IntroductionAutistic adults face persistent challenges in obtaining and sustaining meaningful employment. Despite growing attention to workplace inclusion, research on autistic adults’ employment experiences in non-Western contexts remains scarce. The potential of emerging technologies, such as large language models (LLMs), to support workplace integration is also still largely unexplored, yet off-the-shelf models may reflect neurotypical norms that risk reinforcing masking or overlooking neurodivergent needs. This qualitative, participatory study therefore centered autistic adults’ perspectives to understand workplace experiences and identify potential LLM affordances that could facilitate integration.MethodsTwenty autistic adults with at least 3 months of work experience were recruited in Singapore. Data was collected through semi-structured group discussions. Using reflexive thematic analysis, we identified workplace challenges, needs, and potential support LLMs can provide. We had a multidisciplinary team of autistic and non-autistic researchers, and autistic perspectives actively shaped the design, conduct, and interpretation of the research.ResultsTwo overarching themes emerged: (1) assumed neurotypicality of the workplace, evident in work processes and social participation, and (2) need for workplace inclusivity, supported through both individual accommodations and systemic change, including identity-affirming support, alignment of work design and tools with neurodivergent working styles, empowered access to supports and accommodations, and shared responsibility for workplace integration. Potential LLM functionalities involve supporting executive functioning, encouraging self-reflection, and fostering mutual understanding between autistic employees and their coworkers.DiscussionWorkplace barriers for autistic employees often stem from assumed neurotypical norms rather than individual deficits. Participants reported challenges related to ambiguous work processes, implicit social expectations, and executive functioning demands, which reflect a mismatch between workplace structures and neurodivergent ways of working. Crucially, inclusivity cannot rely solely on individual accommodations; meaningful workplace inclusion requires systemic change. Designing LLM tools that align with neurodivergent working styles can complement systemic inclusivity efforts and empower autistic employees. Implications and future directions are discussed.
Microbiome biomarkers in autism spectrum disorder: Toward prediction, diagnosis, and prognosis
Wong et al. review gut microbiota biomarkers for ASD, detailing gut-brain axis mechanisms, biomarker evolution from taxonomic profiling to multi-omics and multi-kingdom integration, key translational challenges, and actionable research guidelines to boost clinical utility for ASD diagnosis and prognosis.
Oncogenic Signaling Shaped by a Golgi Trafficking Protein Pair
A new study in Science Signaling identifies a previously overlooked control point in receptor tyrosine kinase (RTK) signaling, one that operates not at the plasma membrane, but at the Golgi. The research, published as “Oncogenic receptor tyrosine kinase signaling is driven by the Golgi protein GOLPH3 and its interaction with MYO18A,” reveals that the Golgi‑localized proteins GOLPH3 and MYO18A act together to route RTKs to the cell surface, thereby setting the strength of growth‑factor signaling across multiple pathways.
The work was led by Kyle Starost and colleagues at Case Western Reserve University School of Medicine and the University of California, San Diego. Their findings help explain why GOLPH3 is frequently amplified in human cancers and why its overexpression correlates with poor prognosis across tumor types.
RTKs such as EGFR, insulin receptor, and PDGFR are central drivers of proliferation and survival in many cancers. Although RTK inhibitors are widely used clinically, resistance often emerges, underscoring the need for alternative strategies that modulate signaling upstream of the receptor. The new study identifies one such upstream node: the delivery of RTKs from the Golgi to the plasma membrane.
Using an unbiased signaling analysis, the team found that siRNA knockdown of GOLPH3 or MYO18A impaired phosphorylation of EGFR at Tyr1068 and Tyr1086, as well as downstream AKT and ERK signaling. These defects persisted even when PI3K/AKT/mTOR signaling was pharmacologically blocked, demonstrating that GOLPH3 acts directly at the receptor level rather than through mTOR modulation.
To pinpoint the mechanism, the researchers turned to trafficking assays. Imaging of endogenous EGFR showed that loss of GOLPH3 or MYO18A caused the receptor to accumulate in intracellular puncta rather than at the plasma membrane. A quantitative PDGFR‑GFP surface‑delivery assay confirmed that both proteins are required for Golgi‑to‑surface transport. Treatment with brefeldin A or golgicide A, which disrupt Golgi structure, produced similar reductions in surface receptor levels, reinforcing the conclusion that the GOLPH3–MYO18A complex is essential for RTK delivery.
