Frontiers in Integrative Neuroscience

Objective: To evaluate long-term neurological, mental, and menstrual health outcomes using a mixed-methods approach among women approximately 2 years after concussion compared with non-head-injured controls. Setting: Participants were recruited from [University X] sites, including the Concussion Clinic, Emergency Departments, Student Health Clinic, and [University X] + Me registry (April 2023 to September 2025). Follow-up occurred October to November 2025. Participants: Eligible participants were assigned female at birth, aged 18 to 45 years, not using hormonal birth control, and, for the concussion group, diagnosed within 7 days of injury. Of 45 concussion patients and 29 controls recruited, 11 concussion patients (mean age 30.4 +/- 8.4 years) and 16 controls (31.3 +/- 7.4 years) completed follow-up. Main Measures: Post-concussion symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ), depression using the Patient Health Questionnaire-9 (PHQ-9), and anxiety using the Generalized Anxiety Disorder-7 (GAD-7). Menstrual health was assessed using study-specific measures. Qualitative data captured perceived impacts on daily life, with recurring themes summarized using word clouds. Results: At follow-up, concussion patients reported significantly greater symptom burden (RPQ: 31.6 +/- 13.5 vs 9.4 +/- 9.8; p=0.0002; Hedges g=1.90), depression (PHQ-9: 9.5 +/- 6.5 vs 2.3 +/- 2.2; p=0.0005; g=1.60), and anxiety (GAD-7: 9.8 +/- 6.8 vs 2.8 +/- 3.0; p=0.0057; g=1.42). Qualitative findings highlighted persistent headaches, sleep difficulties, reduced interest, and effects on relationships and daily functioning. Conclusions: This study demonstrates significant long-term differences in symptom burden among women with concussions compared to controls. Findings highlight the importance of understanding real-world impacts to improve long-term care.

Background: Depression symptoms following traumatic brain injury (TBI) are common and strongly associated with adverse overall outcomes in military service members, veterans, and civilians. Cognitive behavioral therapy for depression (CBT-D) is considered a first-line treatment for depression symptoms in many contexts. However, costs associated with CBT-D can be substantial, and there are insufficient numbers of providers trained to perform CBT-D. In contradistinction, digital therapeutic interventions such as smartphone apps have virtually unlimited availability and low per-patient costs. However, evidence for efficacy of digital interventions providing CBT-D in the context of TBI is limited. The aims of this study were to design, develop, and test a novel smartphone app to provide CBT-D intended for military service members with depression symptoms and history of mild TBI. Results: We designed a novel smartphone app featuring digital avatar coaches to provide CBT-D intended for military service members with depression symptoms and history of mild TBI. Key features and goals of the 12 weekly CBT lessons included stigma minimization, personal engagement, and 1-2 hours per week of personal challenge homework assignments. We performed a randomized controlled trial initially involving military service members and veterans. Inclusion criteria were later relaxed to allow for civilian participation due to practical constraints . The control group received an app providing educational lessons about concussions and depression which did not include the therapeutic components of CBT. There was no difference between the groups randomized to CBT-D (n=19) vs. educational app control (n=23) in self-reported depression symptoms. Nevertheless, there was a statistically significant benefit of the CBT-D intervention in self-reported insomnia severity at the 16-week follow-up (four weeks post intervention) assessment (Cohens D=0.45, p=0.0064). There were also statistically significant positive correlations (r= 0.46 to 0.76, p=0.046 to 0.001) between changes over time in depression symptoms and changes over time in both insomnia and PTSD symptoms in the CBT-D group. There were no such correlations in the control group. Participants reported higher therapeutic alliance (p=0.0001) and overall mobile application user rating (p=0.036) for the CBT-D app than for the control education app. More favorable therapeutic alliance and mobile application user ratings correlated significantly with greater improvements in depression symptoms in the CBT-D group (r=0.53 to 0.66, p=0.02 to 0.002). However, dropout was substantial (40/59 in the CBT-D group and 31/54 in the control group) and results may not be fully representative of the population at risk. Conclusions: There remains a major unmet need for widely available, low-cost, effective interventions for depression symptoms in the context of mild TBI. The challenges of designing and rigorously assessing the effects such interventions remain formidable. However, the lessons learned from this study and indications of benefit in a highly relevant secondary outcome measure (insomnia) suggest that remote app-based interventions remain therapeutically viable. Trial Registration: clinicaltrials.gov NCT05147506, submitted 20 July 2021, posted 7 December 2021.

