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The widespread use of YouTube has raised concerns about its potential for addiction, particularly in Arabic-speaking populations where social media consumption is prevalent. A culturally tailored tool to assess YouTube addiction is essential for effective research and intervention in these communities. This study aimed to translate and validate the 6-item YouTube Addiction Scale (YAS) into Arabic, ensuring its psychometric robustness for assessing YouTube addiction among Arabic-speaking emerging and young adults. A cross-sectional study was conducted with 1,134 Arabic-speaking emerging and young adults from Bahrain, Saudi Arabia, Jordan, and Tunisia recruited through convenience sampling on social media platforms. The YAS was translated via the forward&#x2012;backward&#x2012;forward technique. The psychometric evaluation included confirmatory factor analysis (CFA), item response theory (IRT), reliability analyses (McDonald's &#x3c9;, Cronbach's &#x3b1;, and composite reliability [CR]), and test-retest reliability. Convergent and divergent validity were assessed through correlations with the Insomnia Severity Index (ISI), Modified Yale Food Addiction Scale (mYFAS), Depression Anxiety Stress Scale (DASS-21), and Bergen Social Media Addiction Scale (BSMAS). The Arabic YAS demonstrated a unidimensional structure with adequate factor loadings (0.55-0.73). The model fit indices were excellent (CFI&#x2009;=&#x2009;0.99, TLI&#x2009;=&#x2009;0.98, RMSEA&#x2009;=&#x2009;0.06, &#x3c7;&#xb2;(9)&#x2009;=&#x2009;40.66, p&#x2009;<&#x2009;0.001), with good internal consistency (&#x3c9;&#x2009;=&#x2009;0.81, &#x3b1;&#x2009;=&#x2009;0.80, CR&#x2009;=&#x2009;0.80) and test-retest reliability (ICC&#x2009;=&#x2009;0.87). IRT analysis confirmed item fit (infit/outfit 0.86-1.17) and person reliability (0.78). Significant correlations with the total score of BSMAS (r&#x2009;=&#x2009;0.66), DASS-21 (r&#x2009;=&#x2009;0.40), mYFAS (r&#x2009;=&#x2009;0.32), and ISI (r&#x2009;=&#x2009;0.26) supported validity. Measurement invariance was confirmed across gender and weekly YouTube use. Scalar invariance was also supported across age groups (18-21 vs. 22-25 years). The Arabic YAS is a psychometrically sound tool for assessing problematic YouTube use among Arabic-speaking emerging and young adults, enabling researchers and clinicians to screen for elevated risk in this high-engagement developmental stage. Further studies should examine age-related differences within and beyond emerging adulthood, as well as longitudinal patterns of use and associated outcomes in this population.

Transcranial direct current stimulation (tDCS) is a promising intervention for treatment-resistant obsessive-compulsive disorder (OCD), yet clinical outcomes remain inconsistent. To investigate the neural mechanisms underlying therapeutic variability, we conducted a patient-specific finite element (FE) modeling study of electric fields (EF) induced by tDCS in OCD patients. Forty-two patients from a double-blind, randomized clinical trial received active tDCS with the cathode over the pre-supplementary motor area and the anode over the right supraorbital region. Clinical response was assessed using the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), and responders were defined as those achieving &#x2265;35% score reduction. Individual head models were created using SimNIBS, and current density directionality (Jn) and magnitude (Jmagn) were analyzed. Voxel-wise comparisons revealed significantly greater depolarization (Jn>&#x2009;0) in the left anterior prefrontal cortex (BA10) and right frontal eye field (BA 8) associated with a reduction of Y-BOCS. A link between hyperpolarization of right pars orbitalis (BA47) and improvement in symptoms was also found. Notably, no significant findings emerged using EF magnitude (Jmagn), underscoring the relevance of current directionality in treatment response. To our knowledge, this is the first study to associate directional EF modeling with clinical outcomes in OCD. Our findings highlight the importance of considering both EF direction and anatomical variability when optimizing tDCS protocols. This approach may contribute to more personalized and effective neuromodulation strategies for psychiatric disorders.

