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Mind mapping is a visual, non-linear learning technique in which information is organized around a central concept with related topics and subtopics arranged as branches. It promotes active learning by helping students organize, understand, and recall information. In medical education, where students are required to learn large volumes of conceptual content, mind mapping may serve as a useful self-directed learning tool. This study aimed to evaluate the effectiveness of mind mapping as a self-directed learning method among first-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students and to assess students' perceptions regarding its use in the context of physiology. This quasi-experimental, non-randomized controlled crossover study was conducted among 100 first-year MBBS students at All India Institute of Medical Sciences (AIIMS) Jammu in Jammu, India. Students were divided into two routine practical batches of 50 each. In Phase 1, Batch A served as the mind mapping group and Batch B as the traditional learning group for the topic "Acid-Base Disorders". All students were first trained in mind map preparation using a topic unrelated to the study intervention. Students in the mind mapping group studied the assigned topic by preparing mind maps, while students in the traditional learning group used their usual study methods. Immediate and delayed post-tests were conducted, with the delayed test performed one month after the intervention. In Phase 2, crossover was performed using the topic "Physiology of EEG and Clinical Relevance", and the same process was repeated. At the end of the study, students' perceptions were assessed using a structured five-point Likert scale questionnaire. Data were analyzed using IBM SPSS Statistics for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois, United States), and a p-value of ≤0.05 was considered statistically significant. Immediate assessment scores did not differ significantly between the mind mapping and traditional learning groups in either phase or in the combined analysis. In the delayed assessment for Phase 2, the mind mapping group scored significantly higher than the traditional learning group. The combined delayed assessment analysis also showed significantly higher scores in the mind mapping group compared with the traditional learning group, with 100 observations in each group (6.97±1.97 vs. 6.30±2.28; p=0.029; Cohen's d=0.313). Student perception was favorable, with most students reporting that mind mapping improved understanding, organization of concepts, engagement, confidence, active participation, and independent learning. These findings suggest that mind mapping was well accepted by students as a self-directed learning strategy and may contribute positively to independent learning, engagement, and the overall learning experience in undergraduate medical education. Mind mapping did not significantly improve immediate assessment performance compared with traditional learning; however, it was associated with better delayed assessment scores, suggesting a potential benefit in long-term retention. Students perceived mind mapping as an engaging and useful self-directed learning tool. Mind mapping may be incorporated as an adjunct to traditional teaching-learning methods in undergraduate medical education.
Adherence to the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND) diet, which emphasizes fruit and vegetables and thereby carotenoid intake, is associated with better cognitive health in older adults. However, as neurodegeneration is thought to progress over decades, adopting such a dietary pattern in young adulthood may help prevent its initiation and progression. The aim of this study was to determine whether scores on the MIND diet screener predict skin carotenoid scores in college students, as a measure of construct validity. Participants completed a modified 14-item MIND diet screener and an item on weekly egg intake. Skin carotenoids were assessed using pressure-mediated reflective spectroscopy by Veggie Meter, and the data were analyzed using Pearson correlations. Participants (n = 293; 62.5% female; 20.0 ± 2.0 years) scored 8.3 ± 2.1 on the screener, indicating suboptimal adherence to the MIND dietary pattern, and skin carotenoid scores averaged 305 ± 90. MIND diet screener score predicted skin carotenoid score (r = 0.327; CI 0.220-0.425; P < .001), strengthened by adding the egg intake item (r = 0.353; CI 0.249-0.450; P < .001), and was highest in those consuming ≥7 eggs/wk (r = 0.50). Two dietary patterns emerged from clustering analysis, differentiated by intakes of leafy greens, other vegetables, berries, beans, and nuts. In conclusion, the MIND diet screener score predicts skin carotenoid content in young adults, supporting the tool's validity; however, frequent egg intake strongly moderated the relationship. Egg intake should be considered when interpreting skin carotenoid scores and included in future iterations of the MIND diet screener.