Overexpression experiments completed the mechanistic picture. Increasing GOLPH3 or MYO18A levels enhanced EGF‑stimulated phosphorylation of EGFR and AKT, while a GOLPH3 mutant unable to bind PI4P failed to do so. These results position the GOLPH3–MYO18A complex as a central determinant of RTK availability at the cell surface.
The authors wrote, “The GOLPH3-MYO18A complex at the Golgi apparatus was required and rate-limiting for RTK signaling across the cell types and receptors assessed.” The findings suggest that targeting Golgi‑based trafficking machinery could offer a new therapeutic angle for tumors that rely on hyperactive RTK signaling or have developed resistance to RTK inhibitors.
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Undergraduate Nursing Students’ Experiences of Individualized Digital Reminiscence Using the InspireD App in Care Home Placements: Qualitative Focus Group Study
<strong>Background:</strong> Care home placements offer important opportunities for student nurses to develop relational and person-centered approaches to dementia care. Digital reminiscence platforms are increasingly used to support the well-being of people living with dementia; however, little is known about how such platforms may shape student learning within practice settings. There is limited qualitative evidence examining how digital reminiscence is experienced by students and how it influences their understanding of personhood, relationships, and care practices. <strong>Objective:</strong> The aim of the study is to explore undergraduate nursing students’ experiences of engaging with individualized digital reminiscence using the InspireD reminiscence app during care home placements. <strong>Methods:</strong> Following a pilot implementation of the intervention, a qualitative exploratory study was conducted, in which 13 undergraduate nursing students participated in 4 focus groups. Data were analyzed using reflexive thematic analysis. <strong>Results:</strong> Three themes were developed to capture how participants made sense of their learning and practice experiences when engaging with individual reminiscence using the InspireD reminiscence app. The first theme, “deepening empathy and understanding through reminiscence,” describes how participants developed a greater appreciation of residents’ life histories and personhood. The second theme, “learning through connection,” reflects how relationships with residents and families shaped communication, confidence, and emotional engagement. The third theme, “growing as person-centered practitioners within the realities of care home practice,” highlights how participants reflected on translating this learning into practice while navigating organizational constraints and everyday care demands. <strong>Conclusions:</strong> Findings suggest that the InspireD reminiscence app can support the development of person-centered learning within care home placements, although successful implementation is contingent on supportive organizational cultures. These findings contribute to wider discussions in health professions education by illustrating how digital platforms can mediate experiential learning in practice settings and support the preparation of future health professionals to use digital tools in relational and values-based ways. Future research should examine longer-term learning outcomes and implementation across diverse placement contexts.
COVID-19 Knowledge, Attitudes, and Practices and Perceived Risk: Cross-Sectional Mixed Methods Study
Background: The COVID-19 pandemic was marked by rapidly evolving and inconsistent public health messaging, contributing to confusion regarding recommended preventive behaviors. Knowledge, attitudes, and practices (KAP) and perceived risk frameworks offer a structured approach to examine how education, personal beliefs, and contextual factors influence health behaviors during public health emergencies. Vulnerable populations, such as patients with multiple sclerosis (MS), experience heightened risk perception compared with the general population, which may further shape behavioral responses. Objective: This study aimed to examine COVID-19–related KAP and perceived risk among patients with MS, health care providers, and laypeople during the first 6 months of the pandemic. The aim of mixed methods was to explore quantitative factors associated with KAP and perceived risk and to qualitatively describe participants’ perceptions and emotional responses to the pandemic. Methods: A descriptive, cross-sectional, partially mixed methods explanatory sequential design was used. Participants were recruited using convenience sampling and completed an online demographic questionnaire and a COVID-19 KAP instrument that included perceived risk items. Quantitative data were analyzed using descriptive statistics and inferential analyses to examine group