 17 participants from 4 of these schools are represented in our study. Focus groups with third- and fourth-year Canadian medical students were conducted to identify strategies to improve the delivery of obesity care education. Focus group questions were developed by a medical professional and researcher, and face validity was conferred. Transcripts were anonymized using MacWhisper (Version 12.17), verified for accuracy, and analyzed thematically and content-analytically using Atlas.ti (V.25).

Focus group data yielded four main themes-Theme 1: Preceptors lack the knowledge and skills to teach students effective obesity care, which can perpetuate the idea that engagement in obesity care/management is undervalued and contributes to ongoing stigma and health inequities faced by people living with obesity. Theme 2: The medical curriculum and assessment do not emphasize deliberate curricula in obesity care, integrated obesity care across curricula and conditions, given its impact on comorbidities. Theme 3: Students are generally not comfortable with pediatric obesity care because it is not taught. Theme 4: Obesity curricula employ multi-component teaching methods.

Our study identifies methods to improve obesity care education across Canadian medical schools. While multiple methods of curriculum delivery are effective, ensuring that instructors are proficient and stigma-free in delivering obesity-related topics is essential.

People with knee osteoarthritis exhibit overactivity of the knee muscles during functional tasks. This will increase mechanical loads and may exacerbate pain. Cognitive Muscular Therapy™ (CMT) is a new conservative intervention that aims to reduce muscle overactivity and change habitual responses to pain. This study was designed to assess the feasibility of a future randomised controlled trial, designed to compare CMT with usual care.

Patients with knee osteoarthritis, who had failed to benefit from previous therapeutic exercise, were randomised to receive CMT or usual care. Participants in the CMT arm were offered seven individual sessions, delivered by an NHS physiotherapist trained to deliver the intervention. Trial feasibility was assessed by monitoring recruitment, adherence, retention, treatment fidelity and acceptability through an embedded process evaluation. Secondary outcome measures included WOMAC and the Pain Catastrophizing Scale.

82 patients were recruited from 164 screened. Of the 42 allocated to the CMT arm, 32 completed the treatment. Retention was acceptable in the CMT arm but higher than anticipated in the usual care arm. Both patients and physiotherapists found the treatment to be acceptable, and the mean intervention fidelity score was 91%. Composite WOMAC score reduced by 17.1 points in the CMT arm from baseline to 20-weeks, and 2.8 points in the control arm over the same period.

CMT is an acceptable intervention for people with knee osteoarthritis. Future large-scale trials are now required to quantify the clinical effectiveness of this promising new treatment.

ISRCTN25291958.

Rising mental health challenges among adolescents are a global priority, yet tools to identify at-risk individuals remain limited. The development of objective tools, such as plasma biomarkers, could enhance the implementation of early preventive strategies for individuals at increased risk. We explored plasma metabolites associated with overall psychosocial difficulties in 197 adolescents aged 11-16 from the WALNUTS study. Psychosocial difficulties were assessed using self-reported Strengths and Difficulties Questionnaire (SDQ) scores. Plasma metabolomics data were generated by untargeted liquid chromatography high-resolution mass spectrometry using cross-sectional plasma samples. Linear regression modelling was performed to identify associations between plasma metabolites and the total SDQ score. Logistic regression and Precision-Recall curves were used to evaluate the classification performance of candidate metabolites in distinguishing the SDQ groups (low: 0-14; raised: 15-25). Additionally, pre-existing red blood cell fatty acid profile data were analysed to detect differences between the low and the raised SDQ score groups. Three metabolites: isoleucine, pregnenolone sulfate, and lysophosphatidylcholine 20:1, were significantly associated with the SDQ score, and are involved in energy metabolism, neuronal functions and phospholipid-related signalling. In addition, a trend towards lower proportions of red blood cell n-3 polyunsaturated fatty acids was observed in individuals with the raised SDQ score. This exploratory study observed associations between three plasma markers and the total SDQ score, reflecting psychosocial, behavioural, and emotional difficulties in adolescents.

