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Trauma exposure can lead to posttraumatic stress disorder (PTSD) in a subset of vulnerable individuals. Circadian rhythm disturbances have emerged as a candidate pathway of vulnerability, yet mean circadian levels often show limited discriminability. We tested whether circadian instability at trauma aftermath prospectively predicts long-term PTSD risk, and what behavioral and physiological indices are most predictive. For that, 211 survivors of the Supernova music festival mass-trauma event and 113 matched comparison participants were monitored in real-world settings for one-month, two-to-six months post-event, using wearable sensors that tracked their heart rate (HR), activity, and sleep-wake cycles. PTSD symptoms were assessed before and after the recording period, as well as at follow-up eight-to-eleven months post-event. Linear regression models compared circadian metrics between trauma survivors and comparison participants, and tested associations between circadian measures two-to-six months post-event and PTSD status and severity at follow-up. Results revealed that trauma survivors exhibited reduced circadian stability relative to comparison participants, characterized by greater sleep interday instability and higher variability in daily HR acrophase, as well as elevated rhythm-adjusted mean HR (MESOR). Further, circadian instability at two-to-six months post-event was particularly elevated among survivors with PTSD at follow-up and predicted their symptom severity. Finally, hierarchical models highlighted sleep instability at trauma aftermath as the most significant circadian predictor of long-term PTSD risk, above and beyond initial PTSD severity. Together, specific behavioral and physiological metrics of circadian instability at trauma aftermath prospectively index PTSD risk, highlighting circadian regulation as a target for vulnerability monitoring and early intervention.

The death of a loved one invariably triggers a complex constellation of profound emotional, psychological, and physical grief reactions. While theoretical frameworks for understanding the grieving process are well-established, the advent of assisted dying presents a novel and under-examined context for grief and bereavement. Thus, this study sought to generate a theory explaining the grieving process of family members involved in assisted dying. A grounded formal theory approach was employed. Extensive systematic searches were undertaken across various four databases for eligible qualitative studies. Constant comparison was employed to iteratively refine emerging codes and categories. Fifteen (15) qualitative studies were retained. Reconciling, emerged as central to conceptualising the grieving process associated with assisted dying reflecting four interconnected categories: navigating ambivalence, anticipating, transitioning, and navigating the aftermath. This process is characterised as a complex, iterative, and often non-linear proactive journey of meaning-making, through which families strive to integrate the profound dichotomies. Reconciling, as a mid-range theory, extends existing grief models by demonstrating that bereavement in assisted dying involves a proactive, ethically charged negotiation of autonomy, suffering, and relational responsibility; dimensions not accounted for in stage-based or oscillation models. The grieving process in assisted dying is best understood as Reconciling, a dynamic, iterative negotiation of autonomy, suffering, love, and loss. Families move through ambivalence, anticipation, transition, and aftermath in ways that blend emotional complexity with profound meaning-making. This theory offers a transferable framework to understand and support families navigating this ethically charged form of bereavement.

Healing after attempted intimate partner homicide (IPH) is critical not only for women's psychological recovery but also for their ability to sustain parenting roles and rebuild family life in the aftermath of near-lethal violence. While existing research has examined women's survival of attempted IPH, little attention has been paid to their experiences as mothers and to the ways parenting may shape processes of healing. Drawing on narrative identity as a theoretical framework, this study explored the role of parenting in mothers' meaning-making and recovery following a near-lethal attack. Using interpretative phenomenological analysis methodology, in-depth, semi-structured interviews were conducted with eight mothers who had survived an attempted IPH. Four themes emerged: (1) Parenthood as a Healing Resource, (2) Parenthood as a Victory, (3) Parenting as a Barrier to Healing, and (4) What Does the Future Hold? The findings illuminate the ambivalent role of motherhood in the aftermath of attempted IPH, revealing how parenting can simultaneously foster resilience, purpose, and continuity while also intensifying emotional strain and constraining survivors' healing trajectories. These results point to the importance of trauma-informed, family- and parenting-sensitive interventions that recognize healing as a relational process embedded within ongoing caregiving responsibilities and family contexts.

