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Camouflaging of autistic traits has gained increasing attention as a psychological construct capturing strategies used to conceal or compensate for autistic characteristics in social contexts. Given the cultural specificity of social behavior, the adaptation and validation of measurement instruments across diverse populations are essential. The present study aimed to culturally adapt and validate the Persian version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and to examine its measurement invariance and group differences between adults with high and low autistic traits in Iran. Following a standardized forward-backward translation procedure and expert panel review, the Persian CAT-Q was administered to 1,100 individuals, of whom 948 (aged 15-50 years) met the inclusion criteria after data screening. Construct validity was examined using confirmatory factor analysis (CFA). Convergent validity was assessed through correlations with the social camouflage subscale of the Comprehensive Autistic Trait Inventory (CATI), and reliability was evaluated using Cronbach's alpha and mean inter-item correlations. CFA supported the original three-factor structure of the CAT-Q (compensation, masking, and assimilation) with acceptable fit indices (Comparative Fit Index [CFI] = 0.91, Root Mean Square Error of Approximation [RMSEA] = 0.06). Measurement invariance testing supported configural, metric, and scalar invariance across high and low autistic traits groups, indicating comparable measurement properties. Convergent validity was confirmed through significant correlations with the social camouflage subscale of the CATI. Internal consistency was strong, with Cronbach's alpha coefficients ranging from .66 to .89 across subscales and .89 for the total scale, although the assimilation subscale showed comparatively lower reliability. The Persian version of the CAT-Q demonstrates satisfactory psychometric properties and measurement equivalence across groups, supporting its use in research contexts within Iran. Findings should be interpreted with attention to cultural context and the relatively lower reliability of the assimilation subscale.Lay AbstractMany autistic people use "camouflaging" to cope in social situations. Camouflaging means trying to hide autistic traits or to compensate for social difficulties so that others will not notice differences. These efforts may help someone blend in, but they can also be tiring and may affect wellbeing. Because social rules and expectations differ across cultures, researchers and clinicians need tools that are carefully adapted for each language and society. This study adapted the Camouflaging Autistic Traits Questionnaire (CAT-Q) into Persian and examined whether it works well for adults in Iran. The questionnaire was translated using a standard forward-backward process, reviewed by specialists for clarity and cultural suitability, and then tested in a large Iranian sample recruited online. We examined whether the Persian CAT-Q keeps the same three parts found in earlier research: (1) compensation (actively managing social situations), (2) masking (hiding autistic traits), and (3) assimilation (trying to fit in by suppressing one's natural style). We also tested whether the questionnaire measures camouflaging in the same way for people with higher versus lower levels of autistic traits, so that comparisons between these groups are fair. Overall, results showed that the Persian CAT-Q is a useful and consistent measure of camouflaging in Iranian adults. The "Assimilation" part was somewhat less consistent than the other parts, so it should be interpreted with extra care. This Persian version can support future research and may help improve understanding of hidden social effort and support needs in Iran.

Anhedonia (loss of pleasure) is a core feature of both depression and psychosis and yet the experience is not well understood. This limits our ability to effectively target it with psychological or pharmacological interventions. The aim of this study was to explore the experience of anhedonia, for the first time from a transdiagnostic perspective. Semi-structured interviews, co-facilitated by lived-experience experts, were conducted among 17 adults with a diagnosis of depression or psychosis and who were experiencing anhedonia. Reflexive thematic analysis was employed to generate themes. Six themes were identified: (a) no longer experiencing pleasure or joy in previously enjoyable activities; (b) grieving for the joyful times that have been missed; (c) the dilemma before trying an activity again; (d) the significant social impact of anhedonia, and the power of lived-experience connections; (e) uncertainty around what causes anhedonia; and (f) the lack of acknowledgement or support from services around this experience. The words disconnection and frustration were those most used to describe what people felt when experiencing anhedonia. The results highlight the negative impact of expectation and social pressure on joy, and the importance of the anticipatory period prior to trying an activity again. The clinical implications highlight the importance of discussing anhedonia with patients: by not doing so is contributing to stigma. This is the first study to directly explore anhedonia in adults, with lived-experience input throughout, and the findings support further work adopting a wider transdiagnostic approach.