Musical aesthetic experience can reveal students' cognitive, aesthetic, and emotional responses to music. However, how professional vocal training alters brain functions in female college students with varying levels of musicianship to promote these is unknown. Here we applied fMRI, psychological measures and Goldsmiths musical sophistication index (Gold-MSI) assessments to study 27 non-music major female college students consisting of instrument group (normal pitch accuracy with instrumental training), general group (normal pitch accuracy without instrumental training) and poor-pitch group (poor pitch accuracy and without instrumental training). After 1 year of one-on-one instructional practice, we found that professional vocal training enhanced information processing related to musical cognition and pleasure during musical aesthetic experiences across all three groups, involving improvements in motor control of vocalization, auditory feedback processing, musical memory and attention together with musical pleasure. Specifically, instrument group showed activation of reward circuits, general group exhibited activation of laryngeal motor control circuits, and poor-pitch group displayed activation of sensory/sensorimotor/motor control circuits. Both pre- and post-training, the instrument group exhibited higher connectivity than the other two groups in the left amygdala-dorsal anterior cingulate cortex (dACC) and the right posterior superior temporal gyrus (pSTG)-left insula pathway. After professional vocal training, the general group showed higher connectivity in the left amygdala-dACC, whereas the poor-pitch group demonstrated increased connectivity in the right pSTG-left insula and dACC-nucleus accumbens pathways. Surprisingly, professional vocal training activated the bed nucleus of the stria terminalis (BNST), a subcortical emotion center, and connectivity with the medial prefrontal cortex associated with musical information processing. Thus, vocal training can significantly improve musical cognition and aesthetic pleasure, and facilitates neural modulation in the brain's emotional centers.

BACKGROUND Children receiving extracorporeal membrane oxygenation (ECMO) are at high risk for focal cerebral injury (FCI). There is emerging evidence that electroencephalography (EEG) may aid FCI detection. The EEG Correlate of Injury to the Nervous System (COIN) index quantifies and displays focal background asymmetries. We evaluated whether COIN is associated with FCI in pediatric ECMO. METHODS Retrospective, cross-sectional study of patients age 28 days to 21 years, on venoarterial ECMO at a tertiary children's hospital, who received EEG monitoring and neuroimaging during ECMO. COIN was calculated from all available EEG data. COIN of 0 implies a symmetric EEG and negative COIN values are observed with FCI. Median COIN values near FCI recognition time were compared to median COIN values from randomly selected control EEG batches using logistic regression. A receiver operator characteristic curve was used to identify multilevel FCI test ranges. Likelihood ratios were calculated to estimate the posttest FCI probability for each COIN range. RESULTS During the 8-year study period (2015-2023), 33 of 142 ECMO runs met study criteria for COIN analysis. Twelve patients (36%) had FCI. The COIN cutoff of -13.3 had 92% sensitivity and 67% specificity for FCI. The COIN cutoff of -27.7 had 67% sensitivity and 90% specificity. Likelihood ratios were 0.13 for COIN (0 to -13.3), 1.1 for COIN (-13.3 to -27.7), and 7.0 for COIN (< -27.7). Posttest probability was 0.02, 0.13, 0.49 in each respective range. CONCLUSION FCI on ECMO is associated with COIN-measured EEG asymmetry. COIN may support FCI risk-stratification during ECMO.