&#xa0;Thrombotic thrombocytopenic purpura (TTP) is a life-threatening thrombotic microangiopathy characterized by severe ADAMTS13 deficiency and accumulation of ultralarge von Willebrand factor multimers. Although therapeutic plasma exchange (PEX), corticosteroids, rituximab, and caplacizumab have improved outcomes, refractory and relapsing disease remain important clinical challenges. N-acetylcysteine (NAC) has been explored as an adjunctive therapy because of its ability to reduce disulfide bonds within von Willebrand factor multimers. &#xa0;This systematic review aimed to summarize the published clinical experience with NAC in TTP, including treatment strategies, reported outcomes, and safety. &#xa0;A systematic search of PubMed was performed from database inception until December 31, 2025, using combinations of the terms "thrombotic thrombocytopenic purpura", "TTP", "N-acetylcysteine", and "acetylcysteine". Two reviewers independently screened records, assessed full texts against predefined eligibility criteria, and extracted study-level data. Eligible studies included case reports and case series describing therapeutic NAC use in patients with TTP. The review was conducted in accordance with PRISMA 2020 guidance. The protocol was not prospectively registered. &#xa0;Six publications comprising 22 adult patients were included. NAC was used as adjunctive therapy, predominantly in refractory or relapsing TTP, alongside PEX, corticosteroids, rituximab, and/or other immunosuppressive therapies. Platelet recovery was reported following NAC initiation in the included cases, with concurrent improvement in hemolysis markers and neurologic symptoms described in some reports. No serious NAC-related adverse events were reported in the included cases. Because all evidence was derived from uncontrolled reports with concomitant therapies, the independent contribution of NAC cannot be established. &#xa0;The available case-based literature suggests that NAC is a biologically plausible and generally well-tolerated adjunctive therapy in refractory or relapsing TTP. However, the current evidence remains hypothesis-generating and is insufficient to establish efficacy. Prospective studies are needed to clarify its therapeutic role, optimal dosing, and patient selection.

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The impact of higher ambient temperature on suicide is well documented in the general population, although it remains unclear in youths despite their particular biosocial vulnerability. In an ecological study, the authors examined this relationship, focusing on seasonal differences. The authors calculated monthly suicide rates in young people (ages 5-24) by county using data from the U.S. Centers for Disease Control and Prevention and the U.S. Census Bureau from 1980 to 2004 in the contiguous United States. Fixed-effects regression was used to estimate relative risk of suicide per 1&#xb0;C change in average monthly temperature overall and by season, accounting for precipitation, region, county, month, and year. Age-stratified analysis (ages 4 to 65+) assessed whether effects were unique to young people. Heterogeneity models examined the impacts of legal sex, income, race, education, geographic division, and rurality. Averaged across seasons, suicide in young people increased 0.75% (95% CI=0.34, 1.16) per 1&#xb0;C increase, comparable to the general population (0.73%, 95% CI=0.53, 0.93). This effect was significant only in summer, and it was substantially larger in summer (2.68% per 1&#xb0;C; 95% CI=1.42, 3.94). Age stratification showed that 15- to 24-year-olds were uniquely vulnerable compared to other age groups (2.97% per 1&#xb0;C; 95% CI=1.30, 4.65). Most geographic regions experienced this association, and no sociodemographic differences were identified. Summer heat is associated with higher suicide rates among late adolescents and young adults, who appear most at risk. This association likely reflects neurobiological and socioenvironmental conditions of young people that amplify heat-related mental health risk. These data highlight the need to study how ambient temperature impacts youth mental health and develop biosocially informed interventions as temperatures rise.