Autism spectrum disorder (ASD) diagnosis often encounters substantial delays due to several reasons, such as shortages of trained specialists and limited access to care in rural and underserved communities. Moreover, it is very difficult to perform behavioral assessments within a single clinical visit, as it is significantly dependent on the child's behavior. Delayed diagnosis can postpone early intervention, which is important for improving developmental outcomes in children with ASD. Although artificial intelligence (AI) is increasingly explored in healthcare, its adoption in ASD screening remains limited due to concerns about reliability, governance, consent management, bias, and clinical trust. In this work, we propose a conceptual, governance-driven, clinician-augmented AI framework designed to assist clinicians during the ASD screening process rather than replace them. The proposed architecture collects various inputs such as text, audio, and video of a child from parents, schools, or caregivers, and then it runs through multiple specialized agents who are responsible for consent validation, bias monitoring, model selection, confidence-based abstention, and providing a structured report which will help clinicians in their assessment. Caregivers receive only non-diagnostic guidance, while clinicians receive structured decision-support information designed to aid clinical evaluation. The main goal of this article is not to validate model performance. We are mainly trying to design an agentic framework where governance and safety rules can be managed properly through multiple specialized agents. Although we have performed a single model training using a ResNet-50 facial-image classification model on a publicly available dataset, our main goal was to validate the governance and multi-agent system. The Stage 1 governance validation was done using more than a hundred scenarios. It is very important to highlight that our article should be viewed as a conceptual governance-driven agentic framework with Stage 1 validation, and it is definitely not a fully workable clinical solution. In the next phases, we plan to collect clinically validated data and focus more on model training, multimodal integration, and real-world validation.

Stochastics is a science that studies mathematical models trying to predict how a given phenomenon may evolve over time because of chance. It is necessary to abandon the binary thinking of "it works or it doesn't work" and rely on the logic of probability and randomness, which represent the measures of uncertainty people are destined to confront in their life and health choices. In making decisions shared with the patient, the physician must consider the baseline risk, the risk ratio, the variation in absolute risk, the competing risk within the patient, but also the number of patients needed to treat to determine the benefit (NNT) or harm (NNH) in the "theoretical" patient of clinical research, the "average" patient of guidelines, and the "imagined" patient of administered medicine. The NNT indicates the magnitude of the random benefit in the "real" patient, while the NNH indicates the harm. These two elements can represent the interface between statistical and stochastic medicine for simplified shared decision-making in "real" patients.

The Default Mode Network was a key finding for cognitive neuroscience, but being the result of a data-driven analysis of resting-state fMRI data, its psychological and clinical implications have been difficult to elucidate. This is because in the resting-state paradigm we cannot directly correlate an observable specific task with specific brain connectivity patterns, and therefore inferences about the relationship between particular cognitive domains and the resting-state networks are limited. A similar problem arises when trying to link the network with personality traits: the DMN, as other intrinsic networks, is not a simple metric to compare with the results of a psychological test, but a complex composite of spatio-temporal features. Although over the last two decades several research works have provided insights about these relationships, we still lack a consensus on the methodology that best captures these interactions. In this context, we propose an alternative method to model the psycho-physiological relationships of the resting state components with behavioral data, based on the dimensionality reduction of an extensive psychological evaluation and the spatial dimension of the intrinsic connectivity components. Our results show that the connectivity networks are low to moderately related with behavioral and personality traits, or at least this relation is not in a direct way. This integration of neuroimaging and psychological assessment data creates valuable pathways for cognitive neuroscience, potentially revealing with precision how intrinsic brain network organization relates to individual variations in cognitive functioning and personality dimensions.

To explore the relationship between malocclusion, orthodontic treatment and peer relationships in adolescents. A cross-sectional qualitative study. Three secondary schools in the South-East of the U.K. A total of 14 schoolchildren aged 14-16 years (mean age = 15.7 years; age range = 14.4-16.5 years). In-depth one-to-one semi-structured interviews carried out online. All interviews were transcribed verbatim and analysed thematically according to Braun and Clarke's model of thematic analysis. The central finding of this research was that adolescents are self-conscious of their dental appearance, it impacts on social interactions, and peers and friends are both a source of pressure and support regarding dental appearance and treatment. Two main themes were identified: (1) malocclusion and peer relationships; and (2) social expectations and experience of orthodontic treatment. Participants reported being self-consciousness of their teeth before treatment, and this increased with age. They feared being judged based on their dental appearance, undertaking behaviour to hide their teeth in social situations, in photographs or online. All participants reported either being teased personally about their teeth or witnessing this happening to someone else although they mostly did not see this as bullying. This had a negative impact on self-confidence. No one reported being teased after starting orthodontic treatment. Orthodontic treatment was seen as desirable and normal within this age group, with an expectation it would improve self-confidence, particularly in social settings. Friends and peers were a source of support during treatment. Young people are self-conscious of their dental appearance, which impacts their peer relationships and can make them a target for teasing and bullying. Orthodontic treatment is considered normal, with peers and friends providing support. Study interviewing young people about their experience of having crooked or sticking-out teeth and braces, and how this impacts on friendships and relationships within their peer groupHaving a malocclusion in the form of crooked or sticking-out teeth is very common, meaning a lot of children and adolescents wear braces. This is during a period when they are moving away from the control of their parents or guardians and their psychosocial development is more influenced by their peers. Peer relationships are very important for healthy development, with poor relationships or being a victim bullying being linked to loneliness, depression, poor academic achievement and poorer quality of life in the long term. In this study, we interviewed 14 young people aged 14–16 years about their social experiences of having crooked or sticking-out teeth and subsequently braces to treat them. From the interviews, it was found that being very self-conscious and embarrassed socially about their teeth was very common, resulting in trying to avoid smiling and hiding their teeth in photographs. As this study was carried out during the COVID-19 pandemic, a couple of the participants reported that wearing face masks made them feel more confident. They also felt they were being judged by their peers about the appearance of their teeth, even if nothing explicit was said. They in turn were aware they judged other people. All the young people had either experienced being teased or having mean comments made about their teeth or witnessed it happening to someone else. Although most tried to shrug this off, it was apparent that some of the young people found this very hurtful both in the short and long term. Most were having brace treatment or waiting for it to start. This was seen as positive thing and a normal part of growing up. None of them reported being teased for wearing braces and their friends were very supportive and helpful during treatment.