differences and associations between perceived risk and preventive behaviors. Chi-square testing was applied to compare perceived risk across groups, and correlational analyses were used to examine the relationships between perceived risk and behavioral practices. Qualitative comments provided by participants were analyzed using thematic analysis to further contextualize quantitative findings and to explore perceived risk experiences. Results: A total of 148 participants were included, comprising 43 (29%) individuals with MS, 50 (33.8%) health care providers, and 55 (37.2%) laypeople. Overall, 90% (n=133) of participants demonstrated basic knowledge of COVID-19 transmission and prevention. Attitudes toward public health guidance and self-reported preventive behaviors varied across groups. Lay participants most frequently reported a moderate perceived risk of COVID-19 infection, whereas participants with MS and health care providers more commonly reported high perceived risk (²=12.65, =.049). Neither immunosuppressive treatment status nor vaccine hesitancy significantly predicted perceived risk. However, higher perceived risk was significantly associated with greater avoidance of crowded and public places. Qualitative analysis yielded 5 interrelated themes describing participants’ perceived risk experiences: uncertainty related to evolving scientific information; anxiety regarding personal and family safety; fear of infection and long-term consequences; vulnerability, particularly among individuals with chronic illness and frontline exposure; and accountability toward protecting others through adherence to preventive measures. These themes provided contextual insight into the emotional and cognitive processes underlying reported attitudes and behaviors. Conclusions: Knowledge of COVID-19 is associated with favorable attitudes and engagement in preventive practices across populations. Differences in perceived risk highlight the importance of tailoring risk communication and educational strategies to specific populations. KAP-focused educational interventions that explicitly address uncertainty, emotional responses, and behavioral translation may strengthen preparedness and promote sustained protective behaviors during future public health emergencies. Trial Registration: ClinicalTrials.gov NCT07021716; https://clinicaltrials.gov/ct2/show/NCT07021716
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Effects of an Eye-Tracking Digital Serious Game on Cognitive Function in Mild Cognitive Impairment: Pilot Intervention Study
<strong>Background:</strong> Cognitive decline in aging populations underscores the need for early interventions in mild cognitive impairment (MCI), where pharmacological treatments show limited benefit. Eye-movement metrics serve as sensitive markers of cognitive deficits in MCI, and digital programs integrating these tasks offer scalable, data-driven training approaches. <strong>Objective:</strong> This study aimed to evaluate the effectiveness of a digital cognitive training program incorporating eye-movement tasks in individuals with MCI, and to determine whether eye-movement indicators can serve as objective markers of cognitive improvement. <strong>Methods:</strong> A total of 12 participants aged 60-85 years with MCI (Korean version of the Montreal Cognitive Assessment [K-MoCA] score of ≤22) completed baseline and postintervention assessments using the K-MoCA and Mini-Mental State Examination-Korean version (MMSE-K). Longitudinal changes in visuospatial attention and oculomotor performance were examined using Spearman correlations across sessions, and pre-post comparisons of eye-tracking metrics were conducted to assess training-related improvements. <strong>Results:</strong> Cognitive scores improved significantly, with K-MoCA increasing by 1.5 points (from mean 20.3, SD 1.1 to mean 21.8, SD 1.7; <i>P</i>=<i>.</i>004; Cohen <i>d</i>=1.38) and MMSE-K by 1.3 points (from mean 21.9, SD 2.0 to mean 23.2, SD 2.2; <i>P</i>=<i>.</i>002; Cohen <i>d</i>=1.29). Fixation duration decreased (<i>r</i>=0.248; <i>P</i>=<i>.</i>003), and saccade velocity increased (<i>r</i>=0.258; <i>P</i>=<i>.</i>002), indicating enhanced visual processing efficiency and faster attentional shifts, whereas fixation count and saccade amplitude showed no consistent changes. In addition, saccade duration decreased by 21.72 ms, and saccade velocity increased by 114.54 °/s. <strong>Conclusions:</strong> Digital cognitive training yielded measurable gains in visuospatial attention and oculomotor efficiency in MCI, with optimized fixation and saccade patterns indicating enhanced attentional control and information processing. These findings support eye-movement metrics as sensitive indicators of cognitive change and highlight digital interventions as scalable, noninvasive tools for cognitive support in aging populations.
