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Recent studies demonstrate that individuals who attend psychiatric services in adolescence, especially inpatient care, have an increased risk of psychotic disorders in adulthood. Given the extensive literature demonstrating a relationship between developmental trauma and psychosis, we investigated whether trauma history would help to identify elevated psychosis risk within a clinical cohort. The sample consisted of patients admitted to a regional adolescent inpatient psychiatric unit (Oulu, Finland) between April 2001 and March 2006. The Kiddie Schedule for Affective Disorders and Schizophrenia was used to assess history of developmental trauma. Primary analyses investigated childhood sexual and/or physical abuse and secondary analyses investigated other types of traumatic events (car accident, other accident, fire, witness of a disaster, witness of a violent crime, victim of a violent crime, confronted with traumatic news, witness to domestic violence, other). Diagnoses from specialist healthcare were followed up in the national healthcare register until June 2023. Logistic regression was used to assess the relationship between childhood trauma and subsequent schizophrenia-spectrum disorders (SSDs). Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 14% reported a history of childhood sexual abuse and 27% reported a history of childhood physical abuse. Exposure to childhood sexual or physical abuse was not associated with a subsequently increased risk of SSDs (adjusted OR = 1.05, 95% CI = 0.59-1.83). Similarly, none of the other developmental adversities were associated with a subsequently increased risk of SSDs. In a clinical cohort made up of non-psychotic adolescent psychiatry inpatients, a group known to be at elevated risk of psychosis, none of the assessed developmental adversities were prognostic factors for subsequent psychotic disorders.

Mental health professionals (MHPs) play important roles in providing expert opinions in courts; however, dated studies indicate that legal professionals prefer psychiatrists as mental health expert witnesses as well as mental health testimony on ultimate opinions, clinical diagnosis, and interpreting the legal standard for mental conditions. This mixed-methods study surveyed 132 judges and lawyers in the United States and Canada to examine their preferences for mental health testimony elements and MHPs as expert witnesses. Updating previous research conducted between the 1980s to 2010s, respondents were presented with 11 questions describing different elements of mental health testimonies and were asked to rate the importance of these testimonies and rank their preference for psychiatrists, psychologists or social work experts. Legal professionals preferred expert testimony on clinical diagnosis, psychological testing, and descriptive testimonies. American legal professionals considered testimony on crime statistical data related to diagnosis as more essential than did Canadians, and Canadians ranked testimony on measure of dangerousness higher. Overall, American legal professionals preferred having psychologists as expert witnesses, whereas Canadian legal professionals preferred psychiatrists. Using a qualitative reflexive thematic analysis of participants' comments on factors that contribute to a useful testimony, four themes summarized the indicators of useful expert testimony: Qualified and Engaged Experts, Relevant and Useful Information, Empirical Rigor in Testimony, and Clarity and Accessibility. Results reveal that American legal professionals are increasingly understanding the value of forensic psychologists as expert witnesses, whereas Canadians hold preferences for psychiatrists.

In Japan, providing reasonable accommodation for people with intellectual disabilities became mandatory on 1 April 2024, but evidence from non-psychiatric hospital care is limited. We conducted semi-structured interviews with nine hospital-based non-psychiatric physicians in Japan (October 2023-March 2024) and analysed data using inductive thematic analysis. Physicians described accommodations in (1) medication management tailored to understanding, preferences, and home support; (2) relationship-centred communication to elicit symptoms and confirm comprehension; and (3) flexible care processes, including time, environment, and team roles. They mitigated risks through witnessed explanations, clear documentation, and proactive coordination with nurses and family members. Practical, workflow-embedded accommodations are common in non-psychiatric settings and could be strengthened by structured communication supports and systematic information sharing. Non‐psychiatric hospital doctors in Japan described practical ways to adjust care for people with intellectual disabilities. Helpful changes included clearer step‐by‐step explanations, extra time, and medication plans that match support available at home. Risk was reduced by witnessed explanations, clear documentation, and proactive coordination with nurses and family members. Future work should test structured communication tools and hospital workflows that make reasonable accommodation more consistent and safer.

