PurposeTo compare electrooculogram (EOG) parameters between eyes with reticular macular disease (RMD) and eyes with early-to-intermediate age-related macular degeneration (AMD) without reticular pseudodrusen (RPD), and to assess whether RMD is associated with generalized RPE–photoreceptor complex dysfunction.MethodsIn this observational cross-sectional study, 42 eyes from 21 patients were analyzed (without-RPD group: 28 eyes; RMD group: 14 eyes). RMD was diagnosed using multimodal imaging (infrared reflectance and SD-OCT). EOGs were recorded with the RETI-port/scan 21 system according to ISCEV standards. Extracted parameters included dark trough (DT), light peak (LP), light rise time (Light Rise), and the LP:DT ratio. Group comparisons used the Wilcoxon rank-sum test. Linear regression evaluated the association between RMD and LP:DT ratio with and without adjustment for age.ResultsAge did not differ between groups (median 69 vs. 72 years; P = 0.5). Absolute standing potentials were similar (DT: 598 vs. 681 μV, P = 0.2; LP: 1,092 vs. 1,150 μV, P = 0.8). Light rise time was also similar (8.00 [IQR 7.50–9.00] vs. 8.00 [IQR 7.00–9.00] min; P = 0.6). In contrast, the LP:DT ratio was significantly reduced in RMD (1.65 [1.50–1.80]) compared with without-RPD controls (1.90 [1.80–2.10]; P = 0.0043). RMD was independently associated with a lower LP:DT ratio (β = −0.25, 95% CI [−0.41 to −0.09]; P = 0.004).ConclusionCompared with AMD eyes without RPD, RMD eyes demonstrate a selectively reduced LP:DT ratio without a change in absolute standing potentials or light rise timing. This EOG pattern supports attenuated light response consistent with generalized dysfunction of the RPE–photoreceptor complex in RMD.
Modelling learning dynamics in autism therapy through explainable multimodal representation learning
BackgroundAutism Spectrum Disorder (ASD) presents with complex, temporally evolving motor and social behaviours that are difficult to quantify in ecologically valid clinical contexts. While recent computational methods offer diagnostic insights, many depend on fully supervised learning, high-resolution video, or artificial experimental constraints, limiting scalability, interpretability, and privacy compliance. Few approaches leverage unsupervised models to uncover dynamic behavioural structure from minimally invasive inputs.MethodsTo address these limitations, we propose a privacy-preserving, unsupervised representation learning framework that operates solely on skeletal pose and optical flow features. Using 255 multimodal windows from 15 therapy sessions in the MMASD corpus, a publicly available, privacy-safe dataset of child-clinician interactions, we train a denoising temporal autoencoder to derive compact latent embeddings of behaviour.ResultsThe model uncovers a low-dimensional behavioural manifold composed of six latent motor clusters. Transition graphs reveal structured topologies, including behavioural hubs and bottlenecks. Saliency analyses identify anatomically and socially relevant features, such as joint pairs (LWrist-LAnkle, Neck-Rear Head) and dynamic flow regions (e.g., index pair 7, 14). Temporal saliency, based on reconstruction error, highlights spontaneous gesture onsets and socially salient events. KL divergence between early and late session phases quantified intra-session adaptation (range: 0.06–17.7) and showed a strong negative correlation with joint attention duration (r = −0.96, p = 0.002), suggesting links between behavioural dynamics and social engagement.DiscussionThese findings offer preliminary evidence that interpretable behavioural structure can be extracted from low-resolution, privacy-compliant inputs. While based on a limited sample, the framework illustrates potential for modeling learning dynamics, identifying salient motor patterns, and supporting objective progress tracking in ASD therapy. Future work will involve clinical validation and application to larger, longitudinal datasets to assess generalizability and therapeutic utility.
Circadian–immune crosstalk in insomnia disorder: mechanisms and therapeutic implications
Insomnia disorder (ID) is a common sleep–wake disorder characterized by persistent difficulty initiating or maintaining sleep, early-morning awakening, or non-restorative sleep, accompanied by daytime functional impairment. ID has traditionally been explained by the hyperarousal model, which emphasizes cognitive, emotional, cortical, neuroendocrine, and autonomic overactivation. However, this model alone does not fully account for the chronic persistence, relapse tendency, and multisystem associations of ID. Emerging evidence suggests that circadian rhythm disruption, impaired melatonin signaling, hypothalamic–pituitary–adrenal (HPA) axis activation, autonomic imbalance, and low-grade inflammation may also contribute to the development and maintenance of ID. Available evidence indicates that sleep disturbance is more consistently associated with selected inflammatory markers, particularly C-reactive protein (CRP) and interleukin-6 (IL-6), whereas findings for tumor necrosis factor-alpha (TNF-α) remain less consistent. The circadian system regulates sleep, endocrine function, metabolism, and immune-inflammatory activity through the suprachiasmatic nucleus, melatonin and cortisol rhythms, peripheral clock genes, and rhythmic immune-cell responses. Disruption of this temporal network may alter melatonin secretion, inflammatory rhythmicity, and stress-related neuroendocrine responses, thereby contributing to the persistence of insomnia symptoms. Compared with previous reviews that have separately discussed hyperarousal, circadian rhythm disruption, melatonin signaling, or sleep-related inflammation, this review integrates these processes into a circadian–immune perspective for understanding ID. We summarize alterations in sleep–wake rhythms, melatonin signaling, HPA-axis activity, autonomic regulation, and immune-inflammatory responses in ID, and discuss potential intervention strategies, including light management, melatonin and melatonin receptor agonists, cognitive behavioral therapy for insomnia (CBT-I), physical activity, time-restricted eating, and stress management. This review aims to provide a mechanistic basis for understanding the chronicity and heterogeneity of ID and for developing individualized intervention strategies.