Sex differences in mortality after traumatic brain injury (TBI) have been inconsistently reported, even after accounting for age, injury severity, and other injury related factors. Understanding the sources of this heterogeneity is important for prognostic research and the development of data-driven clinical decision-support tools. We conducted a systematic review and meta-analysis of sex-specific mortality after adult TBI and used explainable machine learning (ML) to investigate potential modifiers of between-study effect estimates. We searched eight databases from inception to August 25, 2025, for studies reporting mortality estimates adjusted for at least age and injury severity. Risk of bias was assessed using the Quality in Prognosis Studies tool. Male-to-female mortality estimates were pooled using random-effects meta-analysis. Three explainable ML algorithms were used to identify important modifiers of study-level effect estimates. Among 9,418 records identified, 21 studies comprising 899,813 participants and 98,286 deaths met the inclusion criteria. Pooled analyses showed lower mortality among females than males (OR 0.88, 95% CI 0.80-0.98; HR 0.76, 95% CI 0.59-0.98). Lower mortality among females was also observed for in-hospital mortality (OR 0.86, 95% CI 0.76-0.97) and overall or unspecified mortality (OR 0.83, 95% CI 0.78-0.88). Substantial residual heterogeneity remained across analyses. Explainable ML identified mean age, study sex composition, and study quality as important modifiers of reported effect estimates. These findings were consistent across sensitivity analyses. Female sex was associated with lower mortality after adult TBI, although substantial between-study heterogeneity remained. Explainable ML identified demographic and methodological factors that may contribute to variation in reported associations. These findings highlight the importance of population characteristics and study context when developing, validating, and interpreting explainable digital prognostic tools for TBI. PROSPERO: CRD420251252136.

Objectives To evaluate the positive and adverse effects of parent-mediated interventions (PMIs) versus care as usual for children with autism. Setting Systematic review and meta-analysis and Trial Sequential Analyses (TSA), following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Methods We searched for randomised clinical trials of PMIs for children with autism in the databases CENTRAL, EMBASE, LILACS, PsycINFO, MEDLINE, and SCI-EXPANDED (up to 13 August, 2025), complemented with manual searches. 12,359 articles were screened. Data were synthesised using meta-analyses and Trial Sequential Analyses (TSA), and risks of bias and certainty of the evidence were evaluated. Primary and secondary outcome measures The primary outcome was autism characteristics. Secondary outcomes were adverse effects, child adaptive functioning, child language, child and parent quality of life, and parental stress. Ten exploratory outcomes were included. Results 32 trials (N=1,625) comparing PMIs to usual care, waiting list, or no intervention were included. All trials had a high risk of bias. The multiplicity-adjusted threshold for statistical significance was p = 0.013 due to the number of outcomes. Meta-analyses and TSAs showed it could be rejected that PMIs reduced autism characteristics (MD = -0.88; 95% confidence interval -2.92 to 1.15; p = 0.05, 4 trials, N=353, low certainty), child adaptive functioning (7 trials, N=408), child language (4 trials, N=308), or parental stress (7 trials, N=385). Due to insufficient data, the remaining secondary meta-analyses could not be conducted. Meta-analyses of exploratory outcomes showed beneficial effects concerning child behaviour problems and parent sensitivity/synchronicity. Conclusions This meta-analysis found no benefits of PMIs on child autism characteristics, child adaptive functioning, child language, or parental stress. Benefits were found in reduction of child behaviour problems and improved parent sensitivity/synchronicity. The evidence remains uncertain, and more trials including outcomes of adverse effects and quality of life are needed.

Learning is an important process for survival. Many studies find that variation in learning ability is related to personality type. Bold individuals generally learn faster than shy, however, the underlying neural mechanisms are not well understood. Potential mechanisms for differences in learning speed are variation in neurotransmitter activity, specifically dopamine and serotonin, and functional connectivity across the brain. In this study we quantified the number of generally active, active dopaminergic, and active serotonergic neurons using immunohistochemistry across 12 brain regions at two timepoints in bold and shy zebrafish undergoing an associative learning task. There were no interactions between treatment and personality type in any of the cell count measures suggesting that individual region activity and neurotransmitter activity do not explain learning differences. However, analyses of general neural activity networks revealed that the connection from the posterior zone of the dorsal telencephalon (olfactory cortex homolog) to lateral zone of the dorsal telencephalon (hippocampus homolog) was positive in bold but negative in shy fish undergoing learning. Overall, the results suggest that differences in activity involving reward processing in the brain may explain differences in reward learning between personality types.

