Introduction: Sexual assaults often go unreported on college campuses, and unwillingness to report can harm victims' mental health by decreasing their access to services. One variable which may impact sexual assault reporting is perceived social norms (i.e., what individuals think others believe). While a wide body of literature supports the impact of social norms on a wide array of college student behavior, little is known about how macrosystemic factors, such as policy change, affect social norms. One such policy change which may impact social norms related to sexual violence involves changes made in 2019 to the Federal Policy, Title IX, which raised the standard of evidence that victims must provide in order to make a formal complaint. Accordingly, the authors sought to examine the relationships between students' knowledge of Federal Title IX policy, their awareness of changes made at the Federal level, their perceptions of their peers' acceptance of these policies broadly, and willingness to report incidents of sexual violence to their specific campus's Title IX office following these changes. Participants/Method:A sample of students at a university in the southeastern U.S. (N = 308) were surveyed. Results: Within our sample, slightly less than a quarter (20.4%) of students were familiar with the purpose of the Federal Title IX policy, and the majority (58.7%) believed their peers would have a neutral attitude toward these broad policy changes. Regardless of perceived social norms about the policy, individuals who believed that their university systemically responded inappropriately to Title IX incidents were less likely to report someone else's victimization to the campus Title IX office (B = 0.753, SE = 0.211, β = 0.253, p < .001). Participants who believed others supported the changes to the policy were more likely to increase their reporting to the campus's Title IX under the new Federal policy (B = 0.309, SE = 0.057, β = 0.364, p < .001). Students who believed others did not support the changes to the Federal policy were more likely to decrease their reporting to their campus Title IX office under the new Federal policy (z = 5.65, p < .001). Discussion: Implications for institutions & policy makers are discussed.

Early discontinuation of medication for opioid use disorder (MOUD) is associated with increased mortality and hinders remission. Combining data from electronic health records (EHRs) and patient questionnaires, we examined buprenorphine discontinuation and barriers and facilitators to retention in outpatient settings.

Adults initiating buprenorphine in a Pennsylvania outpatient program (2021-2023) completed 2 questionnaires: at medication initiation (baseline) and 6 months after initiation (follow-up). Among 1189 eligible patients, we evaluated buprenorphine discontinuation (≥30-d gap in medication supply) and compared demographic factors using EHRs. We identified discontinuation reasons among survey participants (baseline n = 374; follow-up n = 197) through medical record review; questionnaires assessed treatment barriers and facilitators.

Within 6 months, 629 (53%) patients discontinued buprenorphine, though 15% restarted medication within the 6-month period. Discontinuation was more common among younger patients. Among baseline survey participants, discontinuation was usually unplanned (66%) or against provider advice (19%). Among follow-up participants who discontinued the program during the follow-up period, 54% reported receiving MOUD at 6 months, indicating that many transition to other treatment programs. Those not receiving medication at 6 months cited lack of need (46%). Travel challenges (distance/transportation to clinics), scheduling, and mental health conditions were common barriers to treatment; facilitators centered on improving these factors and clinic processes.

Observed patterns reflect dynamic and noncontinuous receipt of medication over time and underscore the early months of treatment as a critical window for supporting buprenorphine engagement. Findings reveal actionable areas to improve retention by reducing logistical burdens, enhancing nonjudgmental therapeutic support, and integrating mental health care.

The Annie Goodrich Post-Graduate Psychiatric Nurse Practitioner (NP) Fellowship, established in 2017, supports advanced practice nurses transitioning into independent psychiatric roles by emphasizing excellence in care and education. Psychiatric Mental Health Nurse Practitioners (PMHNP-BC) often enter practice with limited experience managing complex psychopharmacologic regimens, creating a critical gap in competency. To address this need, we developed a specialized psychopharmacology curriculum designed to strengthen foundational knowledge and promote confident, evidence-informed clinical decision-making. This educational case study describes the development, implementation, and preliminary evaluation of this psychopharmacology curriculum within a postgraduate psychiatric NP fellowship program. Initial efforts to incorporate multiple disciplines into the curriculum proved challenging, prompting a shift to a focused 10-week seminar series led by interprofessional faculty using a case-based approach. Seminar topics included psychiatric emergencies, prescribing during pregnancy and postpartum, and strategies for safe medication tapering. Curriculum timing and content were refined through iterative feedback from fellows and faculty, as well as preseminar and postseminar evaluations assessing the fellows perceived changes in knowledge, confidence, and relevance to clinical practice. Key lessons learned include the importance of aligning content with NP professional identity, addressing interdisciplinary barriers, and fostering sustainable faculty collaboration. This innovative approach offers a replicable curriculum for enhancing psychopharmacology education in postgraduate psychiatric NP training. By bridging foundational knowledge with advanced clinical decision-making, the curriculum was designed to support the development of practitioners prepared to deliver safe, person-centered, and collaborative psychiatric care.