While virtual reality (VR) is increasingly used across health-related domains to improve cognitive abilities, mental health, and motor function, the mechanisms underlying the transfer of skills learned in VR to real-world performance (the ultimate objective of health interventions) remain largely unknown. This study investigated the effectiveness of VR training in transferring spatial and visual memory skills to real-world performance using an everyday task consisting on navigating and locating items in a grocery-store aisle, a complex instrumental activity of daily living. Forty-seven healthy adults were randomly assigned to train either in a virtual replica of the aisle or directly in the physical setting. Participants trained in VR subsequently demonstrated significantly improved real-world task performance, exhibiting shorter task completion times and reduced travel distances compared to those performing the task for the first time. However, while skill transfer from VR to real-world tasks was confirmed, performance improvements in task completion time were superior following direct real-world training, consistent with the principle of encoding specificity. Consequently, although the results provide robust evidence supporting VR as a valuable training tool for improving skills relevant to daily activities and indicate the utility of VR as a preparatory training stage, precise context-dependent tasks might necessitate direct physical practice for maximum efficacy.

Tinnitus heterogeneity is well-documented across phenotypes, etiologies, risk factors, comorbidities and associated burden. However, variability in treatment response remains insufficiently explored and often masked by the group-level comparisons of clinical studies. Moreover, little is known about the temporal trajectories of symptoms during treatment. Longitudinal monitoring via smartphones using Ecological Momentary Assessment provides rich inter- and intraindividual data on fluctuations and trajectories of symptoms. In this study, we investigated whether individual 12-week trajectories of daily self-reported tinnitus symptoms during treatment could be meaningfully sub-grouped. 147 patients provided 9634 observations while undergoing single or combined applications of hearing aids, cognitive-behavioural therapy, structured counseling, and sound therapy. A four-class growth mixture model best fit the data. One class was characterized by an increase in tinnitus symptoms over time (18%), another showed stable symptom trajectories (40%), while the remaining two classes described symptom reductions with different onsets during treatment (early improvement: 20%; late improvement: 21%). The identified classes did not differ in baseline characteristics, indicating that this information could not be used to predict symptom trajectories. Additionally, all four classes were represented in nearly each treatment arm. Notably, retrospective patient-reported outcome measures (PROMs) did not consistently align with latent symptom trajectories. These results underscore the heterogeneity and non-linearity of symptomatic change both within and across treatment modalities. We propose that app-based trajectories reveal details about symptom improvement that cannot be seen in standard PROMs.

Despite advances in prognostication for uveal melanoma (UM), mortality from this disease remains high due to a lack of effective treatments to prevent metastatic progression. Novel therapeutic targets are needed, but few studies have been able to compare UM to its progenitor cell due to a lack of commercially available uveal melanocyte cell lines. We established novel uveal melanocyte cell lines for comparison to our novel UM patient-derived organoids (PDOs).

Uveal melanocytes were isolated from the choroid of post-mortem donor eyes. Melanocytes were cultured in Ham's F12 medium, and melanocytic markers were confirmed using immunohistochemistry. Melanocytes were grown as spheroids on Cultrex-coated plates prior to Exome- and RNA-sequencing for comparison to UM PDOs.

Uveal melanocytes were successfully established with confirmed melanocytic markers and absence of contaminant cell types. Melanocytes displayed regular, higher order growth patterns in 2D culture compared to more primitive colony formation displayed by UM, and melanocytes could be carried for at least 15 passages. Exome-sequencing confirmed an absence of UM-relevant mutations in the melanocytes, and RNA-sequencing revealed differential gene expression between benign uveal melanocytes and UM PDOs.

Well-characterized uveal melanocyte cell lines can be compared to UM samples in the laboratory to help identify novel UM treatment targets and serve as a control population for future translation research.

Community forensic mental health services (CFMHS) in England were developed to reduce reliance on hospital care for this population, but provision varies. It is unclear whether standard setting work has increased consistency. Freedom of information requests were therefore sent to 50 National Health Service Trusts in England, to examine the population, staffing, treatment provision and organisation of CFMHS.

Data were provided for 32 CFMHS, of which 59% were part of secure hospital-based services and 41% were standalone services working in parallel with general services. There was variation in aspects including professional composition, functions, the settings from where CFMHS accept referrals and long-term approach to patients subject to special restrictions under the Mental Health Act 1983.

CFMHS continue to vary, especially in their interface with services other than forensic hospitals. This may impede standard setting and empirical evaluation. Different approaches to centralising oversight may be needed for standardisation.