A hybrid implementation-effectiveness study of a school-based intervention for promoting health and well-being in low-resource settings: the ISOBAR study protocol
IntroductionSchool-based interventions can improve adolescent health outcomes and tackle the growing burden of non-communicable diseases (NCDs) in low-and-middle-income countries (LMICs). Results to date are variable, partly due to lack of cultural adaptation of Westernised models and limited focus on implementation processes. The aim of the ISOBAR project is to develop, implement, and test a school-based intervention to address the emergence of mental and physical (i.e., nutritional, physical inactivity) health problems in LMICs. The three-stage intervention comprises (1) assessment for mental and physical health problems, (2) universal health literacy, and (3) indicated counselling.Methods and analysisThe ISOBAR multi-site project comprises three phases: (1) pre-intervention (co-development and cultural adaptation of the intervention); (2) implementation of the intervention; and (3) post-intervention evaluation. The intervention will be delivered using a staggered roll-out design to introduce the intervention sequentially to three schools per site (nine in total) in Chennai, Gujarat (India), and Ibadan (Nigeria). Each school will receive the intervention by the end of the study period. Local teams will recruit 200 adolescents per school (Total n=1, 800). All adolescents (in intervention and control conditions) will be assessed for mental health/behavioural problems and nutritional/weight problems at baseline. Adolescents in the intervention school will receive the universal health literacy intervention (main cohort), and those adolescents reaching pre-determined thresholds on mental health and/or nutritional indices (sub-cohort) will be referred to school-based counselling support. A suite of assessments will be conducted throughout the study period including: (1) intervention effectiveness (e.g., impact on help-seeking, weight, and mental health and behavioural outcomes); (2) implementation processes (e.g., facilitators and barriers) and outcomes (e.g., acceptability, appropriateness, sustainability); and (3) cost-effectiveness.Ethics and disseminationThe study was approved by the University of Warwick’s Biomedical and Scientific Research Ethics Committee (BSREC 36/23-24) and the institutional ethics committees of all participating sites. Research findings will be disseminated through peer reviewed scientific publications, public announcements in local communities, policy briefings, print and online media, and institutional and professional social media accounts and websites.
Perception and willingness toward second-generation long-acting antipsychotics among patients with schizophrenia: a cross-sectional survey in Fujian, China
ObjectiveTo assess perceptions and willingness toward second-generation antipsychotic long-acting injectables (SGA-LAIs) among patients with schizophrenia, to identify the influencing factors, and to provide evidence for optimizing clinical implementation strategies.MethodsA cross-sectional survey was conducted in which patients with schizophrenia who attended outpatient follow-up visits at a tertiary psychiatric hospital were recruited via convenience sampling. A validated, expert-reviewed questionnaire was administered. Data were analyzed using descriptive statistics and chi-square tests, with binary logistic regression models employed to explore the determinants of patients’ willingness to accept SGA-LAIs.ResultsThe sample characteristics included 126 males (55.5%), 114 patients (50.2%) aged 31–50 years, 140 patients (61.7%) with an illness course exceeding 5 years, and 126 patients (55.5%) with experience with SGA-LAIs. Overall, 155 participants (68.3%) expressed positive willingness to use SGA-LAIs, whereas 72 participants (31.7%) expressed negative willingness. Univariate analysis revealed significant differences between the willingness-positive and willingness-negative groups in terms of disease course (χ² = 12.314, P = 0.006) and prior SGA-LAI experience (χ² = 55.525, P < 0.001). Binary logistic regression analysis revealed that patients with prior SGA-LAI experience (OR = 11.11, 95% CI: 5.41~23.26, P < 0.001), a disease course of 5–10 years (OR = 2.898, 95% CI: 1.134-7.407, P = 0.026), and a disease course of > 10 years (OR = 3.282, 95% CI: 1.300-8.288, P = 0.012) demonstrated significantly greater willingness to accept SGA-LAIs. Among the willingness-positive group, the most endorsed advantages of SGA-LAIs were “avoiding daily medication” (80.7%) and “increased effectiveness” (68.4%), and the primary concern was “injection pain” (56.8%). In the willingness-negative group, the predominant reasons for refusal were “rejection of needles” (93.1%) and “rejection of changing therapeutic regimens” (79.2%).ConclusionThe overall acceptance of and willingness to use SGA-LAIs among patients with schizophrenia followed up in psychiatric hospitals are high. Experience with SGA-LAIs and disease course were identified as independent factors influencing patients’ willingness to use SGA-LAIs. In clinical practice, patient acceptance can be enhanced by strengthening doctor-patient communication, prioritizing medication education for patients with a long disease course, and improving patients’ initial experience with SGA-LAIs, thereby supporting broader clinical adoption of SGA-LAIs.