This qualitative study explored Thinking a Lot (TAL), a culturally patterned idiom of distress through which individuals describe and make sense of psychological and somatic suffering, among Vietnamese men who have sex with men (MSM). Between June and October 2018, 197 participants completed a verbally administered standardized questionnaire containing quantitative and qualitative questions about TAL. Qualitative responses were analyzed thematically to characterize its features and content. TAL was commonly described as persistent preoccupation with unresolved, often negative thoughts; emotional and mental distress; and difficulty focusing on the present. Concerns centered on professional challenges, societal expectations, family pressures, health, and romantic relationships. Work emerged as the most salient source of TAL, particularly in the context of limited legal protections for MSM in Vietnam. Participants also described pressures related to filial piety and societal norms that complicated efforts to balance employment, caregiving, and personal identity. These findings highlight the compounded stress experienced by MSM in a predominantly heteronormative society, where structural and cultural barriers constrain educational, occupational, and social opportunities. These findings suggest that TAL could provide a culturally salient, non-stigmatizing entry point for screening psychological distress and identifying and potentially intervening in the specific stressors underlying it among Vietnamese MSM.

The use of tele-mental health (MH) care is widespread, with approximately half of all MH visits occurring remotely within the US Department of Veterans Affairs health system. However, little is known regarding the relative quality of video, phone, and in-person MH care.

To study the comparative effectiveness of MH care delivered via video, phone, and in-person.

This retrospective comparative effectiveness study used administrative data for all patients who completed at least 3 outpatient MH appointments during the assignment period from July 2021 to October 2022. Each participant was assigned to a MH modality cohort based on how they received most of their outpatient care in the assignment period: by video, phone, or in-person. Outcomes were assessed over a 1-year follow-up period from 2022 to 2023. Data were analyzed from July 2024 to July 2026.

Receiving most outpatient MH care via video, phone, or in-person.

Outcomes of interest were MH hospitalizations, MH emergency department (ED) visits, suicide behaviors, and percentage of completed appointments. Inverse probability-weighted regression adjustment was used to obtain an average treatment effect (ATE).

The cohort included 813 699 participants (672 833 [82.7%] male; 354 686 participants [43.6%] aged ≥60 years), including 305 189 participants (37.5%) who received most of their MH care in person, 343 543 participants (42.2%) who received most of their care via video appointments, and 164 967 participants (20.3%) who received most of their care via phone appointments. Overall, 3027 video group participants (0.9%), 6547 in-person group participants (2.1%), and 2584 phone group participants (1.6%) experienced an MH hospitalization; 5237 video group participants (1.5%), 8009 in-person group participants (2.6%), and 3713 phone group participants (2.3%) had an MH ED visit; and 3539 video group participants (1.0%), 3780 in-person group participants (1.2%), and 2086 phone group participants (1.3%) exhibited suicidal behaviors. Video group participants completed a mean (SD) of 71.1% (21.7%) of appointments, compared with 68.0% (22.2%) of appointments in the in-person group and 68.4% (23.2%) of appointments in the phone group. The expected probability of MH hospitalization was 0.005 (SE, 0.001) points lower if all patients had received mostly video care instead of phone and 0.005 (SE, <0.001) lower vs in-person care . The same pattern emerged for MH ED visits and suicide behaviors, with expected probabilities being lower for the video group compared to phone (MH ED visit: ATE, -0.006; SE, 0.001; suicidal behavior: ATE, -0.003; SE, <0.001) or in-person (MH ED visit: ATE, -0.005; SE, <0.001; P < .001; suicidal behavior: ATE, -0.001; SE, <0.001) groups. By contrast, the expected percentage of appointments completed was 4.1 (SE, 0.1) percentage points higher in the video group vs phone group and 3.6 (SE, 0.1) percentage points higher in the video group vs in-person group.

