Methodological review: Prioritizing a future research agenda for overcoming immunization implementation barriers in Pakistan.

Borderline personality disorder (BPD) is a mental illness that severely impacts a person's ability to regulate emotions and involves traits such as unstable interpersonal relationships, negative self-image, and marked impulsivity (National Institute of Mental Health, 2022). Extensive research has implied that childhood trauma is associated with BPD traits as well as insecure attachment (Peng et al., 2020). The current study aims to examine the mediating role of insecure attachment in the association between exposure to physical intimate partner violence (IPV) in childhood and BPD traits. A total of 156 adults who had previous childhood exposure to physical IPV were recruited using Amazon's Mechanical Turk (MTurk). Participants were administered questionnaires measuring the level of violence exposed in childhood, anxious and avoidant attachment in adulthood, and BPD traits in adulthood. The results of the study indicated that exposure to physical IPV was positively associated with anxious attachment and BPD traits (medium effect), anxious attachment was positively associated with avoidant attachment and BPD traits (large effect), and avoidant attachment was positively associated with BPD traits (medium effect). The mediation analysis revealed a positive indirect effect of childhood exposure to physical IPV on BPD traits through anxious attachment. However, the indirect effect of exposure to physical IPV on BPD traits through avoidant attachment was not significant. These findings highlight the importance of addressing the role of exposure to physical IPV in childhood as it relates to attachment-related challenges and personality pathology. Interventions for this population should focus on enhancing secure attachment patterns that may be associated with healthier adult relationships and life satisfaction. Given the cross-sectional design, conclusions regarding directionality are limited. Therefore, longitudinal research is necessary to replicate these findings.

Acoustic schwannomas are a highly prevalent yet poorly studied class of benign brain tumors impacting neuropsychological functioning, clinical, and functional outcomes. The study aims to assess neurocognitive functions and emotional processing in right-handed adults of Indian origin with acoustic schwannomas and identify neuropsychological impairments and relevant correlates. A prospective cross-sectional research design with consecutive sampling was employed. The sample (n = 44) was screened according to the WHO Classification of Tumors of the Central Nervous System (2021) and recruited by consecutive sampling from a referral and tertiary care medical center in South India. Selected neuropsychological tests from the Post-Graduate Institute Battery of Brain Dysfunction, Wechsler Memory Scale III, and National Institute of Mental Health and Neurosciences Neuropsychology Battery were administered along with a task developed for the assessment of emotion processing. The data was statistically analyzed using Statistical Analysis System (SAS) for descriptive analysis and non-parametric inferential statistics. The cohort had a mean age of 43.86 (±11.09) years, with a median of 12 (±3.02) years of education and right hemispheric (54.5%) cerebellar-pontine angle lesions. Our results demonstrate impairment in multiple neurocognitive domains, including visuospatial construction, visual/verbal memory, attention, executive functions, and difficulty in emotional processing in acoustic schwannoma patients, consistent with cerebellar contributions to higher-order functions. These deficits correlated with sociodemographic and clinical factors, potentially implicating networks such as the default mode network, cerebello-thalamo-cortical, and fronto-cerebellar pathways. The study highlights the need for comprehensive neuropsychological assessments in acoustic schwannomas and implications for functional outcomes.

Plain-language prompting improves readability of ChatGPT-generated patient education for meniscal surgery without loss of accuracy.

Background Alcohol and substance abuse are associated with increased rates of intimate partner violence (IPV). Manualized treatments that target both problems are associated with improved outcomes; however, therapist drift is an understudied factor that may influence outcomes. Objective This secondary, observational analysis, part of a National Institute of Health (NIH) funded randomized control study (RCT; NCT07140276), examined associations between therapist drift and treatment outcomes among court-mandated male IPV offenders with alcohol and substance use disorders. Therapist drift was not randomized; therefore, findings should be interpreted as associational rather than causal. Methods Sixty-two (N = 62) participants were assigned to one of two 12-session treatments: 1) Integrated Cognitive Behavioral Therapy targeting Substance Abuse and Domestic Violence (CBT-SADV) or 2) Drug Counseling (DC) focused on substance use only. Results Outcomes included substance use (alcohol and cocaine) and self-reported violence. Analyses included descriptives, logistic regressions, t-tests, and ordinary least squares; due to small sample size and limited therapists, multilevel modeling was not feasible. Therapist drift was high (40.3%) across both treatment conditions and linked to poorer substance use outcomes. Within the SADV condition, higher drift was associated with increased substance use, t(15) = −3.40, p = .004. At follow-up, treatment condition was associated with violence related outcomes (b = −3.17, p = 0.04); but, drift was not uniquely associated with violence. Conclusion Findings highlight the importance of maintaining fidelity in manualized treatments to reduce substance use among IPV offenders. Future research should examine these associations in larger, non-court mandated and more diverse samples.