Programmed death-1 (PD-1) antibody-drug conjugates (ADCs) are a new generation of immune checkpoint blockers, which incorporate the delivery of cytotoxic drug targets. The objectives of these ADCs are to selectively target cells in the tumor microenvironment expressing PD-1, causing tumor cells to die, rejuvenating T cell exhaustion, and destroying immunosuppressive cells. PD-1 ADCs aim to address the shortcomings of conventional PD-1 inhibitors, which may be resistant in certain cancers, by harnessing a two-pronged mechanism. This method can also be used to boost antitumor immunity by stimulating the activation and expansion of immune effector cells. Despite promising preclinical and early clinical outcomes, multiple issues remain in the development of PD-1 ADCs, including heterogeneity in tumor antigens, the development of resistance mechanisms, and instability of the ADC linker. Current studies are trying to overcome these challenges by improving ADC engineering, cytotoxic payload optimization, and investigating combination therapy. PD-1 ADCs, with their capacity to specifically regulate immunity and deliver potent cytotoxic drugs directly to tumor cells, have the potential to provide a valuable treatment modality. This would be beneficial for clinical outcomes, especially in cancers resistant to traditional treatment methods, and it represents a great step forward in cancer immunotherapy.

Long before the first symptoms of psychosis were categorized, late eighteenth-century practitioners of psychiatry had frequently noted that their patients suffered from acute stomach pain, skin rashes, and heart irregularities, suggesting at least a handful of them to think of an underlying mind-body pathology. The psychiatric community began debating the connection between mental illness and the body more frequently by the late nineteenth century. Throughout the late 20th century, the body in schizophrenia was largely viewed as a vessel for side effects, a repository for the metabolic consequences of antipsychotic medication. However, we are currently witnessing a visceral turn in the field, a theoretical and methodological shift moving from the brain-only models to mind-body models of psychopathology. This shift acknowledges that the brain isn't just a distinct entity; it is inextricably tethered to the rhythmic oscillations of the visceral organs. This article tries to trace the evolution of the methods used to understand the gut brain axis better. How the understanding evolved from merely trying to understand situational reactivity to a how broader stress-regulatory networks function in the body. The evolution of the brain-gut axis in schizophrenia, from the analog stress tests of 1982 to the network coupling models of 2025, reveals a clear trajectory. We have moved from viewing visceral symptoms as noise to recognizing them as a crucial signal. Current evidence suggests that the gut is key to the pathophysiology of psychiatric disorders.

E-cigarettes are an effective way to stop smoking but there is disagreement regarding their use as treatment. One concern is that recommending e-cigarettes for adults who smoke (AWS) could result in sustained dual use of both products among those who fail to quit smoking. Given most quit attempts end in failure, it is important to understand the likelihood of developing dual use and its consequences when considering e-cigarettes for AWS. We describe variability in dual use within a behavioral economics framework, including literature which addresses the likelihood that trying to quit smoking with e-cigarettes will lead to established dual use as well as the impact that dual use has on smoking heaviness and smoking cessation. Limited evidence suggests that a meaningful minority of AWS who initiate e-cigarettes with support to quit smoking establish dual use. Compared to exclusive smoking, dual use appears to be associated with an overall reduction in smoking and an increase in the likelihood of cessation. However, outcomes appear to vary based on substitutive versus complementary use patterns, with the potential for dual use to lead to sustained or increased smoking for a small proportion of AWS who initiate e-cigarettes. Compared to exclusive smoking, developing dual use is likely associated with reduced smoking for the majority of AWS, providing further support for including e-cigarettes as a smoking cessation treatment option. Future prospective and controlled research is needed to explore predictors of developing substitutive versus complementary patterns of dual use and subsequent smoking cessation.