In this comparative effectiveness study, receiving MH care via video was associated with improved clinical outcomes compared with receiving care via phone or in-person. Findings of possible advantages of video- over phone-based care could impact care modality decision-making if video is a feasible option. Video-based care also was associated with improved outcomes compared with in-person care. However, despite controlling for imbalanced groups, there is still potential confounding, and the magnitudes of the ATEs were small; therefore, results must be interpreted with caution.

With the aging population, identifying the relationship between verbal fluency test (VFT) performance and brain atrophy is crucial for improving the early detection of cognitive decline. This study aimed to investigate the association between cerebral cortical volume and performance on VFTs, specifically category (CFT) and letter (LFT) fluency tests, to identify brain regions associated with verbal fluency. In this cross-sectional observational study, community-dwelling adults underwent brain magnetic resonance imaging (MRI) and completed CFTs and LFTs. Participants with organic brain anomalies on MRI were excluded. Using multiple linear regression, the relationship, adjusted for age, sex, Mini-Mental State Examination score, and total brain volume, between local gray matter volumes in 22 cortical regions in both hemispheres and VFT performance was analyzed. We included 267 community-dwelling adults (70 years and 0.8 months ± 6 years and 2.3 months; 178 men and 89 women). A significant association was found between CFT scores and volume of the left inferior frontal gyrus (R² = 0.1765, corrected-p = 0.0027), specifically the pars orbitalis (R² = 0.1520, corrected-p = 0.011) and pars triangularis (R² = 0.1452, corrected-p = 0.036). No significant associations were observed between LFT scores and cortical volumes. These findings align with previous lesion and functional MRI studies highlighting the left inferior frontal gyrus' role in language production. Lower CFT performance was associated with smaller left inferior frontal gyrus volume. Longitudinal and predictive studies are required before diagnostic or prognostic utility can be inferred.

Weight loss and malnutrition are associated with poorer outcomes in people living with amyotrophic lateral sclerosis (plwALS). This study investigated the prognostic relevance of early weight loss in plwALS and assessed whether existing energy equations provide useful guidance for nutritional management.

In this prospective case-control and within-case comparison study (March 2016October 2024), 170 plwALS and 173 non-neurodegenerative disease controls completed baseline anthropometric and metabolic assessment. Participants with ALS were classified according to weight change during the first six months following study inclusion as Weight Gain, Stable Weight, or Weight Loss. Weight-change groups were compared for subsequent changes in anthropometry, functional capacity, and survival. In a nested cohort of 82 plwALS with reported energy intake and repeat assessments, we assessed whether the relationship between reported intake and equation-derived energy requirements was concordant with subsequent weight change.

Early weight loss was associated with continued loss of body weight, fat mass, and fat-free mass, faster functional decline, and increased risk of earlier death relative to Weight Gain (HR=4.78 [95% CI 2.68-8.53], p<0.001). Concordance between equation-derived energy requirements, reported energy intake and observed weight trajectory was low (17.3-32.1%). The IBW30(30) equation showed the greatest concordance among participants with Weight Loss, but no equation performed consistently across weight-change groups.

Early weight loss identifies plwALS at increased risk of subsequent weight and body-composition loss, functional decline and earlier death. Existing energy equations proposed for use in ALS show limited concordance with observed weight trajectories, particularly when applied at a single time point. These findings support serial monitoring of nutritional risk and individualized, phenotype-informed dietetic care in ALS.

This scoping review will map and describe the literature on interventions or strategies to improve access to mental health services among Black African immigrants residing in high-income countries.

Black African immigrants residing in high-income countries experience a disproportionately high prevalence of mental health issues driven by pre-migration trauma, migration stressors, and post-migration social determinants. Despite this burden, access to mental health services remains limited due to barriers such as stigma, cultural incongruence, and systemic inequities. While existing systematic reviews have explored barriers to care, little is known about interventions or strategies that have been implemented to address these challenges.