Although some migrant origin groups in Europe show elevated risk for cardiovascular diseases (CVDs) and type 2 diabetes (T2D), information is sparse and fragmented. This study examines availability and possibilities for harmonization of health examination survey (HES) data on major determinants of CVD and T2D among migrant origin and ethnic minority groups in EU Member states and EU4Health associated countries (Norway, Iceland, Ukraine, Moldova, Montenegro). We conducted a scoping review, following PRISMA-ScR in PubMed and Web of Science, supplemented by targeted grey literature searches of national health institutes, to identify HESs covering core risk factors for CVD and T2D among migrant origin and ethnic minority groups, older than 18 years and living in EU Member states and selected associated countries. Studies were published between 2014 and 2026. Altogether 2537 peer-reviewed records and 348 grey literature reports were screened. Following full-text screening, 57 peer-reviewed papers were included. In total, 24 individual HESs in 10 countries were identified. The majority (n = 38, 67%) of the surveys were conducted in the Netherlands or Sweden. None of the HESs used nationally representative samples, having been conducted regionally. There was notable heterogeneity in how persons with a migration background and ethnic minorities were defined and grouped. Reported risk factors included obesity, hypertension, hypercholesterolemia, and hyperglycemia. Measurement methods of these risk factors varied by the migrant origin group and country where the study was conducted. We did not identify any eligible publications on CVD or T2D risk factors in migrant origin or ethnic minority groups in 69% of EU Member States/selected associated countries, indicating substantial knowledge gaps among these population groups in Europe. The heterogeneity in measurement methods makes cross-country comparison and data harmonization challenging. Data availability and cross-country comparability should be improved to support effective evidence-based health promotion and prevention measures.

Quantitative Assessment of the Readability of Patient Education Material by the Society of Vascular Surgery.

The NeuroDev study, conducted in Kenya and South Africa, is a large-scale clinical, genetic, and epidemiologic characterization of neurodevelopmental disorders (NDDs) on the African continent. NeuroDev assessments capture birth, demographic, and developmental history; cognitive and behavioral outcomes; and physical health variables. DNA samples are collected for exome sequencing and clinical genetic analysis. This paper presents novel data from 521 children with NDDs, 739 of those children's parents, and 255 unrelated, typically-developing children. The analyses offer unique genetic and phenotypic characterizations of NDDs in two African countries and underscore the importance of including underrepresented populations in NDD research. Ultimately, 107 children with NDDs from the NeuroDev cohort (22.1%) had likely pathogenic or pathogenic variants in established NDD genes. High rates of genetic diagnosis were associated with high rates of environmental risk factors for NDDs. All data, materials, and measures generated from this study are publicly available through the US National Institute of Mental Health.

Innovation in psychiatry relies on laboratory-based neuroscience research using experimental animal models. How to best train and support investigators remains a critical question for the field. We examined how training background, operationalized as MD, PhD, or MD/PhD degree, is associated with National Institutes of Health (NIH) K-to-R01 transition, a key career benchmark. Understanding how clinical and research training impact early research success will inform strategies in medical education and physician-scientist training in psychiatry. This preregistered study used NIH RePORTER to identify recipients of NIH mentored-career-development K01 and K08 awards from neuroscience-focused NIH institutes. Projects using animal models to address a neuroscience question were identified by title-and-abstract review. R01 awards (1997-2024) were identified and linked to prior K awardees (1997-2016) to determine conversion rates. Among 758 awards (243 K01, 515 K08), 51% (388/758) converted to at least one R01. Conversion rates differed significantly by degree (p = 0.035). MD-only investigators were less likely to convert (44%, 86/197) than MD/PhD (55%, 184/333) or PhD (52%, 118/228) investigators. Time to conversion also differed (p = 0.032), with longer duration for MD-only investigators. In exploratory analyses, male PhDs converted more often than females (59% vs. 41%; p = 0.024). No sex difference was found for MD and MD/PhD investigators. Lack of PhD-level research training was associated with reduced and delayed K to R01 transition for investigators using experimental animal models in neuroscience. Integrating PhD-style research training elements into psychiatry residency and faculty development programs may help close training-related gaps and address emerging sex disparities in research advancement.