Nguyễn Phan Quế Mai's Dust Child (2023) provides a transgenerational narrative of the Vietnam civil war repercussions in the context of restorative justice, offering a critical discussion of how first-person accounts serve as a sociological tool for storytelling, testimony, and reconciliation within post-war Vietnam. Methodologically situated within a sociology of literature framework, this research article utilizes a multi-layered theoretical approach combining Rob Nixon's Slow Violence, Stacy Alaimo's Transcorporeality, and John Braithwaite's Restorative Justice, supplemented by frameworks of Trauma and Testimonial Witnessing. Through this lens, the study evaluates the bodily trauma of Phong, an Amerasian child, Dan, an American Veteran, and war-survivors Trang and Quỳnh, revealing how the novel depicts embodied and ecological trauma as a site of collective social and moral accountability. The textual results demonstrate that slow violence persists across bodies, landscapes, and generations while actively challenging the historical silence surrounding chemical warfare. Ultimately, this article discusses how narrating intergenerational trauma through intimate personal testimonies positions storytelling as a vital sociological process of acknowledgment, ethical witnessing, and restorative reconciliation in contemporary post-war Vietnam.

Purpose of ResearchLucidity is the transient recovery of abilities and communication that were seemingly lost among people living with dementia (PLWD). This study describes lucid episodes reported by Alzheimer's dementia (AD) and Lewy Body Dementias (LBD) caregivers. We analyzed survey data from 212 current AD (n = 191) and LBD caregivers who reported the frequency, duration, and characteristics of 653 lucid episodes witnessed in the past month.Major FindingsMost AD caregivers (67%) and LBD caregivers (81%) witnessed a lucid episode within the past month. LBD caregivers reported lucid episodes with greater changes in awareness and communication, compared to AD caregivers. LBD caregivers reported longer lucid episodes and that the PLWD knew about their change in lucidity, compared to AD caregivers.ConclusionsFindings suggest that differences in lucid episode intensity, timing, and meta-awareness between AD and LBD are possible and may inform care strategies for PLWD.

Compressed air-induced colonic barotrauma is a rare but potentially fatal injury type with distinctive forensic significance. Non-iatrogenic pneumatic injuries of the gastrointestinal tract are infrequently documented, yet are associated with high morbidity and mortality, frequently arising in occupational settings because of workplace misconduct or the misuse of pneumatic equipment. We report a fatal case of transanal high-pressure compressed air insufflation in a 15-year-old adolescent. Witness testimony and the accused's confession established that a compressed air hose was inserted transanally on two occasions while the victim was fully clothed. The second instance of insufflation resulted in immediate collapse at the scene with subsequent death. Medicolegal autopsy was conducted at the Egyptian Forensic Medicine Authority. External examination revealed a grossly distended abdomen as well as a grossly distended scrotum, and two vital perianal lacerations with contused and abraded margins, accompanied by perianal bruising. Internal examination demonstrated tension pneumoperitoneum, multiple colonic and mesenteric lacerations, and intraperitoneal hemorrhage. Toxicological analysis and anal swabs for evidence of sexual assault were negative. The cause of death was attributed to hemorrhagic shock secondary to extensive multiple colonic and mesenteric lacerations. Compressed air-induced colonic barotrauma, though rare, represents a forensically significant injury pattern. The current case illustrates the severe, potentially fatal effects of using pneumatic devices improperly and emphasizes the importance of considering scene evidence, witness statements, external examinations, and comprehensive internal autopsy findings to accurately reconstruct the mechanism, manner, and cause of death.

