IntroductionBurnout, depression, and anxiety are major concerns among physicians because they affect individual well-being, patient care, and healthcare systems. Neurodevelopmental traits, including autistic-like traits (ALTs) and attention-deficit/hyperactivity disorder (ADHD)-like traits (ADHLTs), may increase vulnerability to psychological distress. However, little is known about how these traits relate to burnout, depression and anxiety, and empathy among junior residents.MethodsIn this cross-sectional study, 148 junior residents from two teaching hospitals in Japan completed validated measures of ALTs (21-item Japanese version of the Autism-Spectrum Quotient), ADHLTs (Adult ADHD Self-Report Scale Screener), burnout (Maslach Burnout Inventory), depression and anxiety (Hospital Anxiety and Depression Scale), physician–patient empathy (Jefferson Scale of Physician Empathy), and psychological flexibility and inflexibility processes (Valuing Questionnaire, Cognitive Fusion Questionnaire-7, and Work-related Acceptance and Action Questionnaire). Associations were examined using multivariable logistic and linear regression analyses. Exploratory statistical mediation analyses using structural equation modeling examined indirect associations through psychological flexibility and inflexibility processes.ResultsThe prevalence of ALTs and ADHLTs was 23.6% for each trait. ALTs were associated with lower personal accomplishment, a burnout dimension; higher depression and anxiety; and lower physician–patient empathy. ADHLTs were associated with greater emotional exhaustion, another burnout dimension. In exploratory statistical mediation analyses, progress toward values, a core process of psychological flexibility, showed a significant indirect association between ALTs and personal accomplishment, and the direct association was attenuated and no longer statistically significant after including the process variables. Significant indirect associations through progress toward values were also observed for the associations of ALT with depression and anxiety and empathy. Cognitive fusion, a core process of psychological inflexibility, showed a significant indirect association between ADHLTs and emotional exhaustion. Overall, neurodevelopmental traits were associated with distinct patterns of psychological functioning, suggesting variability in both vulnerability and adaptive processes.DiscussionNeurodevelopmental traits such as ALTs and ADHLTs were significantly associated with burnout dimensions, depression and anxiety, and physician–patient empathy among junior residents. Psychological flexibility and inflexibility processes, particularly progress toward values and cognitive fusion, may be relevant to these associations. Process-based support strategies may warrant further investigation for residents with elevated neurodevelopmental traits.Clinical trial registrationhttps://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R00005, identifier UMIN000046897.
Loneliness, rumination, and adolescent psychological crisis in China: a pilot moderated mediation study
BackgroundAdolescent psychological crisis—encompassing depressive disorder, anxiety disorder, and suicidal ideation—is a major public health challenge. One in five adolescents experiences a clinically significant mental health condition globally. Loneliness is a well-documented, modifiable risk factor for these outcomes. However, the exact cognitive-emotional pathways linking loneliness to acute psychological crisis remain unclear. This is particularly true in China, where rapid social change and intense academic pressure increasingly strain adolescent mental health. We do not yet fully understand how protective resources might buffer these specific pathways.Objectives and methodsThis pilot study tests a moderated mediation model based on the Evolutionary Theory of Loneliness and the stress-vulnerability framework. We investigate ruminative thinking as a cognitive-emotional mediator between loneliness and psychological crisis. We also test whether perceived social support and psychological resilience moderate distinct stages of this pathway. Based on a pilot sample of N = 312 Chinese adolescents (ages 12–18), we use structural equation modelling (SEM), confirmatory factor analysis (CFA), and Hayes’ PROCESS Macro (Model 14) with 5, 000 bootstrap replications. Two-wave longitudinal data (n = 187, 8-week interval) were available for the depression outcome only; the anxiety and suicidal-ideation pathways were examined cross-sectionally.ResultsLoneliness is significantly associated with depressive symptoms (β = 0.43, p < 0.001), anxiety (β = 0.38, p < 0.001), and suicidal ideation (β = 0.27, p < 0.001). Ruminative thinking accounts for 40–46% of the total indirect association across all three outcomes. Social support buffers the transmission from loneliness to rumination (b = −0.16, p = 0.002, ΔR2 = 0.023), while resilience buffers the transmission from rumination to crisis (b = −0.19, p < 0.001, ΔR2 = 0.031).ConclusionsThese preliminary, exploratory findings are consistent with the possibility that ruminative thinking partially accounts for the cross-sectional association between loneliness and adolescent psychological crisis in China, and with social support and resilience attenuating this association at potentially distinct stages. Because the pilot is underpowered for the moderated mediation model and the available longitudinal evidence covers depression only, the moderation and stage-specificity results should be read as hypothesis-generating rather than confirmatory. A planned full-scale study (N ≥ 1, 200) will test these mechanisms further. We also outline initial practical implications for school-based interventions.
