Medical assistance in dying (MAiD) is gaining legal and social acceptance; yet it remains ethically controversial and challenging for healthcare professionals. This functional MRI study examines how social norms and empathy influence MAiD decisions in 59 Australian medical students while evaluating hypothetical assisted-dying scenarios. Participants' decisions generally aligned with the legal framework. MAiD was approved when eligibility criteria were met (normative cases) and denied when they were not (nonnormative cases). Nonnormative scenarios elicited greater activation in frontoparietal brain regions involved in response selection and inhibition, consistent with increased decision difficulty. These scenarios elicited heightened activity in the precuneus, temporoparietal junction, and angular gyrus, along with stronger functional connectivity between the anterior hippocampus and the precuneus, suggesting greater reliance on memory retrieval and mentalizing. Normative scenarios were associated with increased amygdala activity, particularly among less religious participants, suggesting a role for negative affective salience. Greater activity in the ventromedial prefrontal cortex, and connectivity between the anterior cingulate cortex and this region, suggest positive feelings related to compassion when a clinician can legally approve an assisted dying request. Normative scenarios were also associated with reduced connectivity between the anterior cingulate cortex and the anterior insula, particularly in those with higher trait affective empathy, suggesting that doctors might feel a reduction in their patients' pain. The findings provide the first empirical evidence of the neural mechanisms underlying decision-making in bioethical cases involving death as the outcome, highlighting distinct contributions and potential risk factors for medical practitioners in normative and nonnormative MAiD clinical situations.

Memory destabilization is a critical phase in memory reconsolidation, during which the transient disruption of consolidated memory traces allows for the incorporation of new information, supporting memory updating and adaptive behavioral modification. While neurotransmitter release and receptor signaling during memory reactivation are known to trigger memory destabilization, the underlying regulatory networks and dynamic interactions remain unclear. Existing studies often examine neurotransmitters in isolation, lacking a unified framework. This review introduces a novel integrative framework that organizes existing evidence on neurotransmitter-mediated memory destabilization around novelty and prediction error (PE) signaling. By synthesizing experimental findings across dopamine (DA), norepinephrine (NE), acetylcholine (ACh), the glutamatergic/GABAergic systems, and the endocannabinoid system, we analyze how PE and novelty engage distinct yet interacting neural pathways. Integrating experimental data and theoretical concepts from multiple systems, we propose the PE-Novelty-Neurotransmitter Network-a unified framework explaining how multimodal neurotransmitter co-release across the midbrain-locus coeruleus-cortex circuit dynamically regulates the balance between memory stability and flexibility. This review addresses diverse memory types, with a focus on maladaptive memories, while also discussing emotional and nonemotional memories. It further discusses potential clinical implications, particularly how neuromodulatory process related to PE and novelty may inform strategies for modifying maladaptive memories and enhancing cognitive flexibility. By bridging mechanistic insights with translational considerations, this work establishes a unified framework for understanding memory plasticity and informs future efforts to translate basic neuroscience into therapeutic contexts.

Adolescent and young adult (AYA) survivors of childhood cancer face complex challenges during the transition to adult-oriented cancer care, highlighting the importance of identifying facilitators and inhibitors of transition readiness. This study aimed to identify the determinants of transition readiness among AYA survivors of childhood cancer.

This study employed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Literature searches were conducted in MEDLINE, Scopus, CINAHL, ScienceDirect, and Wiley between December 15 and 31, 2025. Eligible studies were full-text English-language articles published between January 2015 and December 2025 that involved AYA childhood cancer survivors aged 15-39 years. Data were synthesized narratively using an inductive approach to identify key themes within the framework of Meleis' Transition Theory.

A total of 17 studies from eight countries were included. Determinants of transition readiness were grouped into three transition conditions: personal, community, and societal factors. Personal factors included beliefs and attitudes, socioeconomic status, preparation and knowledge, mental and psychological health, and clinical and sociodemographic characteristics. Community factors included relationships with healthcare providers, family and peer support, communication and shared decision-making, and community resources and services. Societal factors reflected the influence of the healthcare system, continuity and coordination of care, policy and insurance, and geographic context.

