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Effects of Patient Portal Message Framing on Treatment Preferences and Expectations for Degenerative Meniscus Tears: Randomized Exploratory Cross-Sectional Survey Study

<strong>Background:</strong> Degenerative meniscus tears are common in middle-aged and older adults, and current guidelines favor nonoperative care. As patients increasingly turn to portal systems to view imaging results and communicate with their physicians, patient-facing wording may shape downstream treatment preferences and expectations. <strong>Objective:</strong> This study aimed to determine whether subtle differences in physician message framing about an identical degenerative meniscus tear influence preferred management, expectations for improvement with conservative therapy, and satisfaction when a physician recommends a different plan. <strong>Methods:</strong> A cross-sectional 37-question survey was developed de novo and distributed in January 2026 to lay adults in the United States (≥18 years) recruited via Amazon Mechanical Turk. Respondents were presented with a standardized vignette of an adult aged 60 years with knee pain due to a degenerative meniscus tear. Participants were randomized in a 1:1:1 fashion into 3 physician portal message framing groups: neutral, degenerative, and damage. Outcomes were the preferred next step in treatment, expected improvement with physical therapy, and retained satisfaction under physician-respondent disagreement. Chi-square and Fisher exact tests were used to compare categorical variables. Multivariable logistic regression analyses were used to assess associations between framing groups. <strong>Results:</strong> Of the 266 completed responses, 195 (73.3%) were included for analysis (neutral: n=67, 34.4%; degenerative: n=63, 32.3%; damage: n=65, 33.3%). Treatment preferences differed significantly across groups (<i>χ</i><sup>2</sup><sub>2</sub>=6.1; <i>P</i>=.047), and the damage group was significantly more likely to prefer aggressive interventions (odds ratio 2.43, 95% CI 1.17-5.06; <i>P</i>=.02). Expectations for physical therapy success differed significantly (<i>χ</i><sup>2</sup><sub>4</sub>=12.3; <i>P</i>=.02), with the damage group being most pessimistic about conservative care. Retained satisfaction under physician-respondent disagreement did not differ by framing group (<i>χ</i><sup>2</sup><sub>6</sub>=6.7; <i>P</i>=.35) but did differ significantly by initial treatment preference (<i>P</i>=.03) and was the lowest among respondents preferring steroid injection. <strong>Conclusions:</strong> In this exploratory investigation, subtle differences in physician portal message framing regarding a magnetic resonance imaging impression of a degenerative meniscus tear were associated with shifts in treatment preferences and confidence in conservative care. These findings suggest that brief physician portal communications may be associated with shifts in hypothetical patient expectations and treatment preferences before clinical counseling occurs. <strong>Trial Registration:</strong>
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<![CDATA[How FDA priority review vouchers speed psychedelic therapy approvals.]]>
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Substance P–expressing neurons in the hypothalamic paraventricular nucleus mediate chronic cough hypersensitivity via the hypothalamus–airway neural pathway

Background and purposeIncreased cough sensitivity is the key pathophysiological mechanism of chronic cough. Although previous studies have focused on peripheral airway receptor sensitization, the role of the central nervous system—particularly the hypothalamic paraventricular nucleus (PVN)—remains unclear. Whether substance P (SP)–expressing PVN neurons contribute to cough hypersensitivity remains unknown.MethodsThree-week-old Hartley guinea pigs were divided into three groups: citric acid (CA), saline control (SA), and blank control (CON). A cough hypersensitivity model was induced by inhalation of 0.4 mol/L citric acid. Cough sensitivity was assessed using a capsaicin challenge, with the C5 threshold defined as the lowest capsaicin concentration inducing ≥5 coughs. Locomotor activity was evaluated using the open-field test. Airway inflammation and goblet cell hyperplasia were examined by HE and PAS staining. SP and c-Fos expression in the PVN were detected by immunofluorescence and Western blot. HSV retrograde tracing was used to analyze the PVN-airway neural pathway associated with cough hypersensitivity.ResultsCompared with the control groups, guinea pigs in the CA group exhibited a time-dependent increase in cough frequency and enhanced cough sensitivity, as indicated by a reduction in the C5 threshold. Histological analysis revealed increased inflammatory cell infiltration and goblet cell hyperplasia in the airways of the CA group. SP and c-Fos expression, along with the proportion of SP/Fos double-labeled neurons in the PVN, were significantly increased in the CA group (all P < 0.05). Viral tracing confirmed the presence of HSV-positive neurons in the PVN, supporting a neural connection between the PVN and the airways.ConclusionActivation of SP-expressing neurons in the PVN is associated with cough hypersensitivity and suggests the presence of a potential PVN–airway neural pathway. These findings provide a theoretical basis for the development of central-targeted therapies for chronic cough.
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Multimodal CT radiomics-clinical ensemble machine learning model effectively predicts futile recanalization after endovascular treatment of acute ischemic stroke