Subjective cognitive decline (SCD) refers to self-perceived decline in cognition in the absence of objective impairment and may represent a preclinical stage of Alzheimer's disease, particularly when accompanied by worry. However, limited research has examined the influence of age and sex on cognitive performance among individuals with SCD. This study investigated age- and sex-specific associations between SCD (+/- worry) and cross-sectional cognition in the Canadian Longitudinal Study on Aging (CLSA). Participants were categorized into Controls (n = 5713), SCD-No Worry (n = 3379) and SCD + Worry (n = 3511). Analyses were stratified by age (45-54, 55-64, 65-74, 75+) and sex and adjusted for education and depressive symptoms. Cognitive outcomes included four executive function and two verbal memory measures. Regarding executive function, men with SCD + Worry outperformed controls on letter fluency in the 55-64 and 65-74 groups, and women in both SCD groups outperformed controls on letter fluency in the 65-74 group. In contrast, men aged 75+ with SCD + Worry performed worse than controls on semantic fluency. No group differences emerged on Stroop Interference or the mental alternation task. For memory, men aged 45-54 and 55-64 with SCD-No Worry had higher immediate recall, whereas in the 75+ group, lower delayed recall was observed in men with SCD (+/- worry) and women with SCD-No Worry compared to controls. Overall, the results indicate that the clinical relevance of SCD may increase with age, independent of sex and worry status. These findings may improve the clinical utility of SCD and inform earlier detection of individuals at risk of future cognitive decline.

Objective: Preclinical research and cognitive neuroscience implicate the hippocampus as a critical node in the neurobiology of drug addiction, as is vividly illustrated in this clinical case study. Method: The patient, JD, was a 52-year-old male with a long history of severe cocaine use disorder who sustained a bilateral ischemic stroke to the hippocampus due to a cocaine-related overdose. He was evaluated at the initial injury and at 12-month follow-up. Results: While hospitalized, neuropsychological assessment revealed both severe 2-year retrograde amnesia and anterograde amnesia with preserved global cognitive functioning. At 12-month follow-up, JD exhibited a similar neuropsychological profile. Most significantly, JD reported full sustained remission of cocaine use disorder at follow-up, without cravings or effort to achieve this outcome and despite intact declarative and autobiographical memory of his past cocaine use. His remission was confirmed by his son with whom he lived. A 12-month follow-up 3T MRI confirmed bilateral total hippocampus volumes in <1^st%ile compared to normative nomograms. In addition, high-resolution segmentation of the hippocampus comparing JD to a healthy community sample revealed that the largest differences were in the hippocampal tail , CA1 subfield, CA4 subfield, dentate gyrus, molecular layer, and fimbria of the hippocampal body. Conclusions: JD's case reveals the essential role of memory systems subserved by the hippocampus in maintaining addiction, even in the presence of declarative historical memories. Moreover, although no longer relevant for JD, this case underscores the importance addressing the memory systems in addiction treatment.

This scoping review will explore and analyze the literature on the delivery of pre-registration palliative care nurse education within higher education. The review will identify and map the design and modes of education delivery and identify any educational frameworks underpinning such approaches.

Nursing students report feelings of unpreparedness when supporting patients requiring palliative care and have expressed the need for further education. Therefore, education and guidance must be provided at pre-registration level to improve delivery, engagement, and proficiency in palliative care. Despite existing guidelines for pre-registration nursing education on palliative care, a standardized framework or approach is necessary to integrate and deliver education on this topic.

This scoping review will include both published, non-published, and gray literature. Eligible sources will focus on pre-registration nursing students enrolled in pre-registration general, mental health, intellectual disability, and children's nursing programs. Sources reporting on the delivery of palliative care education, including how it is embedded or integrated into curricula in theoretical learning settings within higher education institutions, will be included.

The review will follow the JBI methodology for scoping reviews. CINAHL, MEDLINE, PsycINFO, Academic Search Complete (all via EBSCOhost); Scopus; and the Cochrane Library will be searched for published studies. Gray literature will also be considered. Reference lists of included studies will be hand-searched for additional papers. Literature published in English from 2014 onward will be considered. Three reviewers will independently screen studies, with data extracted and presented in tables alongside a thematic narrative summary.

OSF https://doi.org/10.17605/OSF.IO/VEHBK.