Autism service barriers for Latine children and their families: a participatory approach to adapting autism diagnostic care
IntroductionLatine children from families with limited English proficiency (LEP) experience barriers to timely autism diagnosis resulting in persistent health inequities. This participatory mixed-methods study examined these barriers and identified multi-level strategies to adapt diagnostic care models for Spanish-speaking Latine families.MethodsParticipants included twelve caregivers of thirteen autistic children with parent reported diagnosis of autism, twelve clinicians, and six care coordinators. All participants completed surveys and participated in qualitative interviews or focus groups.ResultsQuantitative findings revealed significant lag between caregiver’s first developmental concern and diagnosis, limited autism knowledge, and difficulty navigating care. Qualitative results highlighted systemic barriers, including clinician-patient language discordance, interpreter inaccuracies and quality variability, cultural stigma, and long waitlists. Clinicians reported challenges with communicating about autism with Spanish-speaking families and emphasized language and cultural differences as primary barriers. Caregivers described social isolation, mistrust of health systems, and emotional distress compounded by immigration-related stressors.DiscussionFindings underscore the need for structural adaptation of care approaches beyond translation services.
Real-world outcomes of intranasal esketamine and intravenous ketamine induction therapy for treatment-resistant depression in a community clinic: a retrospective cohort study
IntroductionIntravenous (IV) ketamine and intranasal esketamine are NMDA receptor antagonists used for treatment-resistant depression (TRD). Both have demonstrated efficacy in controlled trials, but observational evidence from real-world community settings is limited.MethodsWe conducted a single-center retrospective cohort study of adults aged 18 to 65 receiving induction therapy for TRD with intranasal esketamine or IV ketamine at a community psychiatric clinic from January 1 through December 31, 2025. Patients with prior exposure to either medication or to oral ketamine derivatives were excluded. The primary outcome was change in Patient Health Questionnaire-9 (PHQ-9) score from baseline to end of induction. Secondary outcomes included response (≥50% PHQ-9 reduction), remission (final PHQ-9 ≤4), clinically meaningful improvement (≥5 PHQ-9 reduction), induction completion, and adverse events. Within-group and per-protocol analyses were exploratory.ResultsSixty-three patients met inclusion criteria (esketamine n=37; IV ketamine n=26). Baseline PHQ-9 scores were similar (18.22±4.49 vs. 18.27±5.41; P = 0.967), as was mean change from baseline (-10.31±5.59 vs. -9.50±5.69; mean difference 0.81, 95% CI -2.12 to 3.75; P = 0.589). Response rates were 64.9% vs. 69.2% (RR 0.94, 95% CI 0.66 to 1.33; P = 0.790), remission 32.4% vs. 23.1% (RR 1.41, 95% CI 0.61 to 3.26; P = 0.573), and clinically meaningful improvement 83.8% vs 73.1% (RR 1.15, 95% CI 0.87 to 1.51; P = 0.353). Induction completion exceeded 90% in both groups; one patient per cohort discontinued from intolerable side effects, and no serious adverse events occurred. Within-group PHQ-9 reduction was large: 10.31±5.59 points (paired t[34]=10.91; P<0.001; Cohen’s d=1.84) for esketamine and 9.50±5.69 points (paired t[23]=8.18; P<0.001; Cohen’s d=1.67) for ketamine. Findings remained statistically significant and clinically large under a pre-specified baseline observation carried forward (BOCF) sensitivity analysis (Cohen’s d=1.65 and 1.45).ConclusionsInduction therapy with intranasal esketamine and intravenous ketamine was associated with robust antidepressant effects in a community outpatient setting, consistent with prior trial data. The modest sample size limits power to detect between-group differences and increases the risk of type II error; the absence of statistically significant between-group differences should therefore not be interpreted as evidence of equivalence. Protocol asymmetry between arms (esketamine: 12 sessions over 8 weeks; IV ketamine: 6 sessions over 3 weeks) further limits direct comparison of endpoint values between groups. Practical considerations including insurance coverage, cost, and administration logistics may help guide treatment selection. Longitudinal follow-up is planned to characterize treatment durability.