Transition readiness is shaped by multidimensional determinants that interact at the personal, community, and societal levels.

These findings underscore the need for a multidimensional, integrated approach to planning and implementing healthcare transitions from pediatric to adult care for AYA survivors of childhood cancer. They highlight key factors influencing transition readiness. For healthcare professionals, these findings provide an evidence-based foundation to deliver comprehensive, age-appropriate transitional care. For researchers, this synthesis identifies critical knowledge gaps, refines theoretical and measurement frameworks, and guides the development and evaluation of targeted transition interventions.

Brain-derived neurotrophic factor (BDNF) has been proposed as a potential biological correlate of repetitive transcranial magnetic stimulation (rTMS). However, its relationship with clinical and cognitive outcomes in mood disorders remains unclear. In this prospective exploratory pre-post study, 28 adults with major depressive disorder or bipolar disorder underwent 12 sessions of high-frequency left dorsolateral prefrontal cortex (DLPFC) rTMS while continuing pharmacological treatment. Assessments included Hamilton Rating Scale for Depression (HDRS-24), Wisconsin Card Sorting Test (WCST), plasma BDNF, and baseline glymphatic efficiency (diffusion tensor image analysis along the perivascular space (DTI-ALPS)). Over the study period, HDRS-24 scores and WCST perseverative errors decreased, whereas the number of WCST categories completed did not significantly change at the group level; peripheral plasma BDNF also increased. Greater BDNF change ratios were associated with higher baseline ALPS indices and with individual variability in WCST categories completed, but not with changes in depressive symptoms or perseverative errors. Given the uncontrolled design, these longitudinal changes should be interpreted as associations observed over time rather than treatment effects attributable to rTMS. Baseline glymphatic efficiency may therefore reflect an individual biological characteristic associated with neurotrophic responsiveness to rTMS. These exploratory findings require replication in larger controlled studies using standard clinical protocols.

Despite its clinical significance, pharmacological treatment options for alcohol use disorder (AUD) remained limited, which highlights the need for novel therapeutic targets. The ghrelin system has emerged as an important regulator of alcohol craving and intake. Liver-expressed antimicrobial peptide 2 (LEAP2) has recently been identified as an endogenous ghrelin receptor (GHSR) antagonist that influences metabolic and reward-related pathways.

As a secondary analysis of five different clinical trials, we measured LEAP2 concentrations in the collected blood samples and examined their association with alcohol craving and the effects of both acute and chronic alcohol use on LEAP2. In addition, we complemented these clinical trial analyses by conducting preclinical experiments in wild-type and GHSR-KO Wistar rats to investigate the effects of alcohol and ghrelin on LEAP2 concentrations.

In humans, LEAP2 concentrations negatively correlated with both priming- and cue-induced alcohol craving. Acute alcohol administration reduced LEAP2 concentrations 90min after oral alcohol intake, a response that was attenuated by co-administration of the GHSR inverse agonist PF-5190457. An intraperitoneal alcohol administration after a pre-treatment with ghrelin reduced LEAP2 concentrations in wild-type but not GHSR-KO Wistar rats. In contrast to acute alcohol administration, LEAP2 concentrations did not differ between people with alcohol use disorder and healthy controls and were unaffected by evidence of hepatocyte injury and alcohol abstinence.

These results enhance our understanding of the ghrelin system, particularly LEAP2, with regard to alcohol craving and consumption. This work may inform the development of novel interventions for alcohol use disorder.

The UK Medical Research Council's Guidance on Developing and Evaluating Complex Interventions (MRC GDECI) outlines a 4-phase framework for structuring research programs on interventions: development, feasibility, evaluation, and implementation. However, it provides limited practical direction on how researchers should select which phases to conduct or determine when and whether to progress between phases. This gap is particularly challenging in the context of digital health interventions (DHIs), given their fast-paced and rapidly evolving nature.