BACKGROUND: One in three adolescents with a concussion history report experiencing long-lasting somatic, sleep, emotional, and/or cognitive disturbances (persisting symptoms after concussion (PSaC)). Cognitive difficulties, such as attentional problems, are common symptoms and can interfere with ongoing development. Clinically, psychiatric symptoms also present in youth with PSaC. A concussion causes diffuse functional and microstructural alterations to neural networks. To develop targeted treatments for PSaC (e.g., neurostimulation), we need to understand how and where structural alterations and neural dysfunction intersect to cause long-lasting symptoms. OBJECTIVES: 1) Identify functional and microstructural properties in intrinsic connectivity networks, as well as neuropsychological outcomes, that differentiate adolescents with concussion with PSaC from those who do not have PSaC. 2) Determine whether neural activity within intrinsic connectivity networks mediates the relationship between network microstructure and specific neuropsychological features in adolescents with concussion. METHODS: CAMBY is a prospective study of adolescents aged 12 to 18 years with a history of concussion. Participants are allocated based on recovery status (PSaC vs. No-PSaC (recovered controls)). Advanced structural (magnetic resonance imaging; MRI) and functional (magnetoencephalography; MEG) neuroimaging and neuropsychological measures will be collected one month or more after concussion. Microstructural and functional features will be computed within intrinsic connectivity networks, then compared between PSaC and recovered control groups and related to symptom domains and neuropsychological profiles. IMPACT: This will be the first study to integrate MRI, MEG, and neuropsychology in adolescents with PSaC to identify disrupted networks underlying PSaC. This observational study is a necessary step towards future clinical trials that accurately target promising therapeutic neurostimulation protocols.

Background Vitamin D may influence bone healing and recovery after spine surgery, but its clinical effects remain uncertain. Objective To evaluate clinical, functional, and bone-related outcomes associated with vitamin D status and supplementation in patients undergoing spine surgery. Methods This systematic review and meta-analysis was registered in PROSPERO (CRD420261467482) and reported according to PRISMA 2020. PubMed/MEDLINE, Scopus, Web of Science, Embase, and the Cochrane Library were searched from inception through 1 June 2026. Random-effects meta-analyses used mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes. Direct supplementation analyses were prioritized, while analyses combining supplementation, baseline vitamin D status, or co-interventions were considered exploratory. Risk of bias was assessed using design-specific Joanna Briggs Institute tools. Results Thirteen studies were included. Four supplementation studies involving 177 participants showed no significant reduction in postoperative pain (MD -0.82, 95% CI -2.50 to 0.86; I2 = 84.3%). Three studies involving 277 participants showed lower Oswestry Disability Index scores in an exploratory analysis (MD -6.40, 95% CI -10.41 to -2.39; I2 = 96.8%). Three supplementation studies involving 128 participants showed no significant improvement in fusion rate (RR 1.17, 95% CI 0.78 to 1.74; I2 = 31.5%). An exploratory four-study fusion analysis was also not statistically significant (RR 1.24, 95% CI 0.98 to 1.57; I2 = 45.5%). Conclusion Current evidence does not establish that vitamin D supplementation independently improves postoperative pain or fusion rates after spine surgery. Possible benefits for disability and other bone-related outcomes remain uncertain because of small study numbers, heterogeneity, co-interventions, and residual confounding. Larger randomized trials stratified by baseline vitamin D status are needed.