In the aftermath of trauma exposure, timing of clinical intervention is of crucial importance to prevent progression of disease symptoms. Present treatments sometimes fail to correct the whole range of symptoms, especially in cases of delayed interventions. Various pharmacological agents including steroids, benzodiazepines, selective serotonin reuptake inhibitors and anti-inflammatory drugs have been evaluated in rodent models for their timing-dependent efficacy. This is crucial considering the dynamic evolution of disease symptoms in trauma-aftermath. Thus, while some interventions that counter sympathetic hyperactivity (e.g., propranolol) and correct neuroendocrine function (e.g. glucocorticoids) are effective in the immediate and early phases, anti-inflammatory drugs could be better suited for delayed interventions occurring days to weeks later to combat long-term effects. We synthesized existing evidence of such diverse pharmacological interventions at distinct timepoints across rat and mice acute stress paradigms. We propose an updated concept of a 'sliding' golden window - where treatment strategies can be guided by the temporal evolution of symptoms post-trauma, to maximize drug efficacy. Such a dynamic, time-dependent pharmacological strategy could improve symptomatic outcomes of stress-disorders, with the preclinical body of evidence forming a strong foundational basis for future clinical validation across demographic factors and trauma etiologies.

Adverse posttraumatic neuropsychiatric sequelae are common after trauma. Early identification of individuals at risk for these outcomes could enable the deployment of preventive interventions to survivors at greatest risk. Smartphone keystroke biomarkers show promise in identifying individuals with neuropsychiatric symptoms; however, to our knowledge, no research has examined whether they can be used to identify symptoms in the aftermath of trauma. This study evaluates whether passively collected keystroke data from smartphone use in daily life could identify individuals with high symptom levels, as well as worsening or recovery of symptoms, after trauma exposure. Data from a diverse cohort of individuals presenting to 27 emergency departments after trauma were analyzed. Inclusion criteria were presenting to the emergency department within 72 hours of trauma, age 18-75, and the ability to speak and read English. Exclusion criteria were solid organ injury, significant hemorrhage, operative intervention, or likely admission for over 72 hours. Participants installed an app that passively collected keystroke data during use of any app on their smartphone, beginning in the emergency department. Participants also completed serial symptom assessments over 8 weeks after trauma exposure. A total of 3445 patients met study criteria, provided informed consent, and completed assessments in the emergency department. Of these, 1072 (mean age 40, SD 13; 616/1072, 57.46%, women; 565/1072, 52.71% non-Hispanic Black) installed the app on their Android smartphone and completed the 8-week assessment and were therefore included in analyses. Keystroke biomarkers related to typing speed, identified using bivariate linear mixed models controlling for false discovery rates, were associated with elevated pain, reexperiencing, and mental fatigue (absolute values of rs=0.22-0.25, Ps=.02). Separate change-of-operation and scrolling keystroke biomarkers were associated with increased reexperiencing symptoms (r=0.18, P=.047) and mental fatigue (rs=0.18-0.19, Ps=.031-.047). Further, changes in specific keystroke biomarkers were associated with worsening or recovery of pain (rs=0.07-0.10, Ps=.02), somatic symptoms (rs=0.02, Ps=.02), mental fatigue (rs=0.02-0.04, Ps=.02), sleep disturbance (absolute rs=0.07-0.09, Ps=.02), reexperiencing (rs=0.02-0.04, Ps=.02), and hyperarousal (rs=0.02-0.04, Ps=.02). In general, slower typing and scrolling speeds were associated with higher symptom levels, with small to medium effect sizes. Keystroke data passively collected via smartphone use may help identify individuals with significant or changing posttraumatic symptoms. Future research should continue to explore these keystroke biomarkers and whether they can be leveraged to connect vulnerable trauma survivors to appropriate services. Overall, these results add to the literature, indicating that passively collected keystroke data may help identify individuals with neuropsychiatric symptoms or changes and are, to our knowledge, the first to test whether keystroke biomarkers are useful in the aftermath of trauma. This represents a critical period during which preventive interventions could be deployed to reduce the long-term burden of trauma-related sequelae.