Mobile App–Based Smoking Cessation in Hispanic or Latino Adults: Culturally Tailored Spanish-Language Formative App Development Study
Background: Despite the notable proliferation of smoking cessation mobile apps, to date, no validated, Spanish-language, culturally tailored mobile intervention exists for Spanish speakers in the United States. Objective: The aim of this study was to conduct formative research to inform the adaptation of an evidence-based smoking cessation intervention developed for Spanish-speaking Hispanic and Latino individuals from a printed format into a mobile app. Methods: Guided by a user-centered approach and in collaboration with product design industry experts, wireframes were developed to present the app’s layout and functionality. Focus groups were conducted over Zoom (Zoom Communications) with Spanish-speaking individuals who currently smoke to assess their previous mobile app experience, attitudes toward mobile apps, and feedback on app architecture and design. Two independent reviewers (RB in collaboration with another member from the qualitative core) trained in qualitative methods coded the focus group data using a thematic analysis approach and identified emerging themes. Results: The app wireframes included 4 navigation buttons on the home screen to organize and deliver evidence-based intervention content—Home (), Learn (), My Coach (), and Profile (). Different wireframe designs were generated in distinct color palettes. Data saturation was reached after three focus groups. Participants were 54% (7/13) women, had a mean age of 56 (SD 14.9) years, 39% (5/13) had an education ≤high school, and 31% (4/13) were married or cohabitating. All participants smoked daily, a mean of 14 (SD 7.8) cigarettes per day, for 32 (SD 16.9) years, and 54% (7/13) smoked ≤30 minutes of waking. Participants reported using social media, news, shopping, and gaming apps, but few used mobile health apps. Salient barriers for app use included worries regarding privacy breaches and fears about misinformation. Desired features included community-building elements, personalization, reward badges, knowledge checks, and audiovisual presentation of content within the app. Participants disliked having a countdown to quit date, preferring an “I quit” button to initiate monitoring progress. They also viewed sharing progress with support networks as a source of unwanted pressure, although a few saw it as motivational. Overall, participants liked the app design and indicated willingness to use it. Conclusions: This formative research provides critical insights into preferences related to the development of culturally tailored mobile smoking cessation interventions for Spanish-speaking individuals. Key findings highlighted enthusiasm for a smoking cessation app and the importance of including features that foster social connection and allow for personalization.
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Primary Care Physicians’ Interactions With a Novel Web-Based Active Learning Tool (The Community Fracture Capture Learning Hub): Qualitative Analysis
Background: Osteoporosis poses a significant global health burden and is responsible for over 8.9 million fragility fractures annually. Despite evidence-based guidelines and treatment, a substantial care gap persists, with only a low percentage of fracture patients receiving guideline-concordant care. Primary care physicians (PCPs) are pivotal in community-based fracture prevention but face challenges in translating knowledge into practice. While hospital-based fracture liaison services are effective, their reach is limited, necessitating scalable alternatives. Virtual communities of practice and web-based learning tools offer promising avenues for PCP professional education; however, their application in osteoporosis management remains underexplored. The Community Fracture Capture (CFC) Learning Hub was developed as an interactive, case-based platform to address these gaps by enhancing PCPs’ knowledge, confidence, and engagement in osteoporosis care. Objective: The study aimed to conduct a qualitative evaluation of PCPs’ interactions with the CFC Learning Hub, focusing on barriers and facilitators of the online learning tool and exploring PCP perceptions of the program. Methods: A qualitative analysis was performed using data from 55 PCPs across four 6-week cycles of the CFC Learning Hub (May 2022-October 2023). Data sources included discussion forum comments and responses to open-ended questions in end-of-cycle evaluations. Relational content analysis was used, with 2 researchers independently coding data using semantic and latent approaches. Themes were identified through iterative discussions and validated against existing literature. Results: Four themes emerged from PCP interactions: (1) user experience–guided platform design, where participants emphasized intuitive navigation, minimized fragmented sections, and clarity of interface as critical for engagement; (2) learning-supportive course structure, highlighting the importance of explicit links between case studies and foundational knowledge, weekly summaries, and quizzes aligned with content; (3) learners’ different styles and preferences, with diverging needs for synchronous vs asynchronous learning, didactic sessions, and peer-to-peer interactions; and (4) program content, where participants requested expanded topics and postprogram refreshers. Conclusions: The CFC Learning Hub demonstrated efficacy as a specialist- and peer-to-peer–supported online learning model for PCPs, addressing osteoporosis care gaps through user-centered design, adaptable content delivery, and collaborative moderation. Key successes included resolving usability issues iteratively and accommodating diverse learning preferences. These findings underscore the potential of the Hub to enhance primary care professional education and fracture prevention. The study advocates for broader adoption of the platform to bridge osteoporosis care disparities.
