ObjectivesThe present study aimed to establish a consensus on a definition of forensic mental health systems and services, and to identify principles and components of forensic mental health systems.MethodsA Delphi consensus-building process was employed among 23 experts in forensic mental health, defined by lived experience of forensic mental health services, professional, clinical or management practice in forensic settings, or academic research in the field. Items were rated on a 9-point Likert scale, with consensus defined as ≥75% of panelists rating an item between 7 and 9. Across three Delphi rounds, items were revised, merged, or added based on participant feedback. Data were collected anonymously using LimeSurvey, with reminders sent to maximize participation, followed by a structured consensus meeting to resolve remaining areas of disagreement.ResultsThe final consensus statement comprises three components: (1) a definition of forensic mental health services; (2) a general statement including 12 guiding principles; and (3) 43 core components organized across 10 thematic domains addressing models of care, pathways and processes, programs and activities, physical health, service user and peer involvement, evaluation and improvement, service integration, safe environments, restrictive practices, and other system-level considerations. While all items achieved consensus at the consensus meeting, areas of sustained discussion related to the integration of cultural expertise, the inclusion of a lived experience workforce, and the distinction between descriptive and aspirational elements of forensic mental health services.ConclusionsThis international consensus statement provides a structured framework for understanding forensic mental health systems. By articulating shared principles and core components while allowing flexibility across jurisdictions, the framework offers a foundation to support service development and evaluation across diverse jurisdictions.
Case Report: Suicidality response to treatment for attention deficit hyperactivity disorder in adult females with autism spectrum disorder: three cases
BackgroundSuicidality, suicide attempts and non-suicidal self-injury occur more frequently in untreated attention deficit hyperactivity disorder (ADHD), and in females with autism spectrum disorder (ASD), especially in late adolescence and young adulthood. Diagnosis and treatment of the comorbid ADHD may rapidly improve coping skills, reducing impulsivity and suicidality.MethodsWe obtained IRB approval and written consent to publish the de-identified cases of three young adult females with recurrent suicidality and serious mental illness. Each met DSM-based diagnostic criteria for ASD and ADHD, but received no ADHD treatments on presentation. Presentations, treatment, side effects and precautions are discussed.ResultsEach responded remarkably to ADHD treatments, but with notable side effects especially in one case. Addition of ADHD medications led to rapid improvements in mood, suicidality and self-reported use of coping skills, enabling taper of antidepressants and antipsychotics.ConclusionsADHD diagnosis and treatment may rapidly improve treatment-resistant suicidality and mood, by improving executive functions, impulse control and use of coping skills; larger-scale studies are indicated to elaborate on our findings in these three cases. ASD and comorbid ADHD are important predisposing factors to suicidality that are commonly missed. ADHD treatment may provide remarkable response, described by patients as enabling greater functioning, confidence and use of coping skills when under stress. Suicidality assessment should include screenings for ADHD and ASD, especially in atypical cases. Prior maltreatment, executive dysfunction and impulsivity in females all raise suicide risks.
Research progress on social participation of young and middle-aged stroke survivors: a narrative review
Stroke is characterized by high morbidity, disability, and mortality, and has become the third leading cause of death worldwide. In China, stroke accounts for 39.9% of all cerebrovascular diseases, with young and middle-aged survivors (aged 40–60 years) comprising 33% of global stroke survivors in this age group and over 51.51% of all stroke cases in China. Despite significant improvements in treatment, 70–80% of survivors still lose the ability to live independently, and social participation declines to varying degrees. Social participation plays an important role in rehabilitation outcome indicators, which can reflect the overall recovery of survivors and is closely related to quality of life. Guided by the International Classification of Functioning, Disability and Health (ICF) framework, this review aims to examine the current status, assessment tools, and influencing factors of social participation among young and middle-aged stroke survivors, with the goal of informing future research and guiding clinical practice.
Sequencing peptides by reversing translation
Nature Biotechnology, Published online: 16 April 2026; doi:10.1038/s41587-026-03108-1
A new peptide sequencing approach converts amino acids into DNA sequences, which are easily read.
Diversity-generating retroelements for programmable targeted hypermutagenesis
Nature Biotechnology, Published online: 16 April 2026; doi:10.1038/s41587-026-03078-4
Diversity-generating retroelements are engineered for directed evolution in E.coli.
Trabectedin and low-dose irinotecan to target EWS::FLI1 in Ewing sarcoma: a phase 1/2 trial
Nature Medicine, Published online: 16 April 2026; doi:10.1038/s41591-026-04340-7
In this phase 1/2 trial, patients with Ewing sarcoma received trabectedin and low-dose irinotecan at concentrations known to inhibit the activity of the transcription factor EWS::FLI1, leading to encouraging clinical response rates.
Integrated epidemiological and molecular data inform the relationship between precancer and cancer states of esophageal adenocarcinoma
Nature Medicine, Published online: 16 April 2026; doi:10.1038/s41591-026-04331-8
Analyses of epidemiological, clinical and molecular data from a prospective cohort of 3,100 patients with esophageal carcinoma suggest intestinal metaplasia as a single precancer pathway preceding the disease.
Spatial and single-cell characterization of human glioblastoma tumor microenvironment reveals malignant cellular communities
Nature Neuroscience, Published online: 16 April 2026; doi:10.1038/s41593-026-02265-5
Integrating spatial and single-cell data from 100 patients, the authors define conserved cellular communities and communications in glioblastoma, revealing distinct mesenchymal-like tumor subtypes and predominant neurogliomal synapses that shape tumor progression.
Spatial, temporal and Notch determination of terminal selector expression controls neuronal cell fate in the Drosophila optic lobe
Nature Neuroscience, Published online: 16 April 2026; doi:10.1038/s41593-026-02256-6
The authors characterized the spatial origin of Drosophila medulla neurons, completing their previous characterization of the temporal and Notch origins of these neurons and allowing them to correlate patterning of progenitors and neuronal type-specific features.
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