Aging is associated with widespread deficits in theory of mind - the ability to infer others' mental and emotional states. Theory of mind is a complex construct, but age deficits are generally measured in a single domain, overlooking how older adults engage multiple theory of mind processes concurrently and spontaneously. The current work used neuroimaging to characterize the neural mechanisms associated with older adults' deficits in concurrent theory of mind judgments (awkwardness, deception) during a movie-watching task. 102 older adults (MAge = 73.5, SD = 6.6) and 110 young adults (MAge = 21.75, SD = 4.2) passively viewed a mockumentary television show while undergoing functional magnetic resonance imaging. Continuous ratings of awkwardness and deception were collected from an independent sample of young and older adults and used as parametric regressors. Across both judgment types, young adults had stronger activation in the dorsomedial prefrontal cortex, a region broadly implicated in theory of mind. Moreover, higher activation in the dorsomedial prefrontal cortex in response to deception and awkwardness was associated with older adults' higher theory of mind performance on an unrelated task. The brain activity involved in decoding concurrent mental states may provide unique insight into older adults' theory of mind deficits.
Achieving a complete understanding of our internal thought processes requires us to understand the behavioral and neural distinctions underpinning controlled thoughts (stimulus-independent control) and spontaneous thoughts (mind-wandering). One unexplored question is whether thought content differs with differing levels of thought control. We had participants perform a task known to elicit high levels of mind-wandering. Throughout the task, we asked participants to report the content of their thoughts in their own words and identify whether their thoughts were externally or self-generated and whether their thoughts were under their control. Task-unrelated thought content was more heterogeneous within participants compared to other thought categories. Self-generated spontaneous thoughts were less similar than self-generated controlled thoughts, even when analyses were restricted to task-unrelated thoughts. Examination of thought content using sentence embeddings found thought content naturally clustered based on thought category. Finally, we found the number of task-unrelated self-generated spontaneous trials, but not controlled trials, correlated with mind-wandering survey measures. Overall, we find evidence for a meaningful distinction between stimulus-independent controlled thought and spontaneous mind-wandering based on thought content.
Although clinical practice guidelines (CPG) emphasize several trauma-focused therapies for posttraumatic stress disorder (PTSD) as effective, many persons with PTSD do not experience full recovery, particularly among military and Veteran populations, leading to some individuals being labelled as having treatment-resistant PTSD (TR-PTSD). Recent advancements in neuroscience have enhanced the understanding of PTSD as a disorder driven by dynamic brain networks that contribute to core PTSD symptomatology, dissociation, moral injury, and systemic symptoms, thus highlighting the need for neuroscientifically informed interventions that address PTSD as it is expressed mentally, bodily, and neurally. This report reviews emerging PTSD interventions guided by neuroscientific advancements, specifically deep brain reorienting (DBR), virtual reality integrative therapy (VRIT), neurofeedback (NFB), and non-invasive brain stimulation (NIBS), as means to augment interventions recommended in CPG. Each of DBR, VRIT, NFB, and NIBS show promise as neuroscience-informed therapies to augment outcomes of psychotherapies recommended in CPG by directly targeting some of the mind-body-brain mechanisms underlying PTSD symptoms. The concept of TR-PTSD should be re-evaluated in light of new therapeutic approaches. Consistent with professional practice guidelines, neuroscientifically informed interventions such as DBR, VRIT, NFB, and NIBS offer a path toward more effective, individualized treatment by augmenting outcomes associated with CPG for PTSD by modulating mind-body-brain connections. Posttraumatic stress disorder (PTSD) is one of the most common mental health diagnoses among military personnel and Veterans. Over the years, many different treatments have been attempted, primarily psychotherapy and medications. Despite several evidence-based treatments being recognized in clinical practice guidelines (CPG), researchers find that most Veterans continue to suffer from PTSD symptoms after receiving these treatments and may thus be considered as having treatment-resistant PTSD (TR-PTSD). A compounding challenge is the lack of a universally recognized definition of TR-PTSD. Thus, the search for newer, safer, and more effective treatments is ongoing and essential. In this article, the authors highlight four new and promising therapeutic approaches to this often difficult-to-treat illness. The common thread linking these approaches includes leveraging the several decades of studying the PTSD brain. Now more than ever, researchers understand the brain changes that occur in PTSD and can target specific brain regions/networks or abnormalities with personalized treatments. Deep brain reorienting (DBR), virtual reality integrative therapy (VRIT), neurofeedback (NFB), and non-invasive brain stimulation (NIBS) are described as examples of novel, neuroscientifically informed, and promising treatments. These treatments may benefit those who have been classified as having TR-PTSD, augmenting outcomes associated with therapies recommended by CPG. Alternatively, they may be described as better matching treatments given the individual presenting problems. Même si les directives cliniques soulignent l’efficacité de plusieurs traitements axés sur les traumatismes pour traiter le trouble de stress post-traumatique (TSPT), de nombreuses personnes ayant un TSPT ne se rétablissent pas complètement, particulièrement dans les populations de militaires et de vétéran.e.s, si bien que certaines personnes sont qualifiées de résistantes au traitement (TSPT-RT). Grâce aux récents progrès en neurosciences, on comprend mieux que le TSPT est mû par les réseaux cérébraux dynamiques qui contribuent à la symptomatologie de base des TSPT, à la dissociation, aux blessures morales et aux symptômes systémiques et font ressortir l’importance de privilégier des interventions respectueuses des neurosciences qui abordent les expressions mentales, corporelles et neuronales du TSPT. Ce rapport passe en revue les interventions de TSPT émergentes orientées par les progrès neuroscientifiques, notamment la stimulation cérébrale profonde (SCP), la thérapie intégrative par réalité virtuelle (TIRV), la neurothérapie (NT) et la stimulation cérébrale non invasive (SCNI), en vue d’améliorer les interventions recommandées dans les directives cliniques. La SCP, la TIRV, la NT et la SCNI sont toutes prometteuses comme traitements respectueux des neurosciences visant à améliorer les résultats cliniques des psychothérapies recommandées dans les directives cliniques, car elles ciblent directement certains des mécanismes de l’esprit, du corps et du cerveau sous-jacents aux symptômes de TSPT. Le concept de TSPT-RT devrait être réévalué en fonction des nouvelles approches thérapeutiques. Conformément aux directives professionnelles, des interventions éclairées par les neurosciences, comme la SCP, la TIRV, la NT et la SCNI, procurent un parcours vers un traitement personnalisé plus efficace qui améliore les résultats cliniques associés aux directives cliniques sur le TSPT grâce à la modulation des liens entre l’esprit, le corps et le cerveau.
Comparative evidence on the effects of different mind-body exercises (MBEs) for psychological outcomes in breast cancer patients remains limited. This study aimed to compare the effects of Yoga, Tai Chi, Qigong, Pilates, and Dance on quality of life, anxiety, and depression in breast cancer patients. PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 31, 2026. Pairwise meta-analyses were performed using random-effects models with Hedges' g. Bayesian network meta-analyses were conducted to estimate standardized mean differences (SMDs) with 95% credible intervals (CrIs). Ranking probabilities were summarized using SUCRA values. Risk of bias and evidence certainty were assessed using the RoB 2 tool and GRADE framework, respectively. Fifty-five RCTs involving 3,770 participants were included. Network meta-analysis showed that Qigong, Dance, and Yoga significantly improved quality of life compared with control, with Qigong showing the highest ranking probability (SUCRA 83.9%). For anxiety, Dance was significantly superior to control and showed the highest ranking probability (SUCRA 90.6%). For depression, Yoga was significantly superior to control and ranked highest, closely followed by Tai Chi (SUCRA 64.3% and 64.1%, respectively). No significant differences were detected between active interventions. Exercise frequency and total dose appeared to be consistent moderators across outcomes. Overall, 55% of included trials were judged to be at high risk of bias, and the certainty of evidence was low to very low. Mind-body exercises may improve quality of life, anxiety, and depression in breast cancer patients. However, because no significant differences were found between active interventions and the certainty of evidence was low to very low, SUCRA rankings should be interpreted as exploratory and hypothesis-generating rather than as evidence of definitive superiority. Higher exercise dose may be associated with greater improvements. Future high-quality head-to-head RCTs are needed to strengthen the evidence base. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335679, Identifier: CRD420261335679.
The analytic mind is a way of thinking that includes understanding the effects of the unconscious on behavior, relationships and decisions expressed in myriad ways. A supervisor and supervisee reflect upon the development of their psychoanalytic minds through their own experiences of training and supervision. The two do not have the same experiences and goals even in the same supervision. A supervisor aims to impart analytic thinking and practice; a supervisee strives to become an analyst. Their goals are achieved within a supervisory relationship holding an optimal tension-the supervisor balances between teacher and analyst and the supervisee between support and autonomy. The learning relationship with its overlapping goals contains convergence (support and scaffolding) and divergence (differing thoughts about what helps a person learn).