Early-life painful events can influence brain development and behaviour later in life, yet the neural mechanisms underlying these long-term effects remain poorly understood. In particular, exposure to pain or tissue injury during early postnatal life has been associated with altered sensory processing, emotional regulation and behavioural responses later in life. Here we investigated whether early-life surgical pain alters adult behavioural and cortical network responses to injury. Using a rat model of neonatal hindpaw incision followed by repeat adult surgical incision, we combined behavioural analysis with continuous electrophysiological recordings from the medial prefrontal cortex (mPFC) and primary somatosensory cortex (S1) in freely moving animals. Early-life incision did not produce an overt alteration in adult social behaviour under baseline conditions. However, following adult injury, rats with prior neonatal incision showed altered social behavioural responses compared with animals receiving an incision only in adulthood. At the network level, adult incision increased beta-gamma phase-amplitude coupling within the mPFC and S1-mPFC theta coherence in animals experiencing their first injury, but not in those incised neonatally. Our evidence indicates that the relationship between mPFC coupling and social interaction differed according to neonatal injury history, revealing a lasting reorganisation of cortical network recruitment and brain-behaviour coupling after repeat injury.

Significance: There is potential for generative artificial intelligence (AI) to perform "full stack" academic publishing, including comprehensive manuscript fabrication, "peer"-review, and editorial decision making. This study evaluated the benefits and cautions in using AI for full stack academic publishing in clinical research about seizures. Methods: Three epileptologists each selected 1 published manuscript in Epilepsia and produced an AI-fabricated manuscript about seizures. AI tools were then used to perform "peer"-review and make editorial decisions with minimal human supervision. The rates of identifying AI-fabricated manuscripts and editorial decisions among the epileptologists was analyzed, and epileptologists' observations on how AI differed from typical human "peer"-review and editorial decisions was collected. Results: Four of 6 (67%) pairs of AI-fabricated and human-generated manuscripts were correctly identified. Only 1 AI-fabricated manuscript was editorially rejected, whereas another had a subtle indicator of fabrication. When compared to human content, AI generated content was comprehensive, detailed, and based on the highest standard of academic publication. However, generated content was more verbose, used more structured responses, and more critical feedback. Conclusions: These results demonstrate that the quality of AI-fabricated manuscripts about clinical research in seizures was sufficiently high that the current methods of peer and editorial review could not easily distinguish fabricated content compared to human-written content. Moreover, AI review and editorial decisions were high quality and appeared reasonable in many cases. AI tools have matured to the point that there should be thoughtful policies that permit AI assistance but prohibit insufficiently supervised autonomous scientific submissions, reviews, and editorial decisions.

Rehabilitation is the cornerstone of clinical care following spinal cord injury (SCI) and is frequently incorporated into preclinical studies to evaluate emerging therapies. However, the variables that influence the effectiveness of rehabilitation interventions in rodent models remain poorly characterized, limiting the translational value of preclinical research. Here, we performed a meta-analysis of 150 preclinical studies comprising more than 3000 rodents and 292 effect sizes to identify such factors associated with successful rehabilitation after SCI. Rehabilitation improved functional outcomes across multiple behavioral domains, with larger effects observed in thoracic than cervical injury models. Meta-regression identified environmental enrichment as the most effective strategy, particularly when combined with task-specific training. Longer rehabilitation duration was associated with improved recovery, whereas greater daily exposure to forced rehabilitation was associated with smaller gains. In contrast, prolonged access to voluntary rehabilitation did not show this relationship. Rehabilitation improved outcomes when initiated at all time points after injury, with greater benefits when initiated during the late subacute and intermediate phases. Rehabilitation approaches associated with higher stress burden produced reduced benefits, suggesting that stress may limit rehabilitation-induced recovery. Collectively, these findings identify rehabilitation type, duration, and delivery context as important determinants of recovery after SCI and support a broad therapeutic window for intervention. Our results favor low-stress, voluntary rehabilitation strategies that promote sustained engagement and provide principles for designing effective and biologically appropriate rehabilitation strategies, potentially improving translational success for emerging SCI therapies. One Sentence SummarySustained voluntary rehabilitation promotes functional recovery across stages of experimental spinal cord injury, whereas prolonged forced training may reduce its benefits.

