Integrating clinical severity with health-related quality of life, psychosocial, and functional measures is essential to fully capture the impact of the disease and to inform patient-centred treatment strategies in patients with bronchiectasis. Accordingly, this study aimed to investigate the determinants of health-related quality of life in non-cystic fibrosis bronchiectasis, examining how psychological factors, disease severity, and functional exercise capacity interact in patients' self-reported quality of life. This prospective observational study included patients with non-cystic bronchiectasis (NCFB) aged 18-60 years. Disease severity was classified using Bronchiectasis Severity Index (BSI). Assessments included the Hospital Anxiety and Depression Scale (HADS), Medical Outcomes, Short-Form Health Survey (SF-36), Leicester Cough Questionnaire (LCQ), Quality of Life in Bronchiectasis (QOL-B), and Six-Minute Walk Test (6MWT). Pearson correlations and multiple linear regression were used to examine associations between psychological variables and outcomes. Thirty-one patients participated (54.8% female; mean age 52.45 ± 15.3 years), and 83.9% had mild - moderate disease. HRQoL was related to anxiety, depression, and functional exercise capacity, and anxiety was also associated with cough severity. Anxiety was negatively associated with the SF-36 Mental health domain (β = -1.80; p = 0.03) and the QOL-B Emotional functioning domain (β = -2.79; p = 0.01), while depression was associated with SF-36 Mental health (β = -2.26; p = 0.01). No association was found between prognostic severity of the disease and HRQoL. Psychological factors and exercise capacity were the main determinants of HRQoL in patients with mild to moderate NCFB, highlighting the importance of simple functional markers, such as the six-minute walk test (6MWT) and mental health assessment, in clinical evaluation and treatment planning.

AI adoption in health care has accelerated rapidly, with ambient documentation tools, diagnostic imaging AI, and clinical decision support systems (CDSSs) entering routine practice. However, the cognitive demands placed on clinicians supervising these systems remain understudied. Specifically, the concept of verification burden requires closer examination. Consequently, institutional decision-makers lack a structured, certainty-graded evidence base regarding the true impact of AI on clinician workload and burnout.

This study aimed to systematically review evidence on cognitive workload and burnout in health care professionals that use AI-powered clinical tools, quantify pooled effects under a conservative inferential framework, and assess certainty of evidence by AI category.

The study was registered in PROSPERO (CRD420261284298) and reported per PRISMA 2020 and PRISMA-S guidelines. We searched MEDLINE, Embase, Web of Science, and Cochrane CENTRAL (January 2015-2026) for studies measuring cognitive workload or burnout using validated instruments (NASA Task Load Index [NASA-TLX] and Professional Fulfillment Index [PFI]) among health care professionals using clinical AI. Risk of bias was assessed using ROB 2.0 and ROBINS-I; certainty was rated using GRADE. Meta-analyses applied Hartung-Knapp-Sidik-Jonkman adjustment with restricted maximum likelihood estimation, incorporating prediction intervals (PIs).

We included 21 studies representing 2885 health care professionals across 7 countries. The synthesis demonstrated that the cognitive impact of clinical AI varies according to its specific application. Pooled analyses of ambient AI documentation showed statistically significant reductions in NASA-TLX temporal demand (SMD -1.46, 95% CI -2.81 to -0.11; k=2; I2=31.1%) and effort (SMD -1.29, 95% CI -2.16 to -0.42; k=2; I2=0%), PFI work exhaustion (MD -0.35, 95% CI -0.58 to -0.12; k=3; I2=0%; 95% PI -1.03 to 0.33), and burnout prevalence (OR 0.47, 95% CI 0.25-0.86; k=3; I2=0%; 95% PI 0.06-3.82). Two pools favored ambient AI but did not reach significance at k=2: NASA-TLX mental demand (SMD -1.29, 95% CI -3.64 to 1.07) and documentation time (SMD -0.24, 95% CI -1.10 to 0.61). Diagnostic imaging AI and CDSS showed mixed or paradoxically increased workload. GRADE certainty was moderate for cognitive workload reduction with ambient AI, low for burnout reduction with ambient AI, and very low for imaging AI and CDSS outcomes.

This review combines validated workload instruments, meta-analysis, and PIs in health care AI, delivering a GRADE certainty assessment across 5 AI categories that prior accuracy- or efficiency-focused reviews have not provided. Ambient AI documentation was associated with reduced cognitive workload and burnout, but only in voluntary early-adopter cohorts and based on few studies; the conservative CIs were wide and, where estimable, PIs crossed the null. Findings inform institutional pilots with prospective workload measurement, regulatory human-factors evaluation of AI medical devices, and human-centered AI design. Net benefit on the health care workforce remains an open empirical question.