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Automated Safety Testing and Reporting Application for Conversational Safety Monitoring of Generative AI Tools for Mental Health: Development and Validation Study
<strong>Background:</strong> Artificial intelligence (AI)–based conversational tools are rapidly expanding within mental health care as a means of increasing access and scalability. At the same time, these systems introduce distinct safety risks arising from both user disclosures (eg, self-harm ideation) and inappropriate or inadequate AI responses. <strong>Objective:</strong> This study aimed to develop and evaluate the Automated Safety Testing and Reporting Application (ASTRA), an external system intended to identify clinically relevant risk behaviors across entire AI-mediated mental health conversations. <strong>Methods:</strong> ASTRA was tested on a dataset of 100 synthetic therapeutic conversations written by licensed clinicians to reflect risk behaviors and harmful responses between users and AI tools. Conversations varied in length and included both subtle and overt risk behavior examples across 8 predefined categories. Human coder consensus ratings served as the reference standard. ASTRA’s classifications were evaluated across 2 prompt iterations using standard diagnostic performance metrics and agreement statistics. <strong>Results:</strong> ASTRA demonstrated consistently high concordance with expert human ratings across all categories. Accuracy exceeded 0.90 for all risk behavior categories examined, with specificity uniformly high and sensitivity varying by category (range 0.55-1.00). Agreement beyond chance was substantial to almost perfect between ASTRA and human raters (κ=0.65-1.00). Detection of user self-harm indicators was particularly accurate, even in conversations where risk was expressed subtly. <strong>Conclusions:</strong> In this initial validation study, ASTRA reliably identified multiple forms of mental health–related risk behaviors at the conversation level. These findings support the feasibility of independent safety monitoring systems as a complement to AI tools used in mental health contexts and underscore the need for further evaluation using larger and real-world datasets.
Digitally Delivered Cognitive Behavioral Interventions for Alcohol and Other Drug Use: Meta-Analysis Across Consumption and Psychosocial Outcomes
<strong>Background:</strong> Cognitive behaviorally based interventions have broad appeal and potential for impact when treating adult alcohol and other drug use. Digitally delivered cognitive behaviorally based interventions (dCBIs) may offer this impact with the benefit of increased accessibility. Although prior reviews have indicated the benefits of dCBIs on substance use outcomes, the extension to psychosocial functioning outcomes is unknown. <strong>Objective:</strong> This meta-analysis provides an overview of dCBI effects across a range of functional end points. <strong>Methods:</strong> A literature search was conducted through October 2024. All primary and secondary reports of clinical trials of dCBI were obtained, and all available study end points were eligible for meta-analysis. Descriptive data were extracted and categorized into 1 of 13 different outcome types (eg, abstinence, quantity, cognitive, and quality of life) and into 2 broader outcome classes (ie, consumption and psychosocial). Robust variance estimation was used to conduct hypothesis tests on random effects pooled estimates with outcome class and comparison type as the primary subgroup variables of interest. <strong>Results:</strong> The study sample included 65 randomized trials (<i>K</i>=110 publications; 753 effect sizes) of dCBI for adult alcohol and other drug use. With respect to efficacy, dCBI as a stand-alone treatment in contrast to a minimal treatment control showed positive and statistically significant effects for consumption (<i>g</i>=0.27; <i>P<</i>.001; <i>I</i><sup>2</sup>=85.1%; <i>k</i>=31; <i>k<sub>es</sub></i>=134) and psychosocial (<i>g</i>=0.16; <i>P</i>=.008; <i>I</i><sup>2</sup>=75.2%; <i>k</i>=16; <i>k<sub>es</sub></i>=60) outcomes. As an addition to usual care, efficacy was demonstrated for consumption (<i>g</i>=0.23; <i>P<</i>.001; <i>I</i><sup>2</sup>=9.8%; <i>k</i>=20; <i>k<sub>es</sub></i>=65), but not psychosocial functioning. Efficacy compared to another digital or in-person intervention or cognitive behaviorally based intervention delivered by a therapist was not observed. Within the dCBI condition, large effect sizes were observed for both outcome classes (ie, 60%-80% of participants showed improvement relative to baseline), and effect size magnitude and statistical heterogeneity varied by the type of outcome examined. <strong>Conclusions:</strong> These results show a benefit for dCBI as a stand-alone therapy and an addition to usual care. Importantly, stand-alone effects were observed for both consumption and some psychosocial outcomes. This study is the first to offer a comprehensive look at dCBI intervention effects across a range of functional end points.