ObjectiveThe purpose of this perspective is to provide a critical reflection on the current systemic and sociocultural influences on autism diagnostic practice, which create clinical challenges for specialists in autism diagnosis.ConclusionsMany people are being referred for autism diagnostic assessments for increasingly non-specific emotional, behavioural or academic difficulties or concerns about functioning. The widespread availability of information about autism online, especially on social media platforms, is often unreliable or misrepresentative, adding complexity both to the clinical landscape and for those individuals presenting for assessment who are trying to make sense of their personal experiences in these forums. In such an environment, adherence to evidence-based diagnostic practices is essential, within a context that recognises the importance of establishing a history of typical versus atypical development and differential diagnosis, to ensure diagnostic accuracy and facilitate access to tailored and timely support.

Chronic low back pain is common, disabling, and often inadequately controlled with current pharmacologic options, underscoring the need for safer non-opioid treatments. Dronabinol, a synthetic formulation of Δ9-tetrahydrocannabinol, has analgesic potential but has not been rigorously evaluated for chronic low back pain. This article describes a phase IIa, single-site, randomized, double-blind, placebo-controlled, parallel-group trial in Veterans with chronic low back pain. Seventy-five participants will be randomized 2:1 to oral dronabinol or matching placebo for 8 weeks following a screening period of up to 4 weeks. The primary objective is to evaluate safety and tolerability. Primary outcomes include treatment-emergent adverse events, serious adverse events, laboratory findings, vital signs, and electrocardiogram results. Secondary outcomes are exploratory and include pain intensity, physical functioning, emotional functioning, global improvement, analgesic use, and medication adherence. This study is designed to generate safety data and preliminary estimates of variance and effect size to inform a future confirmatory trial; it is not powered to test efficacy hypotheses.Clinical trial registration: http://www.clinicaltrials.gov identifier is NCT06454669. Chronic low back pain is common, can last for years, and can make everyday life much harder. Many people continue to have pain even after trying available treatments. Opioid pain medicines can help some patients, but they also have important risks, including dependence, overdose, and other serious side effects. Because of this, safer non-opioid treatment options are needed. Dronabinol is a prescription form of tetrahydrocannabinol (THC), a compound related to cannabis. It is already approved in the United States for other medical uses, but it has not been well studied for chronic low back pain. This article describes the plan for a clinical trial in Veterans with chronic low back pain. The main goal of the study is to learn whether dronabinol can be given safely and tolerated over 8 weeks. The study will also collect early information on whether dronabinol may affect pain, daily functioning, mood, and use of other pain medicines. These additional results are exploratory, which means the study is not large enough to prove that the treatment works. In this trial, 75 participants will be assigned by chance to receive either dronabinol or placebo. The study is double-blind, so neither participants nor study staff will know which treatment each participant receives during the trial. The results will help researchers decide whether a larger future study should be done.

The success of price transparency initiatives requires that prices be defined using a common payment methodology. In this article, we explore how coding schemas and pricing approaches varied in five major markets in the United States in 2024. We investigated how frequently inpatient and outpatient payment were based on the use of Medicare Severity Diagnosis Related Group (MS-DRG) or Healthcare Common Procedure Coding System (HCPCS) codes with fixed prices versus alternative methods, such as per diem revenue codes or a percentage of billed charges for all services. We estimated that fixed-price MS-DRG or HCPCS methods were used for a preponderance of services in only 48 percent of inpatient contracts and 53 percent of outpatient contracts in 2024. Within markets, carriers seldom used fixed-price contracts for all hospitals. Similarly, most hospitals were not paid using fixed-price methods by all carriers. These results suggest that price comparisons by consumers, employers, academics, and other stakeholders face significant barriers because of the heterogeneity of payment methodologies. Moreover, efforts to promote price transparency will also need to confront the heterogeneity in pricing approaches when trying to present prices across different hospitals.