This scoping review examined the research phases conducted, how researchers progressed through them, and the intervention characteristics associated with overall program structure and duration in DHI research, to inform the design of future research programs.

We searched PubMed, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov to identify complex DHIs promoting health among adolescents and young adults, implemented between 2017 and 2026, for which at least 2 phases of the MRC GDECI were reported, including the evaluation phase. For each eligible intervention, all related protocols, preprints, and published articles were retrieved to reconstruct the full research program. For each program, we analyzed the presence of each research phase, its organization (ie, phase arrangements), and the mechanisms guiding progression between phases (ie, progression mechanisms). Phase-specific and overall program durations were recorded.

A total of 31 research programs, covering 31 interventions and reported in 130 articles, were included. Development, feasibility, evaluation, and implementation phases were reported in 26, 23, 31, and 7 research programs, respectively. Three types of phase arrangements were identified: sequential, iterative, and overlapping. Progression mechanisms between phases included automatic progression, conditional progression based on researchers' appraisal of findings without prespecified criteria, and progression based on predefined quantitative criteria. Six main research program structures were observed, combining phase arrangements and progression mechanisms. Iterative arrangements were most common, observed in 22 research programs, followed by overlapping (n=10) and strictly sequential structures (n=7). Most progressions relied on researchers' appraisal of findings without prespecified criteria. Justifications for phase iteration, omission, or progression decisions were rarely reported. The median program duration was 5.8 (IQR 3.8-6.6) years (n=13). Based on these findings, a novel 4-step operational framework and visualization tools were developed to guide the design and planning of DHIs, highlighting key considerations for each step, as well as the strengths, limitations, and risks associated with each phase arrangement and progression mechanism.

This scoping review is the first to systematically examine phase arrangements and progression mechanisms in DHI research programs. Beyond descriptive reporting, it provides a conceptualization of research program structures and offers a flexible operational framework to support the concrete implementation of the MRC GDECI. Greater explicitness in decisions about program structure may enhance methodological rigor, reduce research waste, and improve the integrity and reproducibility of interventions.

PROSPERO CRD42023401979; https://tinyurl.com/mvc265y3.

Cultural competency and awareness are imperative to building trust and relationships between tribal members and non-native health care providers. The Chippewa Cree leaders in Northern Montana and Duke University School of Nursing (DUSON) collaborated to establish a service-learning opportunity focused on providing a children's summer day-camp, Camp Mi-yo-mah-chi-wi-n ("to be well"). The purpose of this project was to assess cultural competency among graduate nursing students, identify evidence-based curriculums for future academic-community activities, and demonstrate a mutually agreed on mental health model for future camps.

Eleven graduate nursing students and Chippewa Cree volunteers participated in a two-group, post-camp experience survey and key informant session at the conclusion of the initial youth camp.

The results indicated a positive and meaningful camp experience among all participants, indicating that the academic-community partnership should be cultivated and sustained. Graduate nursing student participants reported the need for enhanced cultural knowledge and understanding and a desire to ensure culturally competent care in collaboration with tribal volunteers.

Service learning is an effective way to fortify academic-clinical partnerships that are mutually beneficial with inclusion of student preparation emphasizing knowledge, beliefs and cultural competency.

Conditionally Automated Vehicles (CAVs) can operate autonomously under specific conditions, requiring the human driver to be cognitively prepared to intervene when the system reaches its operational limits. This reliance on human intervention raises concerns about the drivers' cognitive readiness during takeover. Individuals, including athletes in high-contact sports, may frequently experience concussions, which may lead to cognitive impairments affecting their driving. This study examined the differences in cognitive and driving performance between groups with and without a history of concussion.