This review aimed to identify existing workplace violence (WPV) reporting forms worldwide, examine their domains and determine the essential information required to develop a more comprehensive and effective WPV reporting form. A systematic search of PubMed, Web of Science and Google Scholar from 1990 to 2025 was conducted. Data extracted included study characteristics, populations, reporting form names, number of items and reporting approaches. Descriptive analysis and hierarchical cluster analysis were performed to determine the number of items and domains included in each WPV reporting form. A total of 22 WPV reporting forms were included. Across these forms, 148 reporting items were identified and grouped into 13 domains: sociodemographic data of the victim, job characteristics of the victim, characteristics of the notifier, characteristics of the incident, characteristics of the injury, measures taken during the violence, consequences of the violence, postviolence treatment, aftermath of the violence, reporting of the violence, perception of victim postviolence, characteristics of the assailant and characteristics of the witness. Hierarchical cluster analysis classified the 22 WPV reporting forms into three clusters based on comprehensiveness: rapid forms (three items), brief forms (mean 13.75 items) and detailed forms (mean 27.77 items). Substantial variation exists in the content of WPV reporting forms. Future WPV reporting forms should, at minimum, include seven most commonly reported domains, particularly job characteristics of the victim, characteristics of the incident, characteristics of the injury, measures taken during the violence, characteristics of assailant, characteristics of the witness and reporting of the violence. The findings highlight substantial variability in the content, structure and domains of existing WPV reporting forms used in healthcare institutions, indicating the need for standardised, evidence-based reporting tools that capture essential information relevant to nursing practice. Standardisation would improve comparability of WPV data across institutions and countries, facilitating more accurate benchmarking and global surveillance, particularly as nurses constitute the largest proportion of frontline healthcare workers. Additionally, nursing leaders, hospital administrators and health authorities can utilise these findings to strengthen institutional WPV policies by implementing clear and accessible reporting procedures and integrating domains related to prevention programmes, incident management and postincident support to guide policy development, staff training and resource allocation.

To investigate the association between low-flow time (LFT) and outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with prehospital extracorporeal cardiopulmonary resuscitation (ECPR). This retrospective study included OHCA patients receiving prehospital ECPR (July 2023-August 2024). LFT, defined as the interval from conventional CPR start to ECPR flow initiation, was analyzed continuously (per 10 min increment). Due to limited events (13 favorable neurological outcomes), the primary logistic regression adjusted for two prespecified confounders (age, initial shockable rhythm). A sensitivity analysis was performed in patients with witnessed arrest and bystander CPR (no-flow time of approximately 0). All analyses are exploratory. Among 76 patients (mean age 58.80 ± 14.84 years, mean LFT 60.33 ± 13.89 min), survival to hospital discharge was 34.2% (26/76) and favorable neurological outcome 17.1% (13/76). Each 10 min LFT increase was associated with lower survival (aOR 0.557; 95% CI 0.368-0.844; P = 0.006) and favorable neurological outcome (aOR 0.461; 95% CI 0.255-0.834; P = 0.011). In the sensitivity subgroup (witnessed + bystander CPR, n = 44, 9 favorable outcomes), the univariable OR for favorable outcome was 0.395 (95% CI 0.176-0.886; P = 0.024), consistent with the primary estimate. Exploratory ROC analysis for favorable neurological outcome gave an AUC of 0.750 (95% CI 0.603-0.896), but the derived cutoff (55.5 min) is not proposed for clinical use. In this single-center study, longer LFT (per 10 min) was associated with worse outcomes, consistent in a no-flow-time-controlled subgroup. Given the exploratory design, external validation is required. No definitive LFT threshold can be recommended.