Analytical performance specifications for laboratory tests are essential components of quality assurance for clinical laboratories. A widely adopted performance criterion is total allowable error (TEa), which includes contributions from both bias and imprecision, which may contribute to test inaccuracies. However, the relationship of TEa to test result misclassification, a clinically relevant quality measure, is unclear. Hypothetical clinical laboratory test results for 4 test models were generated and subjected to proportional bias and imprecision. Test misclassification (TM) as a function of bias and imprecision was determined using pre-defined cutpoint(s). Simulation analyses were then performed on 14 chemistry analytes using 3 data sets from patient results reported at the National Institutes of Health (NIH). We observed a complex and nonlinear relationship between bias and imprecision, and their impact on TM was not additive as may have been expected with TEa. TM scores were influenced by population distribution, the location of cutpoints, and the fraction of abnormal test values at baseline. Stringent TEa requirements did not correspond to low TM scores. On the contrary, TM scores for electrolytes were among the highest. Instead, TM scores closely correlated with the ratio of TEa to the width of the population distribution. TM has the advantage of correctly accounting for the differential effects of bias and imprecision. Compared to TEa, it provides a more accessible metric for evaluating performance and the clinical impact of errors.

Despite six decades of dedicated funding through the National Institute on Aging (NIA) and similar agencies worldwide, the primary causes of human biological aging remain largely unknown. This Perspective argues that this knowledge gap is not a consequence of scientific intractability but rather a structural artifact of how biomedical research is financed. The pharmaceutical-centric model—prioritizing single-disease targets over fundamental mechanisms—systematically disincentivizes investigation into aging per se. Drawing on recent budgetary data from the NIA, success rate analyses from the National Institutes of Health (NIH), and international perspectives from Nature Aging, we demonstrate that successful grant applications focus almost exclusively on age-related diseases rather than the aging process itself. With NIH early-stage investigator success rates collapsing from 29.8% to 18.5% in two years , and the European aging research landscape remaining “highly fragmented” without dedicated funding mechanisms , the structural barriers to aging research have never been more acute. We conclude that the under-exploration of aging’s fundamental causes is a policy-economic phenomenon, not a methodological one, requiring systemic reform rather than incremental adjustment.

NIH-FDA Nutrition Regulatory Science Workshop: advancing research and policy.

Interventions for methamphetamine use among people on methadone maintenance treatment in Vietnam: a sequential multiple assignment randomized trial (STAR-OM).

Safety and efficacy of individualised exercise and NAD+ precursor supplementation in patients with Friedreich's ataxia in the USA: a single-centre, 2 × 2 factorial, randomised controlled trial.

Confirmatory efficacy and safety trial of magnetic seizure therapy versus right unilateral ultra-brief electroconvulsive therapy in depression (CREST-MST): a randomised, double-blind, non-inferiority trial in Canada and the USA.

Polycystic ovary syndrome is distinguished by alterations in ovarian morphology, ovulatory failure, and increased androgen levels. The National Institutes of Health (NIH) defines it as ovulatory dysfunction accompanied by hyperandrogenism. Women with PCOS may have obesity, type 2 diabetes, anxiety, hypertension, insulin resistance, and pregnancy-related complications. PCOS is additionally linked with a greater chance of cardiovascular and metabolic disorders. Several factors, including LH/FSH ratio, FAI levels, and ovarian USG, should be considered when diagnosing PCOS. The Rotterdam criterion is employed to determine the condition when two of the three features are present and other etiologies are eliminated. Biomarkers have developed as a means of optimizing PCOS diagnosis and treatment results. This review has examined a number of biomarkers associated with PCOS, such as insulin, anti-Mullerian hormone, oxidative stress markers, inflammatory markers, and others. Controlling these disease-related markers may aid in lessening the symptoms of PCOS.

The ASCENT Consortium was funded by the National Institutes of Health (NIH) in August 2025 with the goal of advancing palliative care (PC) research, evidence, implementation and practice to improve care of persons with serious illness and those who care for them across the lifespan. ASCENT aims to: (1) Develop and coordinate the national scientific infrastructure and community needed to advance PC research, marshalling research expertise currently distributed across research centers and leveraging the impact of that expertise via partnership and collaboration. Partners include persons who have lived experiences with serious illness personally or as caregivers, practicing clinicians, patient advocacy organizations, professional organizations, community organizations, health care systems/settings/payers across the continuum of care and other NIH-funded consortia and networks. (2) Generate new PC research knowledge and methodologies, directly by conducting projects to establish new knowledge or methods that support the work of PC scientists. (3) Foster career development and impact of the PC scientist workforce by funding career development and pilot and exploratory awards, providing access to methodologic consultations and resources such as PC research methodology and career development curricula and facilitating mentoring. (4) Disseminate PC research findings and facilitate subsequent implementation via a multi-pronged approach, including providing resource libraries, guidance documents, best practices, training, and toolkits to facilitate collaboration and co-design with health system partners and relevant organizations. This article describes the goals, organization, resources, programs and activities of the ASCENT Consortium, intending to raise awareness about ASCENT and encourage engagement with, utilization of and collaboration with ASCENT.