Military resilience programs have grown considerably over the past 2 decades since the Comprehensive Soldier Fitness Program was introduced. Although there is considerable positive evidence that supports the promotion of resilience in this population, there have also been concerns about dissemination, implementation, use of compulsory training and impact on the mission and the servicemember. Parallel civilian wellbeing and resilience programs have popularized psychological concepts such as grit and growth mindset with a patchwork of both positive and lackluster findings. More recently there has been recognition that "one-size-fits-all" resilience programs may be less effective and impactful than adaptations personalized for a specific subpopulation or community. The current study evaluated a tailored adaptation of resiliency programming within a military medical population.

The study utilized the Kirkpatrick model for program evaluation, specifically focusing on level one (reaction). Participants were 156 first-year medical students across 5 cohorts who completed resilience training that consisted of 4 hour-long modules. Data were collected via optional post-training surveys measuring perceived self-efficacy, perceived mental resilience, and willingness to recommend the training to peers. Qualitative themes were also extracted from open-ended responses regarding the students' "biggest takeaways."

The results indicated a consistently positive response to the training across all cohorts, with no significant differences in ratings for perceived self-efficacy or mental resilience. Although most students recommended the program, the cohort that underwent training virtually during the COVID-19 pandemic showed a significantly lower willingness to recommend the program to peers (χ2 = 26.41, P < .001) compared to in-person cohorts. Qualitative analysis revealed that students highly appreciated the acquisition of tangible skills (e.g., cognitive reframing, relaxation strategies), clarifying their values, and connecting with their peers.

The "Grit and Growth" program provides a promising blueprint for adapting military resiliency training to specialized high-stress subpopulations. By successfully integrating individual psychological skills (grit and growth mindset) with systemic awareness and traditional Cognitive Behavioral Therapy models, the curriculum maintained high student satisfaction over 5 years. Although limited by self-reported data, these findings offer a roadmap for future research to evaluate higher Kirkpatrick levels, such as behavioral changes and long-term academic or professional outcomes.

Person-centred follow-up care based on evidence-based clinical practice guidelines and providing individualised information should help to inform and reassure survivors about their medical and psychosocial situation and provide treatment and support where needed.

To describe changes in mental health and resilience in survivors before and after a person-centred follow-up care intervention and analyse associations of mental health improvements with socio-demographic and clinical characteristics.

We implemented the novel person-centred PanCareFollowUp Care Intervention in four clinics across Europe. Survivors aged 16+ years (cancer diagnosed at age < 19 years, 5+ years after diagnosis) completed the Brief Symptom Inventory-18 (BSI-18; somatisation, depression, anxiety, overall distress), Post-traumatic Stress Disorder Checklist and the Connor-Davidson Resilience Scale before (T1) and 6 months after (T2) the clinic visit. We calculated a change score for resilience and a reliable change index for BSI-18 scales and post-traumatic stress symptoms.

In total, 798 survivors participated (51.4% males, mean age = 30.3 years [range: 16-60]). Mental health significantly improved, with lower scores for depression (mean change = 0.89, p = 0.001), anxiety (mean change = 0.68, p = 0.025), overall distress (mean change = 0.99, p = 0.004) and post-traumatic stress symptoms (mean change = 1.09, p = 0.004) at T2 as compared to T1. Around one-third of survivors reported significant distress (no change: p = 0.659). Socio-demographic or clinical characteristics were not associated with changes in resilience or overall distress. A reliable reduction of post-traumatic stress symptoms was more likely in those single (p = 0.020), unemployed or in education/studying (p = 0.003) and with poor physical health (p = 0.004).

Mental health improved after the person-centred PanCareFollowUp Care Intervention. Inclusion in regular follow-up care may help to decrease survivors' distress in the long-term.

Netherlands Trial Register numbers: NL8918, NL-OMON21449.

Understanding the molecular mechanisms of autism spectrum disorder (ASD) and its psychiatric comorbidities, including bipolar disorder (BD), is pivotal for uncovering pathways that shape neurodevelopmental trajectories and clinical heterogeneity. We aimed to identify ASD-specific gene-expression signatures and disrupted biological processes in prefrontal cortex, contrasting them with those observed in BD.

We performed a comparative transcriptomic analysis of RNA-seq datasets from postmortem prefrontal cortex samples of individuals with ASD or BD and controls. Differential expression was assessed with DESeq2, including batch as a covariate in the BD model. Functional interpretation used Gene Ontology over-representation analysis, KEGG Gene Set Enrichment Analysis and gene-concept network visualization.