BackgroundsFutile recanalization (FR) poses a significant challenge in endovascular treatment and there is a lack of reliable predictive models for assessing treatment outcomes in stroke. The aim of this study is to develop a robust CT radiomics-clinical ensemble model that predicts FR in patients with acute ischemic stroke (AIS) following endovascular treatment (EVT) utilizing machine learning techniques.MethodsThis study enrolled 101 patients diagnosed with AIS who underwent successful EVT. A total of 946 radiomics features were, respectively, extracted from non-contrast CT (NCCT), contrast-enhanced CT (CECT), and various CT perfusion maps (CBF, CBV, MTT, and TTP) using PyRadiomics prior to the endovascular intervention. Demographic characteristics, along with baseline clinical, laboratory, and angiographic variables, were incorporated as clinical features in the model analysis. Feature engineering was performed using SelectKBest. Five traditional machine learning algorithms were employed for modeling. The dataset was randomly split into a training cohort (n = 71, 70%) and an internal validation cohort (n = 30, 30%). Receiver operating characteristic (ROC) curves were utilized to evaluate the performance of each model.ResultsAmong the 101 patients, FR occurred in 66 individuals (65%), as determined by the modified Rankin Scale (mRS) at 90 days. The ensemble model integrating clinical data, NCCT, and CBV achieved the highest performance, with an area under the curve (AUC) of 0.918 using the CatBoost algorithm.ConclusionThe multimodal CT radiomics-clinical ensemble machine learning model demonstrated excellent predictive capability for identifying FR in AIS patients with large vessel occlusion prior to EVT.
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Development and validation of a measure of early adverse experiences: childhood adversity scale

IntroductionChildhood adversities disrupt the healthy development of children and often have long-term effects on their physical and mental health in adulthood. Identifying them is essential; however, the majority of the existing tools do not adequately capture their diversity and complexity. Moreover, although the age at which adversities occur and their subjective impacts are known to be important, many instruments fail to assess these dimensions.MethodsTo address these gaps, a new scale was developed based on a review of 300 client files from individuals diagnosed with dissociative identity disorder (DID). The scale items were derived from types of childhood adversity commonly associated with the formation of alternate identities. Psychometric evaluation was conducted using data from three independent samples.ResultsExploratory factor analysis (EFA) with the first sample (n = 338) indicated that a single factor explained more than half of the total variance, supporting a unidimensional structure for the 59-item scale. Confirmatory factor analysis (CFA) with the second sample (n = 413), refined using modification indices, demonstrated good model fit. Convergent validity was evaluated in a third sample (n = 125) using the Adverse Childhood Experiences (ACE) scale. A significant positive correlation was found between the Childhood Adversity Scale (CAS) and ACE, indicating strong convergent validity.DiscussionThis suggests that CAS is a reliable and valid tool that both clinicians and researchers can use for a comprehensive assessment of childhood adverseness.
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The dual-burden of professional and academic stress: a cross-sectional mapping of mental health status and coping efficacy among postgraduate students in Nairobi, Kenya

BackgroundPostgraduate students face a dual burden of intense academic rigour and professional responsibilities, a dynamic particularly pronounced in growing economic hubs such as Nairobi, Kenya. While global literature highlights rising psychological distress in higher education, there is limited evidence on how specific coping mechanisms mediate mental health outcomes among postgraduates at private African universities. Understanding these dynamics is critical for institutional psychosocial support systems.ObjectivesThis study aimed to assess the mental health status (depression, anxiety, and stress) of postgraduate students at Strathmore University. Grounded in Lazarus and Folkman’s Transactional Model of Stress and Coping Mechanisms.MethodsAdopting a quantitative cross-sectional descriptive design, data were collected from 242 actively enrolled postgraduate students using a random stratified sampling technique. Mental health status was measured using the Depression, Anxiety, and Stress Scale (DASS-21), and coping mechanisms were evaluated via the Coping Orientation to Problems Experienced (COPE) inventory. Data analysis utilised descriptive statistics, Spearman’s rank correlation, and multiple linear regression models.FindingsResults indicated significant psychological strain, with participants reporting difficulty winding down and high levels of anticipatory anxiety (DASS means ranged from 2.23/to 2.73 on a scale of 0-3. Regression analysis showed that coping strategies accounted for 40.2% of the variation in mental health. Notably, emotion-focused coping (β = 0.307, p <.001) and avoidant coping (β = 0.344, p <.001) had significant positive effects on mental well-being in this context. Conversely, problem-focused coping (β = -0.189, p = .002) had a significant negative effect, suggesting that direct action-oriented strategies may exacerbate distress for students facing stressors beyond their immediate control.ConclusionThe study finds that postgraduate mental health is profoundly influenced by the “plasticity” of coping strategies. While active problem-solving is traditionally encouraged, for the Kenyan postgraduate master’s student, adaptive emotion-focused and strategic avoidant strategies currently offer greater psychological relief. Universities must move from generic support to “fit-for-purpose” interventions that destigmatise mental health services and promote adaptive emotional regulation to ensure academic and professional success.
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RESCUE- expected usefulness and willingness to participate in a trauma-informed group intervention for coping with traumatic work experiences in the emergency medical services