More than a third of women in the United States are estimated to experience abuse from an intimate partner, in which blows to the head, strangulation, and therefore brain injuries are common. Among 207 survivors of such physical violence, two-thirds reported a partner-inflicted brain injury. These women performed substantially worse than the general population across most cognitive measures, including memory and reaction time. Cognitive performance declined as injury count increased. Translated into cognitive age, survivors with the most partner-inflicted brain injuries performed over two decades older than the general population, and a decade older than survivors with no history of brain injury. Importantly, the cognitive assessment discards scores it judges unreliable, yet these came primarily from the most impaired women, suggesting that the true harm is likely greater than reported here. Such cognitive deficits may limit these women's capacity to live to their potential, including keeping safe from abuse. These findings underscore partner-inflicted brain injury as a major, under-recognized source of cognitive harm, potentially affecting more women than brain injury in professional football or the military while lacking comparable clinical recognition and care.

We used Scopus data on 243949 top-cited scientists to map scientific cosmopolitanism defined as having at least two different countries that contribute alone at least 10 percent of an author published record as indexed in Scopus. 20.4 percent of the top-cited authors were cosmopolitan based on this definition. Based on current author affiliation, rates varied widely from 9% to 76% across countries with at least 250 top-cited authors. Countries with few top-cited authors had almost always high rates of cosmopolitanism. The proportion of top-cited authors who are cosmopolitan has steadily increased over time in younger generations among those who started publishing after 1965 reaching 43% recently. Large differences were also seen across scientific subfields from 1% in General Psychology and Cognitive Sciences to 46% in Econometrics. Across the 30 country pairs that were most over-represented, countries shared borders, languages, most common religion pairs, or any of these features in 15, 19, 26, and 29 cases, respectively. The map of cosmopolitan authors reveals a large and increasing proportion of the most influential scientists who share two or more scientific homes that each has made a substantial contribution to their career. Cosmopolitanism among scientists requires better study to help facilitate its potential positive contributions not only to individual scientists but to science and society more broadly.

Background: Virtual and Augmented Reality (VR/AR) are increasingly used in medicine and may offer novel interventions for Functional Neurological Disorder (FND) by targeting mechanisms of impaired motor control. However, evidence for the effect of different modalities on movement in FND is limited. Moreover, it is hypothesized that visual feedback of one s affected arm could reinforce FND symptoms through maladaptive self-monitoring. The present study aims to compare motor performance under visual feedback of a virtual avatar versus the real arm. Methods: Fifteen FND patients and eighteen healthy controls completed a dual motor reaching task (touching a virtual fruit such as orange or apple appearing in front of them) with a virtual headset across three modalities: Augmented Reality (AR), where participants saw their real arm; Virtual Reality (VR), with a virtual arm; and Virtual Reality Improved (VRI), with artificially enhanced straightness and larger collision zone with the target. Their movement speed, straightness and number of velocity peaks were calculated for each fruit catch. Additionally, the number of collisions between the eyes and the body was calculated with eye tracking technology. Results: FND participants were slower and produced less smooth movements in AR compared to VR (b = 1.09, z = 8.83, P < .001) and VRI (b = 0.85, z = 6.91, P < .001), while the opposite effect was found in healthy controls. Eye tracking showed that FND patients looked more at their affected hand than unaffected hand (b = -1.46, SE = 0.34, z = -4.23, p < .001; OR = 0.23). Conclusions: Virtual feedback of their limbs avatar appears to support better motor performance, while visual feedback of their real limb appears to exacerbate motor impairments in FND patients, likely reinforcing maladaptive self-monitoring. These findings highlight the therapeutic potential of VR interventions and provide the basis for future studies examining longer protocols, clinical outcome and potential implementation in standard motor rehabilitation.