There are notable individual differences in how people manage the lead up to, and aftermath of, stressful events. Trait anxiety has consistently been identified as a key factor contributing to these differences. There is growing consensus that trait anxiety is multidimensional, comprising two distinct dimensions, anxiety reactivity and anxiety perseveration. Yet the cognitive mechanisms driving individual differences in these dimensions remain unclear. The present study investigated the potential role of attentional bias towards information differing in content (situational vs. implicational) and valence (negative vs. positive) in driving these individual differences. Undergraduate university students (N = 93) completed a dual-probe assessment task which presented video clips varying in content and valence. State anxiety was assessed at crucial junctures throughout the experimental session to index anxiety reactivity and perseveration. Results revealed attentional bias for negative implicational information played a significant role in predicting anxiety perseveration. Conversely, attention bias for negative situational information was not a significant predictor of anxiety reactivity. Findings are discussed with reference to limitations and future extensions that could build on these findings to address causality and develop interventions capable of modifying cognitive biases.

Over the years, numerous high-intensity hurricanes have struck Florida, United States of America, resulting in catastrophic damage. This is expected to surge, as climate change causes storms of greater intensity. Damage associated with hurricanes is typically based on destruction of property and loss of life; however, the impact on the mental health of those affected is more challenging to assess. The following case demonstrates a patient who survived a hurricane but emerged from the storm with an exacerbation of previously diagnosed mental health conditions. In the days following a major hurricane strike, a young male in his 20s required inpatient psychiatric hospitalization after reporting a suicide attempt by consuming large amounts of alcohol and cocaine. The patient, who lived on a boat, experienced total loss of housing and personal belongings following the hurricane, a stressor that contributed to significant psychosocial distress and a subsequent suicide attempt. The patient reported previous diagnoses of bipolar disorder and anxiety, for which he was currently being treated with psychotropic medications. At the initial presentation, his affect was flat, and he appeared guarded towards the staff. Adjustments to his psychotropic medication regimen were made throughout his admission. After the third day of admission, he was deemed stable for discharge. This case demonstrates the fragility of mental health in the setting of natural disasters and the complexity of maintaining mental health care in the aftermath. Most studies have focused on the incidence of mental health conditions after storms have caused areas of devastation, rather than on how storms precipitate decompensation in patients with pre-existing mental health illnesses, including substance use. This report explores management options and highlights the need for new policies and resources.

The scene examination, or Phase 1, is the recovery phase of the disaster victim identification (DVI) process, which involves the systematic recording, documentation and retrieval of the bodies of the dead following a mass disaster incident. A wide range of government and non-government organisations and volunteers can be involved in this phase of the DVI process. The need for collaboration between organisations, such as police and defence forces, in managing the aftermath of disasters has been increasingly recognised. Yet it is unclear whether, how, and to what extent practitioners are prepared through joint training and exercises for their roles in scene examination. This paper presents a review of the literature on collaboration across organisations in preparing for disaster incidents. It explores the findings from research and practitioner-oriented literature on the lessons learned from international DVI deployments, training initiatives, and collaborative DVI exercises. It identifies gaps in existing research to inform a research agenda on collaboration in the preparation for disasters among Australian and New Zealand police and defence force personnel.