This review will consider studies involving adult Black African immigrants residing in high-income countries. Eligible sources will include qualitative, quantitative, and mixed methods studies and relevant gray literature that describe, evaluate, or report on interventions or strategies aimed at improving access to mental health care (including approachability, acceptability, availability and accommodation, affordability, and appropriateness).

This review will be conducted in accordance with the JBI methodology for scoping reviews. A comprehensive search will be conducted across PubMed, Embase (Embase.com), CINAHL (EBSCOhost), PsycINFO (EBSCOhost), and ProQuest Central (ProQuest) along with relevant gray literature sources. Two reviewers will independently screen all identified sources and extract data using an extraction tool developed by the review team. Data will be presented in tabular and graphical formats and summarized descriptively. Findings will be mapped to the 5 dimensions of accessibility to identify existing strategies and gaps in the evidence.

https://osf.io/8sqyx.

We aimed to examine whether additional metrics derived from the CERAD Word List Memory Test (WLMT) such as acquisition patterns, error frequencies, and consolidation efficiency, are associated with cerebrospinal fluid (CSF) biomarkers of amyloid and tau pathology, as well as magnetic resonance imaging (MRI) ratings of brain atrophy and small vessel disease, in individuals with suspected cognitive impairment who nonetheless perform within normative ranges on the traditional WLMT measures.

We included 109 patients from a memory clinic setting (46% female, median age 69.5 years, 55.1% with normal AD biomarkers, 25.7% in the AD continuum) that underwent comprehensive neuropsychological assessment, CSF biomarker analysis, and visual MRI rating. Associations between traditional and additional memory scores and the biomarkers were examined using regression analyses, controlling for demographic variables and adjusting for multiple comparisons.

Correlations were modest and partly mediated by demographics. Traditional scores showed the strongest links, but additional scores "lost access" and "learning ratio" were also associated with lower Aβ CSF levels (ρ = -.23, p = .034) and medial‑temporal lobe atrophy (e.g. learning ratio, ρ = -.30, p = .036), suggesting sensitivity to subtle learning‑consolidation inefficiencies. High burden of white matter hyperintensities was associated with intrusion errors (U = 807.5, p < .05, d' = 0.23) and less stable learning (U = 613.0, p < .01, d' = 0.41).

Both traditional and additional memory scores can assist early detection and risk stratification of neurodegenerative disease in patients with normative performance, but these findings require replication in larger, more heterogeneous cohorts.

Progressive neurological disorders (PNDs) are life-limiting conditions with complex trajectories. PNDs require holistic, person-centred care that responds to the needs of both individuals and their families, including the provision of palliative and end-of-life (EOL) care.

This systematic review aimed to identify and synthesize existing international guidelines addressing palliative and EOL care in adult PND populations, with particular attention to their quality and scope.

We searched databases and gray literature sources for guidelines published between January 2013 and February 2026. Thirty-three guidelines were included for review. We appraised guidelines to assess quality and comprehensiveness against the World Health Organization's (WHO) domains of palliative care. We conducted inductive content analysis to identify key themes.

Guidelines predominantly were published from high-income countries and focused on dementia. Overall guideline quality was high. Most addressed physical, psychosocial, and social dimensions of care of the WHO domains; however, spiritual wellbeing was inconsistently addressed. Six interrelated themes emerged: (i) holistic symptom management; (ii) recognition of families and caregivers as partners in care; (iii) early and ongoing communication; (iv) value-aligned decision-making; (v) multidisciplinary team expertise; (vi) navigation of medicolegal complexities.

Findings indicate broad international consensus on the principles of high-quality palliative care in PND, while highlighting gaps in disease/diagnosis representation, spiritual care, and global equity. Future research could consider the importance of disease-specific guidelines, covering regions and countries from across a range of high-, middle-, and lower-income countries.

Clinicians caring for people with progressive neurological disorders can draw on the internationally consistent principles identified in this review including early integration of palliative care, proactive and open communication, and recognition of families as partners in care to benchmark and strengthen their practice. Gaps in spiritual wellbeing, condition-specific guidance, clinical supports, and equitable access represent clear targets for workforce education, service development, and health policy advocacy.