Chronic insufficient sleep kills! Although this statement has high 'face validity', it is only recently that empirical evidence existed to support it. There are now sufficient data for numerous meta-analyses and systematic reviews to demonstrate that chronic insufficient sleep is associated with many inflammatory pathologies that are a public health burden. As a result, it is now well accepted that sleep is important for physical and mental health. This awareness derives from research that began in the late 19th and early 20th centuries and continues to the present day. In this narrative review we trace this rich history within the context of the research contributions of Professor James Krueger and his colleagues. The historic and current research by Professor Krueger and colleagues is fundamental to the many ongoing pre-clinical and clinical research programs focused on all aspects of sleep and immune health.

Open reduction and internal fixation (ORIF) of proximal humerus fractures (PHFs) is a challenging operation with high rates of loss of reduction, screw cut out, avascular necrosis, and subsequent unplanned reoperation. Augmentation of the repair with synthetic bone fillers and other alternatives has shown promise in decreasing adverse outcomes. Our aim is to report radiographic and clinical outcome of impaction grafting with cancellous allograft chips and injection of magnesium-based bone filler for ORIF augmentation of PHFs.

All patients that underwent ORIF for a 3- or 4-part PHF with the standardized protocol with a minimum of 6 months radiographic follow-up by a single surgeon (VE) were included. Radiographs were taken at standardized time points up to 6 months, followed by a final radiographic follow-up, to define radiographic healing or failure. Patient-reported outcome measures were collected at final follow-up. Patient characteristics, complications, reoperations and radiographic measures of reduction quality were also recorded.

17 patients were identified with a mean 34.1 months of radiographic follow-up. Median Penn Shoulder Score was 89 (interquartile range 19), American Shoulder and Elbow Surgeons score was 92 (25), Veterans RAND 12-Item Health Survey Mental Component Score was 53.9 (11.9), Veterans RAND 12-Item Health Survey Physical Component Score was 51.6 (12.8), and Single Assessment Numerical Assessment was 85 (18.5). 14 patients (82.3%) had routine radiographic healing. Two patients (11.8%) developed avascular necrosis with screw cutout. Two patients (11.8%) had reoperation including one hardware removal and one conversion to reverse total shoulder arthroplasty for a subsequent rotator cuff tear. No signs of glenohumeral arthritis were present in 12/17 patients (70.6%), and no signs of cuff tear arthropathy were noted in 13/17 patients (76%). Seven out of nine (78%) patients who worked prior to injury returned to work at a mean of 14.7 weeks postoperatively.

Augmentation of 3- and 4-part proximal humeral fractures with a standardized protocol utilizing cancellous chips and a synthetic magnesium-based bone filler results in a high rate of maintenance of fracture reduction, radiographic healing, and satisfactory patient outcomes. Further comparative data is needed to evaluate the efficacy of this technique compared to alternative methods of augmentation.

To investigate associations between cognitive status and retinal parameters in older adults.

The population-based Beichen Eye Study (BCES) recruited 5840 older adults from Tianjin, China. Retinal thickness and vessel density (VD) were measured using optical coherence tomography angiography (OCT/OCTA). Cognitive function was assessed via the Mini-Mental State Examination (MMSE). Participants with gradable images and valid MMSE scores (n = 3606) were analyzed.

Cognitive impairment (CI) was identified in 32.7% of participants. Compared to non-CI individuals, those with CI exhibited reduced average retinal thickness (p = 0.007) and choroid thickness (p < 0.001). Superficial VD (VD_SVP) was significantly higher in moderate to severe CI compared to mild CI (p = 0.030). Linear mixed-effects regression demonstrated positive correlations between MMSE scores and retinal parameters (r = 0.518 to 0.530).

Retinal thinning may occur in mild CI, with VD changes as CI progresses. Choroidal thinning is a potential cognitive indicator. OCT/OCTA, as a non-invasive tool, offers potential for early cognitive disorder screening in aging populations.