Tobacco use disorder (TUD) remains a leading cause of preventable morbidity and mortality worldwide. Although nicotine replacement therapy (NRT) is recommended as a first-line treatment, its effectiveness is limited by persistent craving and withdrawal symptoms, resulting in high relapse rates. Acupuncture has been investigated as an adjunctive therapy; however, existing evidence is inconsistent and limited by methodological heterogeneity. High-quality pragmatic randomized controlled trials are needed. The co-primary outcomes are nicotine craving reduction (VAS) and biochemically verified 7-day point prevalence abstinence (PPA). This is a single-center, pragmatic, randomized, parallel-group controlled trial. A total of 220 participants with TUD will be randomly assigned (1,1) to receive either harmonizing mind acupuncture (HMA) plus NRT or NRT alone. The intervention period will last 6 weeks, with follow-up to 24 weeks. The co-primary outcomes are: (1) the change in nicotine craving measured by a visual analog scale (VAS) from baseline to week 6; and (2) 7-day point prevalence abstinence (PPA) biochemically verified by exhaled carbon monoxide at week 6. Secondary outcomes include exhaled carbon monoxide (as a continuous measure), quality of life, sleep quality, depressive symptoms, anxiety symptoms, and safety outcomes. Analyses will be conducted according to the intention-to-treat principle. This pragmatic randomized controlled trial will evaluate the effectiveness and safety of HMA as an adjunct to NRT under real-world clinical conditions and provide clinically relevant evidence to inform integrative treatment strategies for TUD. Ethical approval has been obtained from the Ethics Committee of the Affiliated Hospital of Yunnan University (Approval No.: KJR#20251111-R1-055). The study will be conducted in accordance with the Declaration of Helsinki. Written informed consent will be obtained from all participants prior to enrollment. This trial has been registered with the International Traditional Medicine Clinical Trial Registry (ITMCTR) under registration number: ITMCTR2026000683 (https://itmctr.ccebtcm.org.cn/).
Active Mind Active Body (AMAB) is a novel student-led program designed to lessen cognitive and physical isolation in hospitalized patients by facilitating social and physical activities. It offers preclinical undergraduate medical students (UMS), who often have limited clinical exposure, structured encounters while engaging patients socially, cognitively and physically. The aim of this study was to evaluate AMAB patient encounters and assess the experience of participating UMS. Using convergent mixed methods, data were collected from the following sources: anonymized patient encounter records quantifying participating patients and types of activities, a postshift volunteer feedback form and a program evaluation survey. Data were analyzed using descriptive statistics and thematic analysis. A total of 424 encounters with 220 patients were completed from July 2021 to August 2023. Nearly all (98%) encounters included socialization, and many included cognitive activities (27%) or physical activity (22%). Thirty-four UMS (56%, 34/61) completed the study survey. Most UMS perceived AMAB as valuable for patients (94%) and meaningful for UMS (88%). UMS (67%) reported exposure to different medical specialties and (74%) felt their involvement would impact how they engage with patients. UMS indicated improvement in communication skills, interprofessional collaboration and relationship building. Opportunities for program improvement included diversifying activities and implementing peer-to-peer mentoring. The AMAB program provides impactful clinical education for UMS in communication and interprofessional collaboration. UMS also reported perceived benefit on patient mobility and social connectedness. This offers a replicable and low-cost model that can be adapted to other medical education programs.
This paper gives a roadmap for filling in a new integrated worldview, from physics to emergent phenomena, presented at Werbos (2010). That worldview starts from the assumption that the cosmos we live in is a dynamical system, which obeys what I call Hard Core Einsteinian realism (HCER), which can be approximated very well in our level of life by quantum electrodynamics as formulated by Everett, Wheeler and Deutsch (EWD) (Deutsch, 1997). In principle all of the patterns which emerge in such a cosmos are fully, precisely specified by knowing the equilibrium probability distribution (equivalent to the entropy function) for that dynamical system. These functions are known precisely for a wide class of EWD and HCER theories. Thus the understanding of life, mind and other emergent phenomena in our cosmos is equivalent to knowing the parameters of the underlying dynamical law (e.g., H, for the case of EWD), and knowing useful ways to approximate what that probability function looks like. As an example, present theories of Darwinian evolution are basically just crude approximation systems for specific types pof state or pattern or object which we usually call "life."