PurposeDiscussions surrounding the biomedical faculty job market often focus on applicant competitiveness and external metrics such as number of publications and funding records. Consequently, there is typically less discussion about applicant readiness, the point at which applicants perceive themselves as prepared to enter the market. Since 2018 our group, the Faculty Job Market Collaboration (FJMC), has conducted annual end-of-cycle surveys of biomedical faculty job applicants, producing the largest longitudinal dataset on this process to date. MethodsWe employed a mixed-methods design examining faculty applicants in biological science fields in North America. Regression analyses were conducted on a longitudinal dataset of 729 respondents across multiple hiring cycles. To determine how applicants evaluated their own preparation, qualitative interviews were conducted with a separate cohort of biomedical postdoctoral applicants during the 2024-2026 job cycles. ResultsOur findings demonstrate that rather than depending on a single quantitative threshold, readiness is a multifaceted construct shaped by actionable and interpersonal drivers. Key factors influencing an applicants perceived readiness include taking agency to submit applications, receiving explicit support from a mentor, incorporating strategic use of artificial intelligence tools into application preparation, and their career stage. ConclusionBy distinguishing individual readiness from systemic assumptions of market competitiveness, this study highlights a blind spot in academic workforce development. Our results suggest that applicants can achieve readiness and successful outcomes through different combinations of support, strategy, and timing rather than a uniform metric profile. By integrating quantitative and qualitative data, our study provides an evidence-based framework for understanding applicant readiness and offers practical guidance to help trainees navigate the increasingly competitive academic job market. Teaser TextOur mixed-model analysis of the biomedical faculty job market is designed to help prospective faculty candidates assess their readiness to enter the job market. By integrating multiple indicators of academic productivity, funding success, and professional experience, our study provides evidence-based benchmarks that can guide applicants in evaluating their competitiveness and identifying areas for further development before pursuing faculty positions.

Background: Unruptured intracranial aneurysms (UIAs) are increasingly identified incidentally, and management balances rupture risk against treatment risk. UIA diagnosis has been linked to psychological distress, but psychotropic medication initiation after UIA discovery has not been compared across the full UIA management spectrum. Methods: We conducted a retrospective cohort study using IBM MarketScan claims (CCAE, MDCD, and MDCR; 2009-2023) among adults with a UIA diagnosis, continuous enrollment for 365 days before and after the index date, and no SAH/rupture on or before the index date. We compared the prevalence of 6 mental-health diagnoses before versus after UIA discovery and used adjusted logistic regression to examine psychotropic medication initiation within 365 days by management strategy (untreated observation as the reference). Results: Among 54,945 patients (untreated, 78.5%; endovascular, 11.3%; clipping, 3.0%; other/uncertain, 7.2%), prevalence of every mental-health diagnosis was higher after UIA discovery, most for depression (+4.6 percentage points) and anxiety (+4.5 points). Medication initiation was most common for benzodiazepines (8.7%). Endovascular treatment was associated with higher adjusted odds of benzodiazepine (aOR, 1.21), SSRI (aOR, 1.20), and sedative-hypnotic (aOR, 1.25) initiation.Surgical clipping demonstrated the broadest association, with higher odds across 5 of 6 classes, including benzodiazepines (aOR, 1.71) and sedative-hypnotics (aOR, 1.86). Benzodiazepines had the lowest 1-year persistence (10.5%) despite being the most commonly initiated class. Findings were consistent across sensitivity analyses, with the exception of the increase in panic disorder, which was no longer observed after applying a 30-day post-index lag. Conclusions: Mental-health diagnoses and psychotropic medication initiation increased after UIA discovery, and medication initiation was most pronounced among patients treated with surgical clipping. These findings support psychological assessment as part of aneurysm management regardless of strategy.

Objectives To explore the acceptability and tolerability of cranial electrotherapy stimulation (CES) using Alpha-Stim AID as a potential intervention for anxiety associated with breathlessness in people with advanced chronic respiratory disease. Methods A multicentre, mixed-methods, non-randomised interventional feasibility study with a parallel usual-care control group. Participants were adults with chronic respiratory disease and significant anxiety and breathlessness symptoms (assessed via Integrated Palliative Outcome Scale) receiving care from hospice services. The intervention groups used Alpha-Stim AID for eight weeks either at a fixed or personalised dose, followed by a four-week follow-up period. This feasibility study was not powered to assess clinical efficacy. Results 12.5% of screened patients at the primary site were eligible, and 29 unique participants were recruited. Three participants withdrew from the study (10.3%), none of which were attributable to CES. Most adverse events were mild, with headache reported frequently across control and intervention groups. Outcome measure completion was high, with data missingness below 6.4%. Numerical rating scales of anxiety and breathlessness fluctuated daily and remained broadly static, whereas GAD-7 scores assessing anxiety improved over time across all groups. This feasibility study was not powered to assess clinical efficacy. Conclusion CES using Alpha-Stim AID was deliverable within hospice services and was generally acceptable and tolerable among participants who enrolled. Our findings support further evaluation which should involve a fully-powered randomised controlled trial against a sham device to determine whether CES provides clinically meaningful improvements in anxiety for this patient population.