The binary measurement of intensive care unit (ICU) outcomes of mortality and survival are rapidly being replaced by composite patient-centred outcomes. The aim of this study was to investigate the perspectives of ICU survivors and clinicians regarding institution-free days (IFD) as a composite primary outcome. We used the qualitative design using Framework Analysis as the underpinning methodological orientation to investigate IFD as a composite outcome to report ICU survivorship. Purposive sampling was used to identify and recruit adult participants (aged ≥ 18 years) into ICU clinician and ICU survivor (comprises patients and carers) focus groups. The focus groups were conducted between February 2025 and June 2025 using a semistructured interview guide that explored IFD and survival after critical illness. Data were managed using NVivo 15; trustworthiness was reported using Lincoln and Guba's criteria. Fifteen ICU survivors (Ten patients and five carers) and sixteen ICU clinicians (six medical staff members, five nurses, and five allied health professionals) were recruited for this study. Two in-person ICU survivor focus groups and three online ICU clinician focus groups with 31 interviews were conducted in total. The framework domains identified from the ICU survivor focus groups were as follows: (i) Multidimensionality of survival; (ii) Aftermath of survival and adaptations; (iii) Shared journey through ; and (iv) Measurement of full scope of survival. The framework domains developed from the ICU clinician group were (i) Benchmarking survivorship; (ii) Complexities of survival; (iii) Adaptive and innovative health care; and (iv) Caregiver hardships. Overall, the four overarching common domains that were generated from the data were (i) Multidimensional metric; (ii) Measurement scope (using IFD); (iii) Dynamic life adaptations; and (iv) Caregiver hardships. The collective insights derived from the focus groups underscore the conceptualisation of ICU survivorship in contemporary practice. In this context, IFD can be developed, validated and operationalised as a pragmatic outcome to report ICU survivorship in future clinical trials.

Poor health and unstable housing are closely linked. Most research has focused on how housing shapes health, with little empirical study of whether and how health events can lead to future residential mobility or housing instability. This paper uses high-frequency administrative data on residential location and health among Medicaid enrollees in New York City to test whether adverse health events trigger housing mobility or insecurity, independent of the financial toll of medical bills. Using an event study design, I find that health shocks - or, sudden hospitalizations after two hospital-free years - immediately increase residential mobility (21-35 % relative increase) and the probability of living in shelters or on the street (6-10 % relative increase). These increased rates of mobility and instability persist above expected levels for at least two years. For unplanned or urgent hospital admissions, the impact of health events is even greater. These estimates imply that, in their immediate aftermath, adverse health events could be a tipping point for approximately 80,000 additional moves and 20,000 additional cases of homelessness among the U.S. Medicaid-insured population annually. The effects of health events on residential mobility are smaller for those with subsidized housing, a usual source of outpatient care, higher-quality inpatient care, and social support, suggesting potential areas for policy interventions to break the relationship between health problems and housing outcomes, from both inside and outside of health systems. This work also contributes to our understanding of the long tail of social consequences of adverse health events.

Routine post-operative admission to the intensive care unit (ICU) is often advocated following fenestrated/branched endovascular repair (F/BEVAR) of complex abdominal aortic aneurysms (CAAAs) and thoracoabdominal aortic aneurysms (TAAAs). Given limited ICU resources, identifying pre-operative and intra-operative predictors of major adverse events (MAE) is crucial for optimal resource allocation. Consecutive elective F/BEVAR procedures performed between December 2012 and May 2020 were retrospectively analysed. Patients were divided into three groups based on aneurysm extent: CAAA, type 4 TAAA (TAAA4), and type 1 - 3 TAAA (TAAA1-3). MAE were defined according to current Society for Vascular Surgery reporting standards. The primary endpoint was 30 day MAE. Candidate pre- and intra-operative predictors were entered into a least absolute shrinkage and selection operator (LASSO) penalised logistic regression, followed by an unpenalised post-LASSO refit to report odds ratios (OR). A total of 439 patients (129 CAAAs, 193 TAAA4, and 117 TAAA1-3) with 1 694 target arteries were included; 86% had four or more vessels incorporated. Primary technical success was 96%, mean surgical time was 185 ± 68 minutes. MAE occurred in 10% (n = 43), including 4% mortality (n = 16). Most MAE (75%) occurred within 48 hours. Grade 3 spinal cord ischaemia occurred in 2%, which was higher in patients with TAAA1-3 (4%; p = .023). The 30 day re-intervention rate was 8% (3% stent graft related; 3% access related). In the post-LASSO refit, women (OR 3.59, 95% confidence interval [CI] 1.07 - 10.8; p = .03), unplanned additional procedures (OR 2.62, 95% CI 1.18 - 5.75; p = .02), total fluoroscopy time (OR 1.67, 95% CI 1.20 - 2.29; p = .002), and norepinephrine use (OR 3.23, 95% CI 1.46 - 7.14; p = .003) were independently associated with MAE. Model performance showed an area under the receiver operating characteristic curve of 0.78 (95% CI 0.69 - 0.85). This study suggests that women undergoing complex surgeries with unplanned additional procedures or extended total fluoroscopy time would benefit the most from close monitoring in the immediate aftermath of F/BEVAR to detect MAE. In contrast, men without these features might be candidates for standard monitoring.