Insulinomas and functional pancreatic neuroendocrine tumours (pNETs) are rare but important causes of endogenous hyperinsulinaemic hypoglycaemia whose neuroglycopenic manifestations can closely mimic neurological disorders, leading to considerable diagnostic delay. We present the case of a 74-year-old man with epilepsy, seizure-free for 11 years on carbamazepine, and a background of metastatic well-differentiated grade 3 pNET (Ki-67: 40-50%), who was admitted with a 2-3-week history of nocturnal confusion, cold sweats, nightmares, increasing agitation, and an episode of abnormal limb movements. The presentation was initially attributed to possible seizure recurrence or delirium. Routine investigations, including CT brain, carbamazepine levels, and type 1 antineuronal nuclear autoantibody antibody testing, were unremarkable, and blood glucose on admission was normal. The correct diagnosis was reached only during a witnessed ward episode on day two, when capillary blood glucose was found to be critically low and symptoms resolved immediately with intravenous dextrose. Subsequent biochemical evaluation demonstrated markedly elevated serum insulin (42 &#xb5;U/L; reference: 2-24 &#xb5;U/L), C-peptide (2,464 pmol/L; reference: <90 pmol/L), and on formal supervised 72-hour fast, which provoked symptomatic hypoglycaemia after just three hours, insulin was 180 &#xb5;U/L, proinsulin was 730 pmol/L (reference: <10 pmol/L), and C-peptide was 2,136 pmol/L, with a negative sulphonylurea screen, fulfilling the diagnostic criteria for endogenous hyperinsulinaemia. Somatostatin receptor scintigraphy (single-photon emission computed tomography-computed tomography) identified multifocal hepatic metastases and focal uptake in the pancreatic tail, confirming an insulin-secreting primary. The patient was managed with diazoxide and monthly lanreotide but experienced rapid deterioration and died on palliative care. This case underscores the need to consider a functional pNET as a cause of seizure-like episodes even in patients with established epilepsy, and highlights that capillary blood glucose measurement during any witnessed neurological episode is a simple but potentially life-saving clinical step that should never be omitted.

The present study investigated whether the timing and type of domestic violence exposure were associated with adolescents' peer violence involvement. Data were drawn from the sixth wave (2023) of the 2018 Korean Children and Youth Panel Survey, a nationally representative cohort (Mage = 18.4 years; 53.4% male; N = 2,224). Race/ethnicity was not collected as part of this nationwide panel survey, likely reflecting the high ethnic homogeneity of the South Korean population. Retrospective items captured the first developmental period in which youth experienced caregiver-to-child corporal punishment, verbal abuse, and physical abuse, and witnessed interparental verbal and physical violence. A multiple event process survival mixture model identified three exposure-timing classes: late childhood risk spike (1.1%), multi-period multi-type violence risk (3.6%), and low risk (95.3%). Youth in the multi-period multi-type violence risk class reported higher levels of traditional bullying and cyberbullying perpetration and victimization during the past year of high school compared with the other classes. Findings suggest that onset exposure to multiple forms of domestic violence across developmental periods may serve as an important marker of heightened risk for later peer violence involvement, and support developmentally timed, family- and school-based prevention efforts. Many young people who grow up with violence at home also report peer violence, but the timing and form of home violence may matter. Using survey data from 2,224 Korean adolescents in their final year of high school, we examined when they first experienced or witnessed different kinds of domestic violence (verbal and physical). We identified three groups: youth with a late childhood spike in violence onset, youth with onset exposure to multiple forms of violence across developmental periods, and youth with low exposure. Adolescents in the multi-period multi-type violence group reported the highest levels of bullying and cyberbullying, as both perpetrators and victims. Results highlight the importance of developmentally timed prevention and support for families and schools.

"The most exciting thing about my research is the moment of being the first in the world to discover and witness the mysteries of nature&#x2026; If I were a piece of lab equipment, I would be a micropipette because I am precise, reliable, and always ready to deliver the right amount of effort&#x2026;" Find out more about Huasong Ai in his Introducing&#x2026; Profile.

Mitral annular disjunction (MAD) is increasingly recognized as a structural abnormality associated with ventricular arrhythmias and sudden cardiac arrest, particularly in the setting of bileaflet mitral valve prolapse (MVP). A 43-year-old man with a history of migraines presented following a witnessed out-of-hospital cardiac arrest and was successfully resuscitated with a single AED shock. Transthoracic echocardiography showed mitral regurgitation with bileaflet prolapse and suspected MAD. An implantable cardioverter-defibrillator was placed for secondary prevention, and the patient was discharged in stable condition with outpatient surgical follow-up where robotic-assisted mitral valve repair was successfully performed. Advanced imaging plays a pivotal role in diagnosis and risk stratification when MAD presents as sudden cardiac arrest.