Past experiences stored in long-term memory (LTM) provide a valuable resource for making predictions that shape perception and guide goal-directed behavior. Contents from the high-capacity LTM system guide contextual selective attention to enhance sensory and higher-order processing of memory-predicted targets, in a process known as LTM-guided attention. While this essential cognitive function is believed to depend on the hippocampus, evidence is still scarce. In this study, we used a neuropsychological approach to test LTM-guided attention in the context of isolated hippocampal pathology and to explore structure-behavior covariance patterns. We tested healthy individuals (n = 20) and individuals suffering from focal epilepsy, with isolated, unilateral left (n = 20) or right (n = 17) hippocampal sclerosis (HS), in a task probing LTM-guided attention. Behavioral data indicated that individuals with left or right HS retained LTM-guided attention. We also assessed structure-behavior covariance using a multivariate structural neuroimaging approach. Hierarchical clustering analysis revealed that, in healthy individuals, LTM-guided attention performance covaried with atlas-derived subfield measures of the left hippocampal body. The volume of the left hippocampal body also covaried with attentional benefit in individuals with right HS. Interestingly, for individuals with left HS, LTM-guided attention covaried with the volume of the left hippocampus and with part of the right hippocampal volume. Together, these findings suggest that LTM-guided attention can be preserved in unilateral HS, with differences in hippocampal volume-behavior covariance depending on the side of hippocampal pathology.

Tauopathies are neurodegenerative diseases characterized by the presence of hyperphosphorylated tau (p-tau) and neurofibrillary tangles. Autophagy is a critical self-degradation mechanism that preserves cellular homeostasis and function, including the clearance of misfolded proteins. Autophagy is impaired in tauopathies, resulting in excessive accumulation of p-tau. Omipalisib, a dual phosphatidylinositol 3-kinase/mammalian target of rapamycin (PI3K/mTOR) inhibitor, was explored in a phase I clinical trial involving solid tumors and lymphoma. In this study, we aimed to investigate the effects of omipalisib on tauopathy both in vitro and in vivo. Omipalisib increased the levels of protein LC3B and decreased that of p62 in human tau (P301L)-expressing SH-SY5Y stable (SH-Tau) cells by inhibiting mTOR activation in a time-dependent manner. In our study, we hypothesized that omipalisib, a PI3K/mTOR inhibitor, could remove accumulated tau and inhibit memory decline by activating autophagy. Additionally, omipalisib reduced tau phosphorylation in SH-Tau cells without inducing cytotoxicity. Upon administration of 6-month-old PS19 mice with omipalisib (1 mg/kg) for 2 months, the levels of both RIPA-soluble and RIPA-insoluble p-tau were decreased, and spatial memory dysfunction was alleviated in omipalisib-treated PS19 mice. Overall, these results show that omipalisib decreases the expression of p-tau by modulation mTOR-autophagy pathway, resulting in the amelioration of spatial memory deficits. This study highlighted the potential of omipalisib as a candidate treatment for tauopathies.

Recent literature suggests that vicarious racism is linked to adverse psychological health outcomes. However, our understanding of protective and risk factors in this context remains limited. This study examined the relationships among social media use integration, vicarious racism, individual differences (race-based rejection sensitivity and racial centrality), and psychological outcomes (anxiety and depression) in a sample of Black American adults. We hypothesized that higher social media use integration would predict greater anxiety and depression, with vicarious racism accounting for these associations, and that individual differences would moderate these relationships. The sample consisted of 244 Black adults (Mage&#x2009;=&#x2009;30.85, SD&#x2009;=&#x2009;10.83) who reported having a social media account. Participants completed self-report measures assessing experiences of vicarious racism, race-based rejection sensitivity, racial centrality, social media use integration, and symptoms of both anxiety and depression. Results indicated a significant indirect association between social media use integration and psychological distress through vicarious racism, such that greater integration was associated with higher anxiety and depression via increased exposure to these expereiences. Neither race-based rejection nor racial centrality moderated these indirect effects; however, both showed direct effects on mental health, with racial centrality inversely related to anxiety and race-based rejection sensitivity positively related to depression. Findings underscore the psychological risks of digital racial exposure and highlight the role of identity-related factors in shaping mental health outcomes. Implications for interventions addressing online racial stressors are discussed.