Providing access to clean drinking water is a critical challenge in the aftermath of natural disasters. The aim of this study is to conduct a bibliometric analysis of research trends on drinking water provision in disaster-affected areas, identifying strengths and weaknesses in the global research community. This study conducted a bibliometric analysis of research on drinking water supply in disaster-affected areas from 2004 to 2024 using Scopus. A comprehensive search query was employed to include relevant studies, excluding unrelated topics. Data were exported to Excel for analysis, and VOSviewer software was used to create network maps based on co-occurrence relationships, author collaborations, and citation patterns. This study analyzes 709 publications on drinking water supply in disaster-affected areas from 2004 to 2024, sourced from 109 countries and authored by 2804 researchers. The findings indicate a consistent rise in publications, reaching a peak in 2021, with a predominant focus on environmental science, engineering, and social sciences. Peer-reviewed journal articles dominate, followed by conference papers. Prominent authors such as Rosario-Ortiz and Pieper have significantly influenced the field. Research clusters highlight wildfire impacts, water quality management, and treatment systems. Major journals include Water and Journal of Hydrology, with the United States, China, and Australia leading global contributions. This study analyzes research trends in providing drinking water during natural disasters, highlighting a focus on floods and wildfires. It emphasizes the need for more attention to water crises caused by earthquakes and tsunamis, the use of predictive models, smart systems, and international collaborations in future research.

Social media plays an important role in disseminating information and identifying real-time needs during disasters. Its importance was shown on February 6, 2023, when Türkiye was struck by two destructive earthquakes. This resulted in tens of thousands of fatalities and economic devastation. In the early aftermath, social media was utilized as an important instrument for public coordination, information dissemination and social mobilization. The study analyzed 697,313 tweets shared between February 6 and 14, 2023. Data were acquired via the X API v2 and processed to assess the engagement metrics of digitally expressed disaster needs using Python (version 3.12.7). Named Entity Recognition approach was applied to a combined rescue-request corpus to extract and geocode spatial data for heatmap visualization. Most frequent hashtags, types of requests, and patterns of interaction were investigated to examine how individuals communicated and expressed their needs during the earthquake. Findings showed that X contained time-sensitive, publicly generated signals related to rescue appeals, shelter needs, hygiene concerns and humanitarian coordination. During the first 12 hours of the earthquake, communication was primarily characterized by urgent requests for emergency rescue and heavy machinery. By the second day, shelter-related posts became more prominent with blanket and tent related requests. After the fourth day, there was a consistent rise in the posts about hygiene items and mobile toilets. The requests reached a peak between days five and seven. The study highlights the potential value of social media data as a supplementary source for understanding publicly expressed needs during disaster response. X posts reflected a temporary shift from urgent rescue appeals to shelter, hygiene, and recovery-related concerns. However, because this study was descriptive and did not assess post accuracy, operational impact, or predictive performance, the findings should be interpreted as digital indicators of public concern rather than direct evidence of response effectiveness.