ASD samples showed 45 differentially expressed genes (DEGs), mainly downregulated non-coding RNAs, particularly small nuclear RNAs and small nucleolar RNAs. Enrichment analysis indicated a convergent profile related to RNA processing, spliceosome assembly and spliceosomal activity. In contrast, BD showed 12 candidate DEGs, mostly upregulated protein-coding genes. BD enrichment involved metal ion response and detoxification, amine and peptide hormone responses, vascular regulation and hydrolase activity, with genes associated with neuroinflammation such as SERPINA3 and CHI3L1 contributing to this profile. No shared DEGs or enriched GO Biological Process terms were observed between ASD and BD.

These results support transcriptomic divergence in the prefrontal cortex, with ASD characterized by spliceosomal dysregulation, contrasting with metal ion response, vascular regulation and inflammation-associated signals in BD. Our findings provide a transcriptomic framework for future studies investigating disorder-specific molecular mechanisms and candidate signatures in ASD and BD.

Induced pluripotent stem cell (iPSC)-derived brain cells are widely utilised as in vitro models for several neuropsychiatric disorders, as they retain the donor's genetic profile, offering a unique opportunity to study living human brain cells and perform controlled experimental manipulations. In this study, we conducted whole transcriptome sequencing of cortical networks (co-cultures of neurons and astrocytes) derived from 12 participants with bipolar disorder (BD) and 12 participants without a history of mental health disorders. Aiming to identify new molecular mechanisms underlying the pathophysiology of bipolar disorder.

iPSCs were generated by reprogramming peripheral blood mononuclear cells (PBMCs) using episomal vectors. iPSCs were then differentiated into neural progenitor cells (NPCs) and matured into cortical networks (CNs) that express markers of neurons and astrocytes. Whole transcriptome data were obtained using the Illumina NovaSeq X sequencing platform. Differential expression analysis was performed using DESeq2 in R.

Gene set enrichment analysis identified 191 enriched pathways in BD, 171 were downregulated, and around 10% were associated with the immune system. Of these, the toll-like signalling pathway, which is downregulated in BD, was further investigated.

Our results suggest a profound immune dysregulation in BD, with downregulation of the sensing innate immune system, particularly highlighting the immune system's role as a complex signalling network.

Norepinephrine transporter (NET) inhibition is a relevant mechanism across psychotropic medications, although prescribing classifications are largely based on drug class rather than quantitative target engagement.

To facilitate cross-drug comparisons of noradrenergic activity, we developed a pharmacometric model to estimate NET occupancy for 26 psychotropic agents and their active metabolites.

NET occupancy was estimated using National Institute of Mental Health Psychoactive Drug Screening Program Ki data, protein-binding-corrected plasma concentrations, a standard receptor occupancy model, and logit-derived ED50 values, and was compared with published positron emission tomography (PET) estimates.

After protein-binding correction, desipramine, milnacipran, and maprotiline showed very high NET occupancy (⩾90%), nortriptyline, doxepin, and norquetiapine showed high occupancy (70%-90%), and hydroxybupropion and duloxetine showed moderate occupancy (50%-70%). Clomipramine, atomoxetine, and reboxetine demonstrated moderate-low occupancy (30%-50%), whereas venlafaxine showed low occupancy (~28%). Hydroxybupropion exhibited substantially greater NET engagement (~68%) than bupropion (~2%), and most Selective serotonin reuptake inhibitors showed minimal occupancy (<10%). Estimated ED50 values ranged from 6.6 mg (desipramine) to ⩾63 mg (duloxetine), and predicted occupancies correlated moderately with PET data (r = 0.76, p = 0.028, R² = 0.58).

These findings suggest that variability in NET engagement across psychotropic medications may not be fully captured by conventional class-based classifications. The proposed framework offers a mechanism-informed approach to comparative pharmacological analysis and introduces a conceptual noradrenergic activity index. This approach may be useful for hypothesis generation in future studies integrating pharmacokinetic-pharmacodynamic modeling with in vivo imaging and clinical outcomes.

This study examined the effects of a mindfulness-based psychoeducation program on mindfulness, self-compassion, and forgiveness in patients with bipolar disorder using a pretest-posttest randomized controlled experimental design. The study sample comprised of 40 patients (experimental group, n = 20; control group, n = 20). A mindfulness-based psychoeducation program was administered to the experimental group, while no intervention was administered to the control group. Data were collected using a personal information form, the Mindfulness Scale, the Self-Compassion Scale Short Form, and the Heartland Forgiveness Scale. The study revealed that the experimental group's mean scores on the mindfulness, self-compassion, and forgiveness scales following the intervention were significantly higher than those of the control group (p < .05). This study found that a mindfulness-based psychoeducation program increased mindfulness, self-compassion, and forgiveness in patients with bipolar disorder. The findings are limited to a small outpatient sample from a single CMHC and may not be generalizable to hospitalized patients with more severe clinical presentations. Mindfulness-based educational programs may enhance mental health, improve illness insight, support symptom management, and strengthen social functioning in individuals with bipolar disorder. The results emphasize the importance of integrating these programs into treatment processes and reveal the necessity for psychiatric nurses to actively implement mindfulness-based interventions. Psychiatric nurses should consider incorporating mindfulness-based techniques into their practice to improve the mental health of individuals with bipolar disorder, better understand the disorder, control symptoms, and improve social interactions.