Retinal thinning (average retinal thickness: p = 0.007) and choroidal thinning (p < 0.001) are significantly associated with CI in older adults.A paradoxical increase in VD_SVP was observed in moderate to severe CI (p = 0.030), suggesting compensatory vascular remodeling.Choroidal thickness emerges as a robust biomarker for cognitive decline (correlation coefficient range: 0.518 to 0.530).The large-scale population-based study (n = 5840) was conducted integrating OCT/OCTA imaging with MMSE cognitive assessments.The study supports OCT/OCTA as a noninvasive, cost-effective screening tool for early detection of cognitive disorders in resource-limited settings.The study highlights vascular risk management (e.g., glycemic control, smoking cessation) as a dual target for retinal and cognitive health.

Feeding difficulties, such as limited appetite, selective eating, and food phobia, affect caregivers' ability to provide adequate nutrition to children. These issues impact 25%-40% of non-neurodivergent children and up 80% of neurodivergent children.

This review examines how family involvement influences the improvement, worsening, or maintenance of feeding difficulties in neurodivergent and non-neurodivergent preschool and school-age children.

An integrative review was conducted using Embase, PubMed, Scopus, Cochrane Library, Lilacs and grey literature (Google Scholar and Connect Papers). The review focused on randomized clinical trials (RCTs) involving parents or caregivers of children aged 2-10 years, assessing lifestyle or psychological interventions.

From 1,257 studies, 885 primary articles were screened. Of the 100 most recent articles on grey literature, 2 met the eligibility criteria after full-text assessment and were therefore included in the review. Thirty-six studies were reviewed in full, leading to 11 RCTs with 630 children aged 1 to 14. Interventions included behavioral education, sensory education, and cooking classes. Findings indicated increased vegetable acceptance in two studies, improved feeding difficulties scores in five, and reduced avoidant/restrictive food intake disorder (ARFID) symptoms in two studies. One study showed no significant differences between control and intervention groups.

Family-involved interventions generally produced positive outcomes in managing feeding difficulties. However, methodological variability and the predominance of studies from high-income countries limit the generalizability of these results. Future research should focus on standardizing diagnostic criteria and developing culturally sensitive interventions.

Executive dysfunction is a core feature of frontotemporal dementia (FTD). While there has been extensive research into such impairments in sporadic FTD, there has been little research in the familial forms.

Seven hundred fifty-two individuals were recruited in total: 214 C9orf72; 205 progranulin (GRN) and 86 microtubule associated protein tau (MAPT) mutation carriers, stratified into asymptomatic, prodromal, and fully symptomatic; and 247 mutation-negative controls. Attention and executive function were measured using the Weschler Memory Scale-Revised (WMS-R) Digit Span Backwards (DSB), Wechsler Adult Intelligence Scale-Revised Digit Symbol task, Trail Making Test Parts A and B, and the Delis-Kaplan Executive Function System Color Word Interference Test. Linear regression models with bootstrapping were used to assess differences between groups. Correlation of task score with disease severity was also performed, as well as an analysis of the neuroanatomical correlates of each task.

Fully symptomatic C9orf72, GRN, and MAPT mutation carriers were significantly impaired on all tasks compared with controls (all p < 0.001), except on the WMS-R DSB in the MAPT mutation carriers (p = 0.147). While asymptomatic and prodromal C9orf72 individuals also demonstrated differences compared with controls, neither the GRN or MAPT asymptomatic or prodromal mutation carriers showed significant deficits. All tasks were significantly correlated with disease severity in each of the genetic groups (all p < 0.001).

Some individuals with C9orf72 mutations show difficulties with executive function from very early on in the disease and this continues to deteriorate with disease severity. By contrast, similar difficulties occur only in the later stages of the disease in GRN and MAPT mutation carriers. This differential performance across the genetic groups will be important in neuropsychological task selection in upcoming clinical trials.