Pragmatic competence is crucial for effective social interaction and well-being, and yet it tends to decline with age. While most research has focused on basic linguistic skills, the multimodal nature of communication and the cognitive processes that support it have often been overlooked. The present study aims to address these gaps by assessing pragmatic-communicative ability in aging - including linguistic, extralinguistic, and paralinguistic expressive means - and examining the cognitive mechanisms underlying this decline, in particular Executive Functions (EFs), Theory of Mind (ToM), and Cognitive Reserve (CR). We analyzed communicative-pragmatic ability in 84 healthy adults in three age groups (20-40, 65-75, 76-86 years) using the Assessment Battery for Communication (ABaCo). A comprehensive neuropsychological battery enabled the assessment of basic cognitive functions, EFs, ToM, and CR. The results show that older adults demonstrate lower performance in both pragmatic and cognitive domains. EFs emerged as predictors of communicative-pragmatic competence, while ToM appeared to play a less important role. Noteworthy, CR, particularly as reflected in educational background, attenuated age-related decline in pragmatic ability. This study extends our understanding of the cognitive factors contributing to pragmatic decline, as well as protective mechanisms involved. It also emphasizes the need for targeted cognitive and communicative interventions to promote effective communication in older adults.
Human behavior is frequently constrained by the behavior of other agents (increasingly artificial agents like machines and software). In a cooperative setting, each individual needs to understand the partners' intentions and corresponding actions to plan their actions adequately. Misunderstandings have adverse effects and diminish the efficiency of cooperation. We created a game-based experiment to study the effects of understanding a partner's actions in a cooperative setting. In this game, the players depend on each other's ability to make good decisions to succeed. In two studies (N = 87, N = 281), we collected data on the understanding of an artificial agent, operationalized as the ability to predict its actions and the skill at the task itself. The participants improve at predicting the agent's actions and at their subtasks in the game over time. Following an incorrect prediction, the participants' performance on their subtask was worse, as measured by the' quality, speed, and efficiency of their actions. Results of Study 2 suggest that the improvements in predicting the agent's actions are likely the result of an improved understanding of the game rather than an improved understanding of the agent.
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Mild cognitive impairment (MCI) represents an intermediate stage between normal aging and dementia and is associated with an increased risk of progression to dementia. Exercise is a promising non-pharmacological intervention for cognitive decline; however, the comparative effectiveness of different exercise modalities across cognitive domains remains unclear. This study aimed to compare the effects of different exercise modalities on domain-specific cognitive outcomes in patients with MCI and to identify optimal exercise prescription characteristics for the most effective intervention. This systematic review and network meta-analysis followed PRISMA guidelines and was preregistered in PROSPERO (CRD420251152983). Randomized controlled trials investigating exercise interventions in individuals with MCI were identified through database searches. Exercise modalities included aerobic exercise, resistance exercise, mind-body exercise, dance exercise, combined aerobic and resistance exercise, and multicomponent exercise, with passive and active controls as comparators. Standardized mean differences (SMDs) were calculated using change-from-baseline scores. A frequentist random-effects network meta-analysis was performed using Stata 17. Prespecified subgroup analyses examined exercise prescription characteristics for multicomponent exercise. A total of 55 randomized controlled trials involving 4,603 participants were included. Network meta-analysis demonstrated that all exercise modalities were more effective than passive control in improving global cognitive function, with multicomponent exercise ranking highest (SUCRA = 83.3%). For memory-related outcomes, resistance exercise, mind-body exercise, dance exercise, and multicomponent exercise were superior to passive control, with mind-body exercise ranking highest (SUCRA = 83.9%). For executive-function-related outcomes, aerobic exercise, resistance exercise, dance exercise, combined aerobic and resistance exercise, and multicomponent exercise showed significant benefits compared with passive control, and resistance exercise ranked highest (SUCRA = 73.7%). Subgroup analyses indicated that moderate-intensity multicomponent exercise performed at least five times per week was associated with greater improvements in global cognitive function. Interventions lasting 13-24 weeks showed the largest effect estimates, although intervention period was not a statistically significant moderator. Different exercise modalities exhibit domain-specific cognitive benefits in individuals with MCI. Multicomponent exercise appears most effective for improving global cognitive function, mind-body exercise may preferentially benefit memory-related outcomes, and resistance exercise may provide greater benefits for executive-function-related outcomes. These findings support individualized selection of exercise modalities for individuals with MCI. https://www.crd.york.ac.uk/PROSPERO/view/CRD420251152983, Identifier: CRD420251152983.