This article originates from the work of students who participated in the "Psychiatry in Cinema" course, offered annually to medical students at the University of Geneva. An introduction to psychiatry is carried out through the visual support offered by cinematographic works, which have the advantage of depicting psychiatric symptoms in a concrete way to facilitate the teaching of semiology by giving substance and materiality to sometimes abstract theoretical concepts, while also addressing certain stigmas and stereotypes linked to the mental illnesses portrayed in these films, even before students begin their clinical rotations. This article presents their work and reflects their ongoing learning by highlighting the identification of symptoms in the film and matching them with the criteria defined in theoretical reference manuals. Brothers is an American film that tells the story of a soldier named Sam, who returns from the front and struggles to readjust to family life. As a result of the horrors he witnessed, he develops posttraumatic stress disorder. This article discusses posttraumatic stress disorder as depicted in this cinematic work. The different clinical signs that contribute to the diagnosis will be discussed. Secondly, a critique of the staging and the manner in which the protagonist's internal experience is portrayed will be presented. By reading this article, the reader will understand whether the representation of this disorder is consistent with psychiatric diagnostic manuals, as well as with the subjective experience of patients. Thirdly, the social representation of the disorder proposed by this film will be addressed. Does this film offer a stigmatizing image of PTSD, and how might this influence the public's perceptions of patients suffering from this disorder? Finally, the representation of psychiatric care will be addressed; indeed, this point is particularly interesting in the context of American soldiers returning from combat profoundly affected by their traumatic experiences of war. This film raises an important political question regarding the therapeutic care of soldiers who have not always been treated in an appropriate, understanding, and integrated manner upon their return. The methods used by the director to highlight this issue will be discussed and commented on extensively at the end of this article.

Endodontics has witnessed a significant acceleration in innovation. However, the pace at which these innovations are validated through scientific research has not kept up, creating what is referred to as the 'speed of innovation versus speed of validation gap'. This incongruence raises critical concerns about the foundation of evidence-based practice, patient safety and professional accountability. Currently, many innovations are adopted in clinical practice based on preliminary data, anecdotal evidence or popularity on digital platforms, often before thorough clinical validation is achieved. This trend challenges traditional knowledge translation frameworks and reveals significant limitations within existing governance models in dentistry. This article draws on principles of responsible innovation and healthcare regulations to examine the factors contributing to this gap in endodontics and its implications. Although recognising the necessity of innovation for the advancement of the discipline, it cautions against the uncritical and premature adoption of new techniques and technologies, as this may jeopardise clinical outcomes and erode public trust. The article advocates for a more integrated approach that combines innovation with anticipatory governance, critical appraisal and professional reflexivity. Closing this gap is imperative to ensure that advancements in endodontics are founded on robust scientific evidence and conducted in a socially responsible manner.

Yinxing Mihuan Oral Solution (YMOS) is extensively utilized in the clinical treatment of cardiovascular and cerebrovascular diseases (CCVDs), with flavonols and their glycosides identified as the primary active ingredients. Currently, there are relatively few established quantitative methods available for analyzing flavonols and their glycosides, and the research regarding their transformation patterns under simulated gastrointestinal conditions is still limited. In this study, network pharmacology was employed to predict the active compounds and targets of YMOS associated with cardiovascular and cerebrovascular protection. A comprehensive network integrating compounds, targets, bioactivities, and CCVDs was meticulously constructed for 10 flavonol glycosides and their aglycones. It revealed that these compounds exert their blood circulation-promoting and blood stasis-eliminating effects by modulating 20 key targets, highlighting their therapeutic potential in CCVDs treatment. Furthermore, we quantitatively analyzed the 10 targeted flavonols and their glycosides in YMOS using ultra-performance liquid chromatography (UPLC), demonstrating consistent flavonoid levels across all tested samples. This method was also employed to investigate biotransformation rules between flavonol glycosides and their aglycones in vitro. Notably, it was observed that flavonol glycosides undergo a deglycosylation reaction in the rat's intestinal microbial culture medium, which was witnessed in a relatively stable manner under the simulated artificial gastrointestinal fluid. These findings provide important scientific insights into the mechanism of action and the quality control of YMOS.