Atrial fibrillation (AF) is characterized by heterogeneity in presentation, comorbidity profile and prognosis, with different AF subphenotypes having been previously suggested. Mental health disorders are common in the AF population. The current classification of AF, based on episode duration, fails to capture the complexity of the condition. Machine learning (ML) techniques and utilization of information on mental health disorders might improve identification of different and actionable AF subphenotypes.

We utilized Nationwide UK data from the Clinical Practice Research Datalink (199 308 AF patients; age 75.4 ± 12.6; 49.2% women) and unsupervised ML for clustering (k-means). Twenty-five clinical features were used in the model, including the presence of mental health disorders (anxiety, depression, and psychosis). Outcomes were assessed at 5 years across different clusters. We identified five different clusters of AF patients with specific characteristics and behaviour. Clusters were labelled based on the most prevalent features: (i) elderly and cardiopaths; (ii) young age and mental health disease; (iii) elderly and hypertensive; (iv) middle age and depression; and (v) very elderly. Mental health disorders were present in 18% at baseline. When comparing across the different clusters, significant differences were observed for the rates of the different assessed outcomes: higher mortality, heart failure and dementia in cluster (v), cancer and anxiety or depression in cluster (iii).

Using unsupervised clustering we identified five distinct clinically actionable AF subphenotypes. The differences in outcomes and event rates at 5 years, suggests the possibility of specific tailored therapy and interventions requiring further investigation. Management of mental health should be part of holistic or integrated care management in this population.

The integration of computational methods into psychiatry presents profound ethical challenges that extend beyond existing guidelines for AI and healthcare. While precision medicine and digital mental health tools offer transformative potential, they also raise concerns about privacy, algorithmic bias, transparency, and the erosion of clinical judgment. This article introduces the Integrated Ethical Approach for Computational Psychiatry (IEACP) framework, developed through a conceptual synthesis of 83 studies. The framework comprises five procedural stages - Identification, Analysis, Decision-making, Implementation, and Review - each informed by six core ethical values - beneficence, autonomy, justice, privacy, transparency, and scientific integrity. By systematically addressing ethical dilemmas inherent in computational psychiatry, the IEACP provides clinicians, researchers, and policymakers with structured decision-making processes that support patient-centered, culturally sensitive, and equitable AI implementation. Through case studies, we demonstrate framework adaptability to real-world applications, underscoring the necessity of ethical innovation alongside technological progress in psychiatric care.

Unemployment rates among individuals with substance use disorders (SUD) are high, and evidence-based vocational methods are lacking. Employment is important because it improves treatment outcomes and protects against relapse. Individual Placement and Support (IPS) has proven effective in helping patients with psychosis obtain competitive employment. We aimed to investigate the effectiveness of IPS on vocational outcomes for patients with SUD.

Randomized controlled trial.

SUD treatment units at Oslo University Hospital, Norway.

Patients with SUD who wanted to obtain competitive employment. A total of 202 SUD patients were included in the trial, of which eight withdrew consent, five died and two were erroneously included, giving a modified intention to treat analysis set of 187 participants, of which 91 were randomized to IPS and 96 to the enhanced control group condition.

Treatment as usual plus IPS for up to 13 months versus treatment as usual, a self-help guidebook, a workshop of three two-hour sessions and one session of individual counselling.

Employment data were obtained from Statistics Norway and linked with study data. Primary outcome was at least one day of competitive employment during an 18-month period after inclusion in the trial. Secondary employment-related outcomes described job tenure, number of different jobs, hours worked and employment earnings during the same period.

There was no difference between the groups in the main outcome [39.6% vs. 34.4%; odds ratio (OR) = 1.28, 95% confidence interval (CI) = 0.70-2.35], but participants in the IPS group worked more hours (601 vs. 344; b = 330, 95% CI = 25-635) and had higher total salary in Norwegian krone (141 000 vs 73 000; b = 94 000, 95% CI = 17000-170 000) than control group participants. Control group participants were more likely to receive services from the Social and Welfare Services (53.1% vs. 27.5%; OR = 2.99, 95% CI = 1.64-5.57).