A transabdominal cerclage is inserted to prevent recurrent midtrimester loss and spontaneous preterm birth. The transabdominal cerclage often remains as a permanent foreign body for years. Synthetic materials within the abdomen, cesarean birth, and prior adverse pregnancy outcomes have each been associated with long-term complications or poorer health-related quality-of-life. However, the long-term effects of a permanent transabdominal cerclage have not been investigated. We aimed to evaluate patient-reported late effects and health-related quality-of-life in Danish women who underwent transabdominal cerclage between 2004 and 2025.

In this nationwide cohort study, women with a transabdominal cerclage were matched in a 1:1:1 ratio to two comparison groups: (1)women without transabdominal cerclage who had a cesarean birth, and (2)women without transabdominal cerclage who had a non-instrumental vaginal birth and no prior cesarean birth. Participants completed validated questionnaires assessing quality-of-life, anxiety and depression, bladder discomfort, pelvic pain and sexual health. The primary outcome was the General Health scale in SF-36. Domain- and total scale scores were compared between the groups using multiple linear regression. The study was pre-registered on clinicaltrials.gov (NCT06875401).

Two hundred three women with a transabdominal cerclage, 90 with a cesarean section, and 98 with a vaginal birth participated. The mean General Health score did not differ between groups by a predefined minimally important difference of 10 points. Adjusted mean differences were - 4.0 points (95% CI -9.5-1.4) for women with cesarean birth and -0.6 (95% -CI-6.2-4.9) for women with vaginal birth in comparison to the transabdominal cerclage group. Mental health, bladder discomfort, pelvic pain, and sexual health symptom burdens were similar between groups. Response rates were higher in the transabdominal cerclage group, which may have introduced selection bias. Cerclage-related complications leading to suture removal after completed pregnancies were rare (3/203 women, 1.5%). Quality-of-life scores tended to be higher with longer time since cerclage procedure.

Permanent transabominal cerclage was not associated with poorer self-reported general health compared with women without transabominal cerclage, regardless of mode of birth. These findings support that a permanent transabominal cerclage does not appear to have long-term negative health effects.

Differentiating early-stage Parkinson's disease (PD) from the parkinsonian variant of multiple system atrophy (MSA-P) remains a significant challenge due to overlapping clinical phenotypes. This study aimed to identify novel, minimally invasive biomarkers by integrating high-resolution peripheral monocyte transcriptomics with erythrocytic alpha-synuclein (alpha-Syn) distribution patterns.

We recruited 149 participants (75 PD and 74 MSA-P) to evaluate clinical features and composite peripheral inflammatory indices. To resolve subtle immune heterogeneity often masked in bulk blood analysis, single-cell RNA sequencing (scRNA-seq) was performed on peripheral blood mononuclear cells (PBMCs) from early-stage patients, followed by Quantitative Real-Time PCR (qRT-PCR) validation. Additionally, immunofluorescence was utilized to characterize the subcellular compartmentalization of alpha-Syn forms in erythrocytes.

While MSA-P patients exhibited more rapid progression and severe autonomic failure, standard inflammatory markers (e.g., NLR, MLR) failed to distinguish PD from MSA-P in the early clinical stages. However, scRNA-seq revealed distinct monocyte landscapes. Early MSA-P monocytes displayed an aggressive pro-inflammatory profile driven by chemokine upregulation (CXCL10, CXCL5), interferon pathway activation (IFI27). Conversely, early-stage PD monocytes exhibited a profile of precise homeostatic regulation and protective mitochondrial adaptation, characterized by significant GATD3A downregulation verified by qRT-PCR. Furthermore, distinct pathological patterns were identified: oligomeric alpha-Syn was predominantly sequestered on erythrocyte membranes in MSA-P, whereas pS129 alpha-Syn localized primarily to the cytoplasm in PD.

This study uncovers a divergent peripheral immune landscape where GATD3A-mediated monocyte homeostasis distinguishes early PD from the chemokine-driven inflammation and intense oxidative stress of MSA-P. Combined with distinct erythrocytic alpha-Syn membrane distribution patterns, these signatures offer a promising multidimensional strategy for the early differential diagnosis of these synucleinopathies.