To identify factors contributing to gender disparities in the receipt of bystander cardiopulmonary resuscitation (CPR), we examined patient age group and bystander category. We analyzed witnessed out-of-hospital cardiac arrests of presumed cardiac etiology from a nationwide Japanese registry (2005-2023). Gender differences in receipt of bystander CPR were evaluated across five age groups (&#x2264;14, 15-49, 50-64, 65-74, &#x2265;75 years) and five bystander categories. Logistic regression and effect modification analyses were performed to assess the relative contributions and relationships of these factors. Among 453,441 eligible patients, females were more likely than males to receive bystander CPR overall. However, among patients aged 15-49 and 50-64 years, females were less likely to receive CPR, whereas the opposite pattern was observed in those aged &#x2265;75 years. When bystanders were friends, colleagues, or passersby, females were less likely to receive CPR across all adult age groups. Clear interaction was observed between gender and bystander category, but not age group. Risk differences for not receiving CPR in friends compared with family were 4.0% vs 14.3% for females and males, respectively. When bystanders were staff or related personnel, these differences were 31.4% vs 27.7%. The adjusted odds ratio (OR) for gender was 1.100 (95% CI, 1.084-1.113; female vs male), whereas that for bystander category reached 3.555 (95% CI, 3.500-3.611; staff or related personnel vs family). Bystander category was more strongly associated with CPR receipt than patient gender.

Bystanders witnessing or performing cardiopulmonary resuscitation (CPR) during out-of-hospital cardiac arrest (OHCA) may experience significant psychological distress. Although the need to support bystanders after OHCA is increasingly recognised, existing post-event support interventions have not been previously described. To identify and describe existing post-event support interventions for bystanders involved in OHCA. A scoping review was conducted using Joanna Briggs Institute methodology and PRISMA-ScR reporting. Databases and grey literature were searched from inception to March 2026 for sources describing post-event support interventions for adult OHCA bystanders. Data were charted and synthesised descriptively. Sixteen peer-reviewed articles or published studies, pertaining to eleven support interventions were included, alongside three additional interventions identified through grey literature, giving a total of fourteen interventions. Most interventions were developed in the past decade in high-income Western countries. Support mainly consisted of information-giving and debriefing, which could be delivered on scene, shortly after the event via telephone or in person, or through digital platforms. Promotional methods included on-scene written materials, emergency medical service dispatcher- or clinician-initiated contact, app-triggered messages, and public-facing websites or social media. Only five studies reported participant outcomes, with two assessing psychological distress. No study evaluated intervention effectiveness. New support interventions for bystanders involved in OHCA are emerging, particularly in Western countries. The most common component of these interventions is information-giving, with the majority also providing debriefing and psychological support. However, more research is needed on the most effective ways to promote these interventions and on the effects of these interventions on outcomes important to bystanders.

HER2 (ErbB2), a ligand-independent HER family member, regulates cell growth, differentiation, and survival. Its overexpression, gene amplification, and activating mutations are oncogenic drivers in multiple malignancies. The past two decades have witnessed transformative advances in HER2-targeted therapeutics, exemplified by tyrosine kinase inhibitors (TKIs), including first-generation reversible pan-HER (e.g., lapatinib), second-generation covalent pan-HER (neratinib, pyrotinib), and novel selective HER2 inhibitors (tucatinib, sevabertinib, zongertinib). Nonetheless, the extensive molecular heterogeneity in HER2 activation (e.g., dimerization, amplification) and mutation profiles (e.g., L755S, exon 20 insertions), combined with tumor-type-specific pathogenic mechanisms, poses significant challenges to precision oncology in clinical practice. Currently, numerous promising inhibitors in preclinical and clinical development hold potential for providing more effective treatment options. This review comprehensively summarizes recent advances in HER2-targeted TKIs and their emergent resistance mechanisms, further analyzing strategies to both mitigate off-target toxicity and overcome resistance through rational design of selective HER2 inhibitors. Collectively, these insights provide a roadmap for developing next-generation precision therapies in HER2-driven cancers.