In this randomized controlled trial of Individual Placement and Support (IPS) versus enhanced self-help for individuals with substance use disorders in Norway, there was no difference between groups regarding job acquisition, defined as at least one day of competitive employment during an 18-month period; however, IPS participants worked more hours and earned a higher total salary than control group participants.

Psilocybin has emerged as a potential treatment for alcohol use disorder (AUD), but early efficacy data are inconsistent. Depression following alcohol detoxification significantly increases the risk of relapse. This pilot study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of psilocybin-assisted psychotherapy for patients with comorbid AUD and depression.

A prospective, single-center, double-blind, parallel (2:1), randomized controlled pilot study.

The study was conducted in a French inpatient addiction treatment program offering intensive relapse prevention interventions.

Of 350 screened patients, 30 adults (mean age 49 ± 10 years; 43% female) with severe AUD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5] criteria) and a Beck Depression Inventory-II (BDI-II) score ≥14 were included. Participants had completed detoxification between 14 and 60 days prior to inclusion.

Participants received either two oral sessions of 25 mg (n = 20) or 1 mg (n = 10) psilocybin-assisted psychotherapy spaced three weeks apart, as an add-on to standard care. Patients, investigators and outcome assessors were all blinded to patient group.

The primary outcome was feasibility, according to participation in both dosing sessions and recruitment/inclusion rates. Secondary outcomes included alcohol use (Alcohol Timeline Followback), time to relapse, craving (Craving Experience Questionnaire), depression (BDI-II), safety and blinding integrity.

One participant in the 25 mg group could not receive the second dose due to myocardial infarction occurring three days earlier, unrelated to the treatment. Four participants in the control group refused the second session after guessing their group assignment (p-value = 0.019), with one participant self-administering 3,4-Methylenedioxymethamphetamine (MDMA). At 12 weeks, the 25 mg group showed significantly greater abstinent rate (11/20 (55%) vs 1/9 (11%) (one lost of follow up) (difference = -44%, [95% confidence interval [CI]: -82% to -5.9%]), p = 0.043), reductions in % drinking days -100 (-100 to -49) vs - 93 (-96 to 0), p = 0.038 and craving frequency -8 (-23 to -1) vs + 7 (-2 to 11), p = 0.045, respectively in the 25 vs 1 mg groups (median [25;75]). Relapse rates were 35% in the 25 mg group and 50% in the control group (HR = 0.52 [0.16 to1.65]). No efficacy differences were observed based on antidepressant use in terms of drinking and depression. Blinding was imperfect (correct guess by patients: 93.3%; investigators: 86.7%). Twenty-five adverse events were reported in 10 patients (50%) in the 25 mg group versus 6 patients (60%) in the control group.

Psilocybin-assisted psychotherapy appears feasible, acceptable, and safe in recently detoxified patients with comorbid alcohol use disorder and depression.

Australia has seen the emergence of Clinical Ethics Support Services (CESS) across health care settings over recent decades, with the exception of prison health services which can present inherent complex ethical challenges. The purpose of this paper is a descriptive report of the implementation of a CESS in a prison health service.

A literature review was done to inform the implementation of a CESS by a prison health service. Different CESS delivery models were considered and expert advice obtained from an external clinical bioethicist. A Clinical Ethics Advisory Panel (CEAP) was established and accepted referrals between October 2022 and October 2024. A preliminary review of referrals was conducted to consider whether the CEAP was achieving its objectives.

The CEAP was implemented with a membership that comprised clinical and nonclinical representatives. The CEAP received seven referrals over 24 months from staff of the organization. Six out of seven (86%) referrals involved a clinical operational issue. One referral (14%) involved an individual clinical scenario in addition to a clinical operational issue. All referrals were initiated by senior medical management.

The CEAP has had a beneficial role in supporting staff with responsibility for ethical decision making in a prison health service. CESS can potentially provide an important source of support for frontline clinical staff and clinical management but requires further evaluation.

The implementation of a CESS in a prison health context is rarely described in the literature.