Dissociation and PTSD in women with a history of childhood sexual abuse: a pilot examination of a specialized inpatient unit
BackgroundWorldwide, there are relatively few specialized inpatient units dedicated to women with histories of childhood sexual abuse (CSA) and comorbid psychiatric disorders. This pilot study examined dissociation and PTSD among women admitted to such a specialized integrative inpatient unit in Israel. We conduct an in-depth analysis of the role of dissociation in these women’s clinical picture, as well as in their treatment response.MethodsThe study included two phases. Phase 1 used a cross-sectional design to assess the complex inter-relationships between PTSD and various facets of dissociation in women with CSA histories admitted to a specialized inpatient unit (N = 108). Phase 2 focused on a sub-sample of participants (N = 28) who completed the inpatient program and completed admission and discharge assessments. Measures included the PTSD Checklist for DSM-5 (PCL-5) and the Dissociative Experiences Scale (DES-II).ResultsIn Phase 1, dissociative symptoms were positively correlated with overall PTSD severity and all PTSD symptom clusters, with the dissociative sub-measure of Absorption showing the strongest associations. In Phase 2, PTSD symptoms significantly decreased following treatment. In line with phase 1, reductions in Absorption were associated with improvements in overall PTSD severity and specifically in Hyperarousal symptoms.ConclusionsFindings from this pilot study indicate the therapeutic potential of a specialized integrated inpatient unit for women with CSA histories. Importantly, our results indicate that dissociation should be regarded as a major therapeutic target, most notably patients’ tendency for maladaptive absorption. These preliminary results should be expanded upon in larger, controlled clinical trials, further elucidating the role of dissociation and other mechanisms of change in similar units.
Resilience and Stress Among Health Care Workers Participating in the StressPal Frontline Program: Quasi-Experimental Pretest-Posttest Study
Background: Health care workers continue to experience heightened levels of distress and burnout, which contribute to higher levels of job dissatisfaction, turnover intentions, presenteeism, and staffing shortages. Objective: The aim of this study was to examine how participation in the StressPal Frontline: Essential Resilience Self-Care and Burnout Prevention program influenced health care workers’ stress and resilience. The study also sought to identify specific measures of perceived stress and resilience that were most affected by participation in the program and to explore whether pre-and-post differences varied based on participant characteristics. The StressPal Frontline program is a digital resilience intervention specifically developed for health care workers to enhance psychological flexibility and stress resilience. The self-paced training program, designed for approximately a 6-week period, consists of brief modules, follow-up resources, and a peer engagement community. Methods: A pretest-posttest quasi-experimental design was used to assess the effectiveness of the StressPal Frontline program in reducing stress and building resilience among 76 health care workers who voluntarily joined and completed the program. Outcome measures included the Perceived Stress Scale and the Brief Resilience Scale to assess participants’ perceptions of stressful situations and their ability to bounce back from stress. Descriptive statistics, correlation analysis, paired-samples 2-tailed test, and multiple regression analysis were conducted. The paired-samples test was calculated at the scale level and item level to evaluate the statistical significance of pretest and posttest mean differences, and the Cohen statistic was used as a measure of effect size. Statistical analysis for this study was conducted in Excel (Microsoft), SPSS (IBM Corp), and Jamovi (jamovi project). Results: The results indicated a 1.53-point reduction in the Perceived Stress Scale score after participating in the StressPal Frontline program, suggesting a statistically significant decline in average perceived stress due to participation in the program (=.004). The corresponding value of Cohen was 0.34, suggesting a small-to-medium effect of the intervention, StressPal Frontline program, in reducing perceived stress. For the Brief Resilience Scale, pre-and-post difference was not significant at the scale level (=.07); however, item-level analysis found significant increases in participants’ perception of their ability to bounce back quickly after hard times and handle difficult situations. No significant differences were found in outcome measures based on age, race, ethnicity, professional role, or practice setting. Conclusions: The StressPal Frontline program was associated with positive outcomes in reducing perceived stress. Our study also found no statistical differences in outcomes among participants of different age groups, races, ethnicities, occupations, genders, and practice settings. This is an important finding, as it indicates that the StressPal Frontline program may provide positive benefits for reducing stress across professions, settings, and individual characteristics. This program, along with other resources, could be implemented by health care organizations to support workers’ professional development, behavioral health, and well-being.