To evaluate the relationship between continuous glucose monitoring (CGM)-measured % time <54 mg/dL (%T < 54) and level 2 hypoglycemic events (L2 events; &#x2265;15 min <54 mg/dL) in individuals with type 1 diabetes (T1D). These analyses examined the associations between CGM-measured %T < 54 and L2 events from eight clinical trials over 3-6 months in participants with T1D. Data from 1532 participants with T1D were analyzed (mean age 37 &#xb1; 21 years; 72% adults): 43% using automated insulin delivery (AID), 43% CGM users not using AID (34% multiple daily injections [MDI]; 66% standard pump), and 14% self-monitoring blood glucose (SMBG) users not using CGM (58% MDI; 42% standard pump). There was a strong correlation between %T < 54 and L2 event rate (r = 0.97), but the relationship differed by the average duration of L2 events. For those with 1% T < 54, the predicted L2 event rate per week was 2.4 events for those with short L2 events (average <30 min), 1.9 events for those with medium duration of L2 events (average 30-60 min), and 1.2 events for those with long L2 events (average >60 min). Those meeting hypoglycemic targets (<1% T < 54) had on average 0.6 L2 events per week, irrespective of technology use. Those not meeting targets (&#x2265;1% T < 54) had on average 2.9 L2 events per week, but this differed based on technology use and observed %T < 54. L2 event frequency and %T < 54 are strongly correlated, but the relationship differs by L2 event duration. Therefore, both frequency and duration of L2 events should be reported together. Time-below-range metrics incorporate both aspects and are core CGM endpoints that summarize overall amount of hypoglycemia exposure.

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Cells release heterogeneous extracellular vesicles and particles (EVPs) into circulation, carrying RNA and proteins that reflect their origin. Recently, brain-derived EVs have gained significant attention as non-invasive biomarkers for Alzheimer's disease (AD). Here, we identified sub-50nm extracellular nanoparticles in human brain and blood that lack the hallmarks of small EVs, exosomes, exomeres, and supermeres but are enriched for brain-specific markers, hereafter termed small EPs or 'SECmeres'. We discovered that RNAs associated with SECmeres discriminated AD cases from controls with higher significance than small EVs, large EVs showed no differences. Discriminating RNAs were enriched in small EVs (Synaptotagmin, Alpha-synuclein, MAPT) or SECmeres (L1CAM, Syntaxin, Neurogranin), indicating distinct brain-derived signatures. Single-cell RNAseq deconvolution shows small EVs contain RNAs from diverse brain cells, whereas SECmeres enrich brain endothelial transcripts, lining cerebral blood vessels and forming the blood-brain barrier (BBB). These findings challenge the prevailing view that small EVs are the primary carriers of biomarkers. Collectively, our study shows that blood EVPs carry brain-specific information for liquid biopsy, pending validation in larger blinded clinical trials.

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Membrane order and fluidity influence many biological processes. However, tools to manipulate membranes under physiological conditions have been limited. In the process of high-throughput screening for molecules that shift the phase partitioning between ordered and disordered membrane phases of the tetraspan membrane protein peripheral myelin protein 22 (PMP22), we identified two chemically similar compounds, VU0615562 and VU0619195, that shift PMP22 toward the disordered phase and destabilize the "lipid raft"-like ordered phase. Follow-up experiments showed that this latter activity is, counterintuitively, enhanced by the presence of PMP22, which normally stabilizes the ordered phase. Biophysical studies indicate that these compounds reduce raft stability through a mechanism that involves both direct interactions with proteins and the disruption of lipid packing. We further observed that acute treatment of live cells with VU0619195 modulated membrane fluidity and TRPM8 channel function while both compounds altered KCNQ1 channel activity, providing examples of practical applications for these compounds. These protein-enhanced raft modulators reveal distinct lipid and protein-based forces that destabilize membrane order and may be useful as pharmacological tools for manipulating and probing the biological roles of ordered membrane domains in cells.