TRK inhibitors targeting NTRK fusion-positive cancers have the potential to improve patient outcomes, but also have high costs. We report the first long-term projections of cancer prevalence associated with NTRK gene fusions in Australia, to 2044. We analysed national Australian Institute of Health and Welfare incidence (1982-2019) and survival (1991-2019), NSW Enduring Cancer Data Linkage incidence (1982-2019) and survival data (1982-2019). We projected 1-year to 5-year cancer prevalence using validated statistical methods, for all stages combined, advanced disease at diagnosis (here, distant metastasis/lymph node involvement), and advanced disease after progression post-diagnosis. We estimated prevalence for all paediatric cancers combined (age < 18 years at diagnosis), all adult solid cancers combined, 18 cancer types/groups, and 5 cancer sub-types relevant to current Australian government subsidies of TRK inhibitors. For all solid cancers combined, we project increasing prevalence of individuals who were diagnosed with tumours exhibiting NTRK gene fusions, primarily due to population growth and ageing. For example, for 2-year prevalence (aligning with 2.5 years average treatment assumed in previous economic assessments for a TRK inhibitor subsidy), the projected increases from 2019 to 2044 are: all stages combined, paediatric cancers 80 to 106 (+ 32.5%), adult cancers 645 to 970 (+ 50.4%); advanced disease at diagnosis, paediatric cancers 19 to 23 (+ 21.1%), adult cancers 185 to 261 (+ 41.1%); advanced disease after progression post-diagnosis, paediatric cancers 22 to 30 (+ 36.4%), adult cancers 110 to 180 (+ 63.6%). The results from this study can support healthcare planning and budget forecasts, including for different potential government treatment subsidy scenarios.

With a global prevalence of 1.7%, smoking during pregnancy commonly still occurs in many countries. Tobacco smoke contains several harmful and carcinogenic compounds which can cross the placental barrier and cause adverse effects on maternal and fetal health. Developing brains are particularly sensitive to the harmful effects of chemical exposures. The aim of this systematic literature review was to investigate the association between maternal smoking during pregnancy and childhood brain tumors in children aged 0-15 years. A systematic search was conducted using PubMed, Web of Science, CINAHL, and Scopus databases. Of the initial 192 articles, 18 were included in the final analysis, which comprised of three cohort studies and 15 case-control studies. Studies were evaluated for study quality using The National Health, Lung and Blood Institute Study Quality Assessment Tools website and the quality of the studies was mostly good. This systematic literature review found no consistent evidence of an association between maternal tobacco smoking during pregnancy and childhood brain tumors. Of the 18 studies, four reported an association between maternal smoking during pregnancy and childhood brain tumors (CBT), ependymoma, or astrocytoma. If there was an association between CBT and maternal tobacco smoking, it was seen more commonly in young children, ranging from 0 to 4 years. Further studies are needed to establish a more comprehensive understanding.

Background. Infections caused by Streptococcus pneumoniae are a public health problem worldwide, and penicillin-non-susceptible isolates are a priority for the World Health Organization, which requires further research and development of new antibiotics and vaccines.Aim. To describe the global pneumococcal sequence clusters (GPSCs) among penicillin non-susceptible S. pneumoniae isolates obtained from patients with invasive pneumococcal disease in Colombia after the introduction of PCV10 (Synflorix, GlaxoSmithKline) to generate data on the genetic structure of pneumococcal populations with different antimicrobial susceptibilities.Methods. A subset of 313 pneumococcal isolates with values of Minimum Inhibitory Concentration to penicillin of ≥0.125 µg ml-1, collected through the National Reference Laboratory at the National Health Institute of Colombia, were characterized by whole-genome sequencing to determine the GPSCs, serotypes, sequence types, antimicrobial resistance determinants and pilus islets.Results. Most of the isolates (80%, n=251) were clustered in seven GPSCs: multidrug-resistant GPSC1 (40.6%, n=127) conformed principally to serotype 19A isolates and ST320, GPSC5 (10.5%, n=33) associated with ST338 and isolates of serogroups 23 and 6, GPSC13 (7.3%, n=23) which clustered 68% of 6A isolates, GPSC10 (7.0%, n=22) with 19A and 24F isolates, GPSC6 (5.4%, n=17) related to ST156, GPSC9 (4.8%, n=15) conformed to isolates 15A, 19 F/A and 6A and GPSC47 (4.5%, n=14) with 6C isolates. Only three isolates with PCV10 serotypes were recovered from children younger than 5 years old.Conclusion. The results revealed changes in the population structure expected after PCV10 introduction, with GPSC1 being the most important clone due to its association with multidrug resistance. Genome sequencing of clinical multidrug-resistant isolates contributes to elucidating the antibiotic resistance mechanism and understanding the global pneumococcal population structure.