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Impact of an Artificial Intelligence–Powered Clinical Decision Support System for Acute Kidney Injury Prevention in the Intensive Care Unit: Single-Center Uncontrolled Before-and-After Implementation Study
Background: Acute kidney injury (AKI) is a frequent and serious complication among hospitalized patients, particularly in critical care settings, where its incidence can exceed 50%. AKI is associated with increased mortality, prolonged hospitalization, dialysis dependence, and higher health care costs. Although the KDIGO (Kidney Disease: Improving Global Outcomes) guidelines emphasize supportive care, hemodynamic optimization, and avoidance of nephrotoxins, their implementation remains inconsistent, partly due to the lack of timely risk stratification. Recent advances in artificial intelligence have enhanced early prediction and detection of AKI, offering new opportunities to improve patient outcomes and intensive care unit (ICU) efficiency. The U-Care Renal Platform (UCRP; U-Care Medical S.r.l), a Conformité Européenne (CE)–marked artificial intelligence–powered medical device, integrates directly with the ICU electronic health record to continuously analyze patient data and predict the risk of moderate or severe AKI within 24 hours, providing actionable, guideline-based recommendations. While the predictive performance of UCRP has been validated previously, its real-world impact on clinical and operational outcomes in the ICU remains underexplored. Objective: This single-center uncontrolled before-and-after implementation study aims to evaluate the association between UCRP implementation and selected ICU clinical and operational outcomes in routine practice at SCIAS Hospital, Barcelona. Methods: This study was conducted as a retrospective service evaluation of a workflow-embedded clinical decision support system between March 2023 and March 2025. It included 202 postsurgical adult ICU patients. Outcomes of interest were assessed by comparing preimplementation and postimplementation periods. Months during which the UCRP was inactive were excluded from the analysis (total excluded duration: 10 months; 5 in the preimplementation period and 5 in the postimplementation period). The outcomes included the incidence of moderate-to-severe AKI (KDIGO stages 2 and 3), the use of nephrotoxic medications, the frequency of hypotensive episodes among patients with AKI, and the ICU length of stay. Results: During the postimplementation period, lower rates of moderate-to-severe AKI (9/99, 9.1% vs 12/103, 11.7%), nephrotoxic drug administration, and hypotensive episodes among patients with AKI were observed compared with the preimplementation period. Conclusions: Integration of the UCRP into ICU workflows was associated with differences in selected AKI-related process and intermediate clinical outcomes in this single-center uncontrolled before-and-after implementation study. However, given the study design, causal relationships cannot be established, and the findings should be interpreted as preliminary signals requiring confirmation in larger, controlled, and multicenter studies, including patient-centered outcomes.
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Astrocytes Preserve Memory Persistence Through Ankyrin-2 Protein in Mice
Although scientists have long studied how memories are formed in the brain, how certain memories persist over time for learning and cognitive function remains unclear.
A new study published in Nature Communications titled, “Astrocytic ankyrin-2 enables memory persistence in the mouse hippocampus,” suggests that astrocytes play a critical role in long-term memory through the regulatory protein ankyrin-2 (Ank2).
Removing Ank2 function led to significantly impaired memory in mice after after two weeks. Under normal conditions, these mice showed standard locomotion, sociability, and recent memory immediately after learning.
Astrocytes lacking Ank2 formed significantly less physical contacts with nearby engram neurons, the specialized neurons for memory storage. Additionally, the maintenance of long-term potentiation (LTP) was impaired while normal synaptic transmission remained intact. The findings suggest that astrocytes stabilize the neural circuits required for preserving memories long after they are formed.
On the molecular level, researchers found that Ank2 is required for brain-derived neurotrophic factor (BDNF) signaling through the astrocytic TrkB.T1 receptor and IP3R2-mediated calcium signaling. In the absence of Ank2, calcium signaling weakened, astrocytes failed to undergo normal structural remodeling, and showed reduced ability to maintain contacts with memory-encoding neurons.
The researchers further demonstrated that hippocampal BDNF infusion normally strengthens long-term memory persistence, but this effect disappeared when astrocytic Ank2 was deleted, showing that Ank2 is essential for BDNF-dependent memory stabilization.
To determine whether astrocytic BDNF signaling alone is sufficient to enhance memory, the team developed an optogenetic tool called Opto-T1. Activation of this pathway promoted astrocyte remodeling, maintained long-term potentiation, and significantly enhanced remote memory without affecting recent memory.