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Obesity is associated with risk for chronic health problems and increased mortality. Weight stigma, which entails negative attitudes and behaviors directed at people based solely on their body size, is psychologically harmful and contributes to obesity and obesity-related health problems. Yet, weight stigma is pervasive in society and commonly experienced by patients in healthcare settings, which lowers the quality of patients' healthcare experiences. Healthcare providers and trainees report feeling underprepared to treat obesity, which may lead to overreliance on weight-management strategies that are not evidence-based and are susceptible to weight stigma, such as fad diets emphasizing unrealistic dietary restriction. In the current manuscript, we discuss current weight stigma interventions with other populations and the rationale for integrating training in evidence-based approaches to treat obesity with weight stigma interventions, specifically cognitive dissonance-based interventions. Current learning theories emphasize empathic perspective-taking, and current methods to reduce weight stigma use social-cognitive theories to raise awareness of stereotypes. However, current methods are insufficient because they create discomfort but fail to alter internalized bias nor advise providers on how to deliver non-stigmatizing, evidence-based obesity interventions. Cognitive dissonance theory posits that resolving tension between beliefs and behaviors will change future behaviors. Cognitive dissonance-based interventions have effectively reduced personal weight stigma and are promising to be similarly effective in reducing weight stigma among healthcare providers. In this manuscript, we highlight how cognitive dissonance theory can help improve interventions to reduce bias and support providers' efforts treating obesity.

BATMAN (balloon-assisted translocation of the mitral anterior leaflet) is an increasingly adopted technique to modify the anterior mitral leaflet (AML) and prevent left ventricular outflow tract (LVOT) obstruction during transcatheter mitral valve replacement (TMVR). The aim of this study was to evaluate the feasibility, efficacy, and safety of the BATMAN technique during transseptal TMVR. This was an international, multicenter cohort study of all consecutive patients at high risk for LVOT obstruction undergoing transseptal BATMAN TMVR for valve-in-valve (ViV), valve-in-ring (ViR) and valve-in-mitral annular calcification (ViMAC) at 22 structural heart disease centers in North America and Europe. The primary efficacy endpoint was the rate of successful TMVR free from LVOT obstruction and procedural death. The primary safety endpoint was the in-hospital composite of death, stroke, or major cardiac structural complications. A total of 83 patients were included: 24 undergoing ViV, 39 ViR, and 19 ViMAC procedures. Technical success was achieved in all but 1 case (98.8%) that was converted to tip-to-base LAMPOON (laceration of the anterior mitral leaflet to prevent outflow obstruction). Pre-emptive mechanical cardiocirculatory support was used in 28.9% of cases. The primary efficacy endpoint was met in 95.1% of cases (100% in ViR, 95.8% in ViV, and 84.2% of ViMAC; P = 0.03). The primary safety endpoint occurred in 7.3% of patients and was higher in the ViMAC group (0% in ViR, 8.3% in ViV, and 21.1% in ViMAC; P = 0.02). There was 1 major cardiac structural complication directly attributed to BATMAN in a ViMAC patient. BATMAN was associated with high technical success and effectiveness in preventing LVOT obstruction and appeared to be safe in ViR and ViV procedures. Adverse events were higher in ViMAC.