This study aims to assess the dose-response relationship between different exercise modalities and sleep quality in breast cancer survivors who have completed their primary treatment, and to propose evidence-based exercise prescriptions for clinical practice. Bayesian network and dose-response meta-analyses using a random-effects model were conducted to evaluate the impact of exercise on sleep quality in breast cancer survivors. Exercise dose was calculated as the product of duration, frequency, and intensity, expressed in metabolic equivalent of task minutes per week (METs-min/week), for comparison across studies. A total of 24 studies involving 1495 patients were included. An inverted U-shaped, nonlinear dose-response relationship between exercise and sleep quality was observed, with an effective dose range of 0 to 1100 METs-min/week and maximum effect at 780 METs-min/week (standardized mean differences = 0.7, 95% CrI: 0.38, 1.06). Stratified by modality, aerobic exercise, combined aerobic-resistance training, and mind-body exercise all showed significant associations with improved sleep quality. The comprehensive ranking indicated that 500 METs-min/week of mind-body exercise (standardized mean differences = 1.06, 95% CrI: 0.3, 1.83) may be the most effective modality and dose for enhancing sleep quality. Based on the results of the dose-response network meta-analysis, we developed 9 exercise prescriptions to effectively improve sleep quality in individuals with breast cancer. Mind-body exercise may provide the most significant benefits, while aerobic and combined aerobic-resistance training are supported by more robust evidence due to larger sample sizes. However, the evidence supporting these exercise modalities is of low evidence, highlighting the need for further high-quality studies to validate the recommended doses.
A growing number of women in the United States are cancer survivors. Behavioral and lifestyle factors are important components of health during and after cancer treatment and are modifiable with sustained behavior change. In this review, we summarize published evidence on the associations of the American College of Lifestyle Medicine's 6 lifestyle pillars-nutrition, physical activity, stress management, avoidance of risky substances, restorative sleep, and social connection-with survival and cancer recurrence among female cancer survivors and on the effects of interventions to modify each pillar in this population. We found that most of the 6 pillars have been associated with mortality and recurrence in large observational studies. Physical activity interventions have been associated with the broadest range of health benefits among female cancer survivors, including improved quality of life, cardiorespiratory fitness, physical functioning, mental health, sleep, and survival. Cognitive behavioral therapy and mindfulness-based relaxation, including mind-body exercises such as yoga, have also consistently shown efficacy for improving sleep and mental health. More work is needed to identify effective interventions for diet, alcohol and tobacco use, and social support and for improving maintenance of lifestyle changes. Implications for integrating behavioral and lifestyle medicine into clinical oncology are discussed.
Visit-to-visit blood pressure variability (BPV) may be associated with cognitive decline beyond mean blood pressure (BP), but its relevance across treatment contexts remains uncertain. We pooled individual-participant data from Action to Control Cardiovascular Risk in Diabetes Memory in Diabetes (ACCORD-MIND) and Systolic Blood Pressure Intervention Trial Memory and Cognition in Decreased Hypertension (SPRINT-MIND) (n = 11,104). Participants had baseline and follow-up cognitive testing and ≥3 BP measurements from 3 months onwards. The primary exposure was systolic BP variation independent of the mean (SBP-VIM). The primary outcome was annualized change in standardized Digit Symbol Substitution or Coding Test Z-scores. Each 10% increment in SBP-VIM was independently associated with faster annual cognitive decline (β = -0.008 per year; 95% confidence interval [CI]: -0.014 to -0.003) after adjustment including mean SBP. Associations were observed in the intensive but not standard BP treatment arms of both trials, although the pooled interaction was not statistically significant (p = 0.054). Higher systolic BPV was associated with accelerated cognitive decline independently of mean BP. The exploratory treatment-context pattern warrants prospective confirmation.