Seventeen high-contact sports athletes and seventeen control participants completed takeover tasks in CAV simulator. The takeover tasks required the driver to regain vehicle control when the ADS is particularly unlikely to operate as intended, necessitating cognitive responses within limited timeframe. Mental workload, situational awareness (SA), takeover success, takeover time, manual driving success, and manual driving duration were measured.

Results indicated that high-contact sports athletes exhibited longer response time to future oriented SA queries and shorter manual driving duration than control group.

These findings may reflect group differences potentially related to concussion history. This study highlights the need for further research into CAV design improvement and clinical guidelines for safe return-to-driving timelines for cognitively impaired drivers.

The risk of falls is a global public health issue, with over 38 million disability-adjusted life years lost annually due to falls. However, older adults with mild cognitive impairment (MCI) are more likely to fall and suffer more severe injuries compared to cognitively normal older adults, which also has an impact on their quality of life.

This study was a randomized, controlled trial with two parallel groups, allocated in a 1:1 ratio using a concealed allocation mechanism and assessor blinding. 53 participants were randomly assigned to the 12-week Wuqinxi exercise group or the 12-week stretching exercise group. Overall cognitive function, risk of falls, and quality of life were assessed at baseline and at post. Independent t-tests and non-parametric tests were used to compare the outcome variables between the two groups.

There were no significant differences in baseline demographic characteristics or assessment indicators between Wuqinxi exercise group and stretching exercise group (P > 0.05), indicating comparability between the groups. After 12 weeks of intervention, the Wuqinxi exercise group showed significant improvements in primary outcome measures, including cognitive function and risk of falls (P < 0.001). In the SF-12 quality of life, Wuqinxi exercise group showed statistically significant improvements in six dimensions (P < 0.05), including general Health (GH), physical Function (PF), role Physical (RP), body Pain (BP), role Emotional (RE), and mental Health (MH). In two dimensions insignificant vitality (VT, P = 0.649) and social function (SF, P = 0.089). The median and interquartile range after intervention were also overall better in the Wuqinxi exercise group. In addition, the Mini-Mental State Examination (MMSE) was significantly negatively correlated with Timed Up and Go TestTimed Up and Go Test (TUG) (r = -0.52, p < 0.01) and significantly positively correlated with Modified Falls Efficacy Scale (MFES) (r = 0.463, p < 0.05). The improvement in quality of life in the BP and SF dimensions was significantly positively correlated with the increase Montreal Cognitive Assessment (MoCA) and MMSE respectively (BP-MoCA: r =  0.406, p < 0.05; SF-MMSE: r = 0.399, p < 0.05).

The Wuqinxi exercise is a feasible and acceptable intervention for improving cognitive function, preventing falls, and enhancing quality of life in older adults with MCI. Our study's findings emphasize the importance of Wuqinxi exercise in older adults' health management and confirm the feasibility of a large-scale andomized controlled trial.

Despite the majority of migrants coming to the UK for voluntary reasons such as study, work or family, few studies explore their experiences of mental health. Prevalence of postnatal depression (PND) is higher amongst migrant women compared with non-migrant women. This qualitative study aimed to explore voluntary migrant mothers' experiences of postnatal depression (PND) in the UK.

Seven migrant mothers who had experienced PND participated in individual semi-structured interviews. These were analysed using an Interpretative Phenomenological Analysis (IPA) approach which enabled an in-depth exploration of underlying meanings and significance of participant experiences.

Four Group Experiential Themes were identified along with associated subthemes. These captured the layers of disconnect, isolation, despair and grief participants reflected on when sharing their experiences of PND. The stories shared were embedded in participants' intersecting identities of being both mothers and migrants. The themes also captured testaments of resilience and growth through an ongoing journey of healing.

This research builds on existing literature looking at migrant women's experiences of PND, by focussing on voluntary migrant mothers in the UK. The findings suggest that migrant mothers who experience PND would particularly benefit from community support in addition to tailored clinical interventions. Further research and clinical implications are discussed to help improve migrant mothers' experiences of seeking help for PND in the UK.