“Our findings show that astrocytes are not passive support cells, but active regulators that determine how long memories last,” said Wuhyun Koh, PhD, senior research fellow at Institute for Basic Science (IBS) and corresponding author of the study. “By identifying Ank2 as a key regulator of astrocyte remodeling and BDNF signaling, we have uncovered a new mechanism that helps stabilize long-term memories and opens new avenues for understanding and potentially treating memory disorders.”
The researchers indicate the study provides a new framework for understanding how astrocytes contribute to neurological diseases.
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Memory-focused therapy: an integrated intervention to reduce trauma symptoms, maladaptive cognitive processes, and emotional distress in Afghan youth
BackgroundAfghan youth continue to face chronic war-related trauma, terrorist violence, and severe disruptions to education and social support systems, resulting in high rates of posttraumatic stress disorder (PTSD), depression, anxiety, and hopelessness. There is a critical need for culturally responsive, low-intensity, and feasible psychological interventions that can be delivered in low-resource and unstable settings.ObjectiveThis study conducted a preliminary evaluation of the efficacy, acceptability, and mechanisms of change associated with Memory-Focused Therapy (MFT), an integrative intervention targeting autobiographical memory processing, acceptance-based regulation, and future self-construction among youth affected by the Kaaj Education Center attack in Kabul, Afghanistan.MethodsA single-group repeated-measures design was used with 26 participants assessed at baseline, post-intervention, and three-month follow-up. Standardized measures of PTSD, depression, anxiety, stress, cognitive avoidance, cognitive fusion, resilience, and posttraumatic growth were administered. MFT was delivered in 12 structured group sessions. Additionally, qualitative data from semi-structured interviews and therapist field notes were analyzed using thematic analysis.ResultsQuantitative analyses showed significant reductions in PTSD symptoms, depression, anxiety, stress, cognitive avoidance, and cognitive fusion from baseline to post-intervention, alongside significant increases in posttraumatic growth. Several of these improvements were maintained at follow-up. Qualitative findings reflected four overarching themes: (1) facilitator experiences and implementation challenges in high-risk contexts, (2) improvements in cognitive and emotional processing, (3) growth in meaning, relationships, values, and future orientation, and (4) exposure to traumatic memories and reduced avoidance.ConclusionFindings provide preliminary evidence that MFT is a feasible, acceptable, and potentially effective intervention for trauma-affected Afghan youth. By integrating trauma memory processing, present-moment emotional regulation, and future-oriented meaning-making, MFT appears to support improvements in psychological coherence, self-continuity, and resilience. Further controlled and longitudinal studies are needed to confirm these effects and examine underlying mechanisms.
Parental broad autism phenotype traits and executive function in families of children with autism spectrum disorder
BackgroundParents of children with autism spectrum disorder (ASD) frequently exhibit subclinical Broad Autism Phenotype (BAP) traits, though their relationship with executive function (EF) remains underexplored. This study investigated associations between parental BAP traits and their EF performance.MethodsThe Broad Autism Phenotype Questionnaire (BAPQ) was used to assess the BAP traits in parents of children with ASD and parents of healthy children. Among them 20 of the high-BAP ASD parents with a total BAPQ score exceeding 3.55 and 20 of the parents of typically developing children completed executive function tests. The researchers utilized the flanker, 2-back, and Task-switching paradigm to examine their EF. Correlations analysis was used to analyze BAP-EF relationships.ResultsThe self-reported questionnaires indicated that parents of children with ASD had significantly higher BAPQ scores than non-ASD’s parents, with fathers scoring 41.21% versus 15% (χ2 = 31.628, p < 0.01), and mothers 26.25% versus 8.37% (χ2 = 25.764, p < 0.01). Parents of ASD children exhibited significantly prolonged reaction times on the Flanker task (528.95 ± 78.90 ms vs. 426.80 ± 18.40 ms, T = 15.639, p<0.01), with BAPQ total scores positively correlating with slower responses (R² = 0.2325, p = 0.0313). Paradoxically, they demonstrated accelerated 2-Back incongruent reaction times (537.60 ± 80.21 ms vs. 665.70 ± 137.17 ms, T = 6.715, p=0.001) but reduced accuracy (0.947 ± 0.037 vs. 0.983 ± 0.016, T = 16.875, p<0.01), where BAPQ again correlated with reaction times (R² = 0.2318, p = 0.0316). Crucially, these associations were absent in controls, and BAPQ scores showed no relationship with task accuracy in either group.ConclusionsBAP traits are associated with attentional control challenges (indexed by Flanker Task) and a maladaptive speed-accuracy tradeoffs during working memory demands.