Emergency Medical Services personnel (EMS) are confronted with potentially highly stressful and traumatic occupational experiences, placing them at high-risk for mental disorders. Avoidant coping mechanisms, internalized and occupational stigma not only impede disclosure of and processing the incident-related stress but also weaken the overall resilience of the EMS. Effective interventions are needed that operate both at the individual and group level. The aim of this study was to investigate the expected usefulness and willingness to participate in a trauma-informed intervention (Facts derived from Narrative Exposure Therapy, NETfacts). A total of 256 German EMS (67.19% men, 32.81% women) participated in the online survey. We assessed the expected usefulness and willingness to participate in NETfacts, critical incident-related stress (EMS Critical Incident Inventory EMS-CII), burnout symptoms (Professional Quality of Life ProQOL), age and work experience. Overall, about half of the EMS expected NETfacts to be at least somewhat useful, and reported a generally willingness to participate. Expected usefulness was neither associated with critical incident-related stress nor burnout symptoms. Younger participants (<35 years) showed a generally higher willingness to participate than older participants. However, the willingness is across both age groups positively associated with higher levels of critical incident-related stress. Nevertheless, burnout symptoms and the willingness are negatively associated among participants age 35 and older, while remaining stable among their younger colleagues. Early, trauma-informed and age-sensitive prevention programs are needed to mitigate the adverse effects of critical incidents among EMS. Our study presents EMS preferred circumstances to enhance employees’ uptake of such a program.
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Adopting a user-centred design approach for the development of on-device technology to prevent the viewing of child sexual abuse material: app design insights and principles from the development of ‘Salus’

IntroductionThe volume of Child Sexual Abuse Material (CSAM) available online and the global demand for it has reached unprecedented levels. Increasing numbers of individuals concerned about their online behaviour are contacting therapeutic providers for help and support outside of the criminal justice system. Previous research asking individuals what would help them to stop viewing CSAM suggests that the availability of a technological solution to voluntarily self-manage access to CSAM could be an effective tool.AimTo explore the findings from the user-centered design (UCD) of the ‘Salus’ prototype – a technological prevention tool to support effective self-management of individuals at risk of committing a first or further CSAM offence(s).Materials and methodsIn this two-year, European Commission funded project we conducted research in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom (UK). For the UCD phase of the project we conducted semi-structured interviews with 31 at-risk individuals in Belgium (n=10), Germany (n=10) and the UK (n=11), to explore the specific needs, design features, deployment methods, and concerns and barriers for the design, functionality and deployment of Salus. Additionally, four focus group discussions (FGDs) were held in Belgium, the Netherlands, and the UK with service providers (primarily therapists and managers) with extensive experience of supporting individuals at risk of committing CSAM offences to explore the same questions at the service level.ResultsIn terms of privacy and security, the potential discovery of apps such as Salus, data security and legal consequences of app usage are the main concerns of potential app users. There was consensus on the value of blocking CSAM, but opinions on the inclusion of an optional adult sexual content (pornography) filter in Salus design were not unanimous. Users should be able to switch a pornography filter on and off at their convenience. Blocking notifications should be quiet and subtle. Interactivity features are welcomed by potential users – these may include a diary function; a personal CSAM statistics page; a resources section; and a function to allow users to provide feedback to the app developers. Such features should be optional for users in order to prevent any unintended consequences of app usage. Finally, app deployment must be safe and secure.ConclusionBased on these findings, we propose seven evidence-based design principles for user-centered harm-reduction technology: privacy-by-default architecture; discretion through design ambiguity; adaptive notification systems; optional interactivity with user control; trusted-channel deployment; progressive trust building; and fail-safe harm prevention. These principles provide a framework for app developers and researchers working on similar technologies to develop interventions that reduce harmful behaviours.