Background Training in grant proposal writing is an essential component of professional development for academic scientists in the biomedical and behavioral sciences. Despite the expansion of inter- and intra-institutional grant writing coaching groups as an approach to honing these skills, specific features that enhance or limit coaching group effectiveness have not been rigorously studied. Methods Qualitative inerviews were conducted with a subset of early-career investigators (n=204 and coaches (n=36) engaged in a national, U.S. based, group-randomized trial of grant writing coaching groups to test the effects of two variables on submission and funding of national-level proposals: (1) coaching duration (regular/extended dose) and (2) mode of engaging a scientific advisor (someone with content-aligned expertise) in the coaching process. This report focuses on interviews conducted upon completion of the regular coaching dose - 5 months of biweekly, group-based coaching sessions to support active proposal writing. Interviews were designed to identify which coaching group elements were perceived to be the most critical. Transcribed interviews were analyzed using deductive (participants) or open (coaches) coding to identify themes. Results Triangulation of results from participant and coach interviews showed strong concordance that coaches, peers, and scientific advisors all played key roles in supporting intervention efficacy. Sufficient alignment of scientific fields and/or methodologies among group members was important, although breadth of perspectives was also valued. Other critical group features were skilled and well-organized coaches, detailed feedback, peer-to-peer support (technical and psychosocial), and clear expectations for group functioning. Factors attenuating impact included variation in participants' engagement and "readiness to write," within-group mismatches of expertise or grant mechanisms, and limited research support at some participants' home institutions. Conclusion This study identified key elements of successful grant writing coaching groups and potential barriers to their effectiveness, while yielding insights about tailoring this approach for individuals at different stages of proposal development.

Background: Neuroanatomy poses a significant challenge for Psychology students due to its spatial and conceptual complexity. Educational approaches that enhance the relevance and visualization of neuroanatomical content may improve students learning experiences. This study implemented a tractography-based activity focused on the virtual dissection of the arcuate fasciculus, a major white matter pathway, in undergraduate Psychology students and examined the relationships between perceived learning and students perceptions of utility, difficulty and handling, and organizational aspects of the activity. Methods: First-year undergraduate Psychology students participated in a two-session tractography-based activity combining instruction on white matter anatomy and diffusion tractography with a hands-on virtual dissection of the arcuate fasciculus using research-grade software routinely employed in neuroscience research. Following the activity, students completed an anonymous questionnaire assessing perceived learning, utility, difficulty and handling, and organizational aspects of the activity. Pearson correlations, multiple regression analyses, and relative importance analyses were performed. Results: Sixty-eight students completed the questionnaire. Students reported generally positive perceptions of the activity across the evaluated dimensions, with perceived learning receiving the highest mean score (M = 3.44, SD = .85). Perceived utility showed the strongest association with perceived learning (r = .64, p < .001). The regression model explained 41% of the variance in perceived learning (R2 = .41, adjusted R2 = .38, p < .001). Perceived utility was the only significant predictor in the model ({beta} = .59, p = .001), accounting for 67.9% of the explained variance. Conclusions: The findings support the feasibility of integrating authentic neuroimaging tools into undergraduate neuroanatomy teaching. Students who perceived the activity as more useful also reported higher perceived learning outcomes, with perceived utility emerging as the strongest predictor of perceived learning. In contrast, perceived difficulty and handling, and organizational aspects did not make significant independent contributions. These results suggest that students perceptions of educational relevance may play an important role in technology-enhanced STEM learning experiences.