Individuals who engage in illicit or nonmedical opioid use may have elevated risk of health and social consequences, including progression to opioid use disorder (OUD). Preventive interventions to reduce this risk are lacking. This trial tested the impact of a primary care-integrated collaborative care approach for reducing risky opioid use, defined as nonmedical use of prescription opioids or any use of illicit opioids. Cluster-randomized controlled trial randomized primary care providers (PCPs) and their patients into the Subthreshold Opioid Use Disorder Prevention (STOP) intervention or enhanced usual care (EUC). Primary care clinics at 5&#xa0;U.S. sites. PCPs and their patients were recruited January 2021-May 2023. A total of 119 PCP clusters (STOP&#x2009;=&#x2009;48, EUC&#x2009;=&#x2009;51) and 202 patients (STOP&#x2009;=&#x2009;88, EUC&#x2009;=&#x2009;114) enrolled. Eligible patients were adults (&#x2265;18&#x2009;years) having current risky opioid use, without moderate-severe OUD. Patient participants were majority female (63.4%), white (70.8%) and non-Hispanic (96.5%), with a mean age of 55.7 [standard deviation (SD) = 12.7] years. At baseline, 63.4% of participants had moderate-severe pain (Brief Pain Inventory) and below average physical (79.2%) and mental (62.4%) health (SF-12). The STOP collaborative care intervention consisted of brief advice from the PCP about reducing risky opioid use, meetings with a clinic-embedded nurse care manager over 12&#x2009;months and remote health coaching (2-6 sessions). Both groups received primary care treatment as usual and overdose risk reduction materials. The primary outcome was total days of risky opioid use, recorded from 6 monthly electronic surveys. A key secondary outcome was moderate-severe OUD at 6 and 12&#x2009;months. A total of 77 (87.5%) STOP and 107 (93.9%) EUC participants completed the 6-month assessment period. The primary outcome analysis used the Intention-to-Treat sample with multiple imputations of missing data. Mean days of risky opioid use at 180&#x2009;days were lower in STOP than EUC [12.2 (SD = 27.73) vs. 15.5 (SD = 32.64)]; the difference between groups adjusted for baseline risky opioid use was not statistically significant (rate ratio 0.95, 95% confidence interval = 0.52-1.74). One STOP participant (1.1%) and 13 EUC participants (11.4%) developed moderate-severe OUD at 6&#xa0;months, and 3 (3.4%) STOP and 6 (5.3%) EUC participants had moderate-severe OUD at 12&#x2009;months (P&#x2009;<&#x2009;0.001). This cluster-randomized controlled trial did not find evidence that the STOP intervention for reducing risky opioid use produced greater reductions over 6&#xa0;months compared with enhanced usual care, though fewer intervention participants progressed to moderate-severe opioid use disorder. Patients had a high burden of pain and comorbidities that may present challenges to reducing opioid use.

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The Academy for Women in Academic Emergency Medicine (AWAEM) within the Society for Academic Emergency Medicine was established to advance the recruitment, promotion, retention, and career satisfaction of women in academic emergency medicine (AEM). Despite progress, persistent gender disparities remain in several areas, including compensation, promotion, and leadership representation. To better assess and evaluate current AWAEM programming, we developed a logic model to visually and systematically map AWAEM activities and initiatives with current and future metrics for evaluation. The logic model was guided by AWAEM's strategic plan and developed through an iterative process involving feedback from AWAEM members and leaders. The model outlines key inputs, describes activities categorized across five thematic areas, and identifies tangible outputs with corresponding metrics for those activities. The model concludes with short-, intermediate-, and long-term outcomes that speak to the likely impact of AWAEM's programming. The proposed logic model serves as a practical framework to align AWAEM's efforts to outcomes while also embedding evaluation into ongoing programming. It provides a visual tool for identifying gaps and incorporating data-driven modifications, as well as facilitating collaboration across the academy. While there are limitations to this logic model, it provides an initial roadmap and foundation for strategic planning and evaluation. It also provides an opportunity to periodically revise the model as AWAEM's needs evolve to ensure continued relevance and alignment with the needs of the entire membership. Additionally, this model can serve as a framework for other professional development groups, academies, and societies external to SAEM.