Being able to correctly estimate the post-mortem interval is one of the most challenging tasks in forensic pathology, as the most used methods are influenced by various factors that can reduce their reliability. Through this study, the authors propose an innovative method aimed to further narrowing the time interval within which to place the time of death. It is proposed an analysis of the yellow bone marrow using the dual-layer dual-energy computed tomog-raphy (dl-DECT) as a tool to potentially identify its alteration composition occurring post-mortem. In adults, in physiological conditions, DECT does not usually show fluid components within bone marrow. Therefore, the identi-fication of fluid-like components in the bone marrow of cadaveric femurs we observed could be attributable to post-mortem phenomena. The obtained results are still preliminary, therefore further studies are required. In the near future, further analyses will be performed by this research group, trying to identify a correlation between the variations of water in the yellow bone marrow and the time of death.

Large population databases frequently include complicated family structures that are amenable to modern biometric methods: allowing for intergenerational and extended pedigree analyses. To date, much of the latent potential of these resources remains untapped due to numerous complexities that arise in their analysis. Two difficult and critical problems are (1) finding independent extended families within larger population databases, and (2) determining coefficients of relatedness among all pairs of individuals within those extended families. If these problems were solved, researchers could more fully utilize data on extended families for biometric modeling. In this paper, we provide fast, computationally efficient algorithms for both of these problems and several more that are applicable to arbitrarily large and complex pedigrees. The algorithms rely solely on mother-child and father-child relationships that form the basis of many large population databases. These methods will be invaluable to any researcher trying to segment standard pedigree data files into independent extended family units, compute relatedness coefficients within extended families, and conduct intergenerational and other biometric modeling.

Accounts of emotional dysregulation in autism and attention-deficit/hyperactivity disorder (ADHD) are typically based on external adult observations anchored in neurotypical notions of emotional responding. These often fail to place neurodivergent people's emotional responses in the context of the upsetting experiences they face; information best provided by the young people themselves. We interviewed 57 adolescents (11-15 years; 19 females) with diagnoses of ADHD (n = 24), autism (n = 21) or both (n = 12), about their experience of upsetting events using a co-designed semi-structured interview schedule. Reflexive thematic analysis generated shared themes with diagnosis-specific nuances. Four themes were extracted: social dislocation, alienation and conflict; need to mask; self-doubt, loathing, embarrassment; and over stimulation/sensory mismatch. Upsetting experiences, for ADHD participants, were typically perceived as instigated by external agents trying to impose control, and/or a sense of injustice; for autistic participants they often related to feelings of 'not belonging' and alienation. Masking, for autistic participants, included 'hiding' negative emotions to protect others from their intensity; whereas in ADHD, masking usually involved supressing emotional upset to protect oneself from conflict or consequences. Those with a joint diagnosis reported a combination of these experiences, often felt more intensely. First-person accounts of emotional responding could provide new insights with potential to refine current dysregulation-based accounts of ADHD or autism.

To perform an updated systematic review and meta-analysis of the efficacy and safety of intensive (INT) vs. conventional (CONV) blood glucose (BG) targets for critically ill adults on insulin infusions. We conducted a comprehensive search of Embase and OVID Medline databases from inception to October 16, 2023. We manually excluded studies published before 2000 due to potential lack of relevance as glycemic control in the ICU was not routinely practiced before 2000. We included randomized controlled trials (RCTs) evaluating adult, critically ill patients on insulin infusions comparing INT vs. CONV targets for efficacy and safety outcomes. Data were screened and extracted with accuracy confirmed by a second reviewer. Study methodological characteristics, patient population, interventions, and outcome data were recorded. Studies without numerical outcomes were summarized as text statements. Forty-five RCTs were included involving 32,215 patients. No differences were seen between INT and CONV targets for hospital mortality or ICU mortality. INT targets were associated with lower ICU length of stay (LOS), infections, and critical illness polyneuropathy (CIP); however, INT targets demonstrated a 3.6-fold higher risk of severe hypoglycemia. Most of the studies with significant differences contained serious inconsistencies or risk of bias. In the subgroup analyses, INT targets demonstrated favorable neurologic outcomes in neurologic ICU patients, lower ICU LOS in mixed ICU patients, and lower ICU mortality in the cardiac surgery subgroup. INT BG targets demonstrated mild to moderate improvements in several important morbidity secondary outcomes, including LOS, infections, and CIP, but were associated with a 3.6-fold higher risk of severe hypoglycemia. No differences were seen in ICU or hospital mortality. INT targets should not be routinely used over CONV targets when trying to minimize hypoglycemia as a marker of patient safety. However, as stated in the Society of Critical Care Medicine guidelines, a lower target within the INT range (110-140 mg/dL; 6.1-7.8 mmol/L) may be considered acceptable in select centers where the risk of hypoglycemia is documented to be negligible based on routine assessment and with the use of optimized glycemic management protocols.