Work-related stress has adverse effects on individuals and healthcare organizations. Probiotics, live microorganisms such as Lactobacillus species, have shown promise in improving gut health and potentially enhancing cognitive and emotional responses to stress. However, their efficacy on occupational stress remains limited. The purpose of this pilot study was to examine the feasibility, acceptability, and efficacy of probiotics in modulating physiological and psychological stress responses among nurses. One-arm, open-label, pretest-posttest design was used. Participants were nurses exhibiting moderate to high levels of stress and received a 12-week supply of commercially available oral probiotics. Data collection encompassed hair, blood, and survey assessments of self-reported stress, burnout, and sleep quality. Demographic information, work environment characteristics, and participant experiences with probiotics were also gathered. A total of 27 nurses participated. Among those completing the study (n = 15), physical stress symptoms, perceived stress, and burnout significantly decreased, while sleep quality improved. Serum levels of Interleukin-13, Interleukin-1, Interferon-ϒ, and tumor necrosis factor-α significantly decreased while other biomarkers showed no changes. Probiotics acceptability was high. Reasons for discontinuing probiotics included gastrointestinal side effects and emotional disturbances. Findings highlight probiotics as a promising adjunct for managing chronic stress and inflammation, supporting the mind-body connection and the role of dietary supplements in promoting nurse well-being. As an increasing number of people are turning to alternative therapies to help manage their stress, it is important to examine the role of probiotics in moderating the detrimental health effects of chronic work stress.
The rapid expansion of telehealth, which was accelerated by the COVID-19 pandemic, has outpaced standardized approaches to data capture, resulting in fragmented documentation and limited research infrastructure. A centralized telehealth taxonomy would be useful for improving documentation, evaluating utilization, and informing decision-making. However, no comprehensive telehealth taxonomy has been developed to date. A scoping literature review was conducted to identify the characteristics needed to build a comprehensive telehealth taxonomy that informs a data repository. Then, a hybrid hierarchical mind map taxonomy was built using the frameworks and concepts from the reviewed articles, along with insight and feedback from eight telehealth domain experts. The taxonomy was revised using an iterative process, and the final version was approved by the domain experts. Ten articles were ultimately included in this scoping review. Based on the findings of those articles, the final taxonomy includes 14 core variables that span the full telehealth appointment, including previsit preparation, during-visit interactions, and postvisit follow-up. The variables are arranged across both patient and provider perspectives. The taxonomy includes four dimensions: synchronous and asynchronous modalities, user perspectives, functionality, and payment considerations. Furthermore, the taxonomy aligns with electronic health record data fields, thus promoting interoperability and structured data capture. The unified framework developed herein aims to bridge gaps in telehealth research by providing a scalable, interoperable foundation for data repositories. Ultimately, this taxonomy lays the groundwork for improved telehealth data infrastructure and can enhance research, clinical care, and data-informed policy development.
Impaired balance is a common and debilitating sequela among stroke survivors. Tai chi (TC), a traditional mind-body exercise, has emerged as a promising rehabilitative intervention. This meta-analysis aimed to quantitatively evaluate the effects of TC on balance function in post-stroke patients. A systematic literature search was conducted across eight electronic databases (PubMed, Embase, Web of Science, Cochrane Library, CNKI, SinoMed, VIP, and Wanfang Data) from their inception until May 13, 2025, to identify relevant randomized controlled trials (RCTs). Eligible studies compared TC (as an adjunct or standalone therapy) with conventional rehabilitation therapy (CRT) in stroke patients, using balance-related outcomes as endpoints. Methodological quality was assessed using the Cochrane Risk of Bias tool. Statistical synthesis was performed using RevMan software (version 5.4). Twenty RCTs involving 1296 participants were included. The pooled results demonstrated that, compared to CRT alone, the integration of TC with CRT led to significantly greater improvements across multiple balance measures: the Berg Balance Scale (mean difference [MD] = 6.17, 95% confidence interval [CI]: 5.19 to 7.15), the Fugl-Meyer Assessment scale (MD = 7.18, 95% CI: 4.14 to 10.23), the Timed Up-and-Go test (MD = -2.03, 95% CI: -3.65 to -0.41), the Functional Reach Test (MD = 2.81, 95% CI: 0.29 to 5.33), the Modified Fall Efficacy Scale (MD = 8.70, 95% CI: 4.36 to 13.04), and the Fall Risk Index (MD = -0.78, 95% CI: -1.22 to -0.34). Current evidence suggests a beneficial effect of integrating TC with CRT for improving balance after stroke. However, due to methodological limitations and the overall quality of the included trials, these findings should be interpreted with caution. More rigorous and well-designed studies are needed before definitive clinical recommendations can be established.