Probing the linguistic cerebellum: a qualitative review of the effects of cerebellar neurostimulation on language processing
The cerebellum has historically been underrepresented in language research. However, converging evidence from lesion and neuroimaging studies supports its crucial involvement in phonological and semantic aspects of language processing, highlighting the relevance of cerebro-cerebellar circuits in language-related functions. Likewise, cerebellar neurostimulation has emerged as a promising tool for modulating sensorimotor and higher-order cognitive processes. A systematic search was conducted in PubMed and Web of Science following PRISMA guidelines and the present review synthesizes findings from 30 neurostimulation studies probing the causal role of the cerebellum for language processing. It summarizes transcranial electric and magnetic stimulation studies in neurotypical speakers and readers, and individuals with higher-order language disorders. Special emphasis is placed on studies combining cerebellar stimulation with behavioral interventions to assess the potential of improving language-related outcomes in clinical populations. Collectively, these studies support the role of the right posterolateral cerebellum as a key modulator of language functions, especially meaning-related operations.
Occupational burnout and risk of suicidality in healthcare professionals: a PRISMA-guided systematic review
BackgroundBurnout, an occupational phenomenon resulting from chronic workplace stress that has not been successfully managed, is increasingly recognized as a critical threat to the mental health of healthcare professionals. Prolonged exposure to work-related stressors may increase the risk of suicidality, including suicidal ideation, suicide attempts, and suicide deaths. This systematic review aimed to synthesize existing evidence on the association between burnout and suicidality in healthcare professionals and to identify vulnerable subgroups and intervention priorities.MethodsWe conducted a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO registration: CRD420251037488). PubMed, Scopus, Web of Science, and PsycINFO were searched for studies published between January 2005 and December 2024. Eligible studies included healthcare professionals and, where methodologically relevant, closely related high-stress occupational populations used as comparator cohorts assessed with validated burnout instruments and reporting suicidality or closely related suicide-proximal psychological outcomes. Data were extracted independently by two reviewers, and risk of bias was evaluated using the Newcastle–Ottawa Scale. Where appropriate, findings were synthesized narratively and through meta-analysis.ResultsA total of 29 studies met the inclusion criteria and 10 studies were included in the meta-analysis. Strong associations were consistently observed between burnout and suicidality, with emotional exhaustion and depersonalization emerging as the most robust predictors. Reduced personal accomplishment demonstrated weaker or inverse associations. Nurses and physicians were identified as particularly vulnerable, with pandemic-era studies reporting higher effect sizes compared to pre-pandemic research. Overall methodological quality was moderate to high, and heterogeneity was partly explained by profession, region, and burnout instrument used.ConclusionsBurnout, particularly emotional exhaustion and depersonalization, is consistently associated with increased suicidality among healthcare professionals, with supporting evidence from related high-stress occupational populations. Vulnerable groups include women clinicians, younger professionals, and those engaged in rotating or night-shift work. These findings highlight the need for systematic burnout surveillance, confidential access to mental health support, and organizational reforms such as safe staffing ratios and workload regulation. Integrating suicide-prevention strategies into occupational health frameworks is urgently required to protect clinician wellbeing and sustain healthcare system resilience.
Coping styles and mental health outcomes in partners who have experienced a perinatal loss: a longitudinal study
Perinatal loss is common, but little is known about its impact on partners during the grieving process. This study examined psychological outcomes and coping strategies among recently bereaved partners (≤6 months post-loss; N = 73) at baseline (T1) and six-month follow-up (T2) via online survey. Participants were predominantly male (78%) and typically aged 25–44 (90%), and had experienced a range of perinatal losses (<20 weeks’ gestation to 28 days of life). Grief and depression symptoms were assessed using the Perinatal Grief Scale (PGS) and PHQ-9 respectively, and multivariate regression analyses examined the role of coping styles, demographic characteristics, and loss-related factors. Participants reported varying levels of grief and depression symptoms, with 38% displaying moderate-to-severe depression symptoms at follow-up. Across the cohort, participants reported using a range of coping strategies; however, avoidant coping was uniquely associated with higher grief and depression scores at baseline (PHQ-9: β = .30, p = .007; PGS: β = .49, p <.001). Avoidant coping also predicted poorer grief and depression outcomes at follow-up, although these relationships were no longer significant after controlling for baseline symptoms. Additionally, stillbirth, female gender, and younger age were associated with greater psychological distress at baseline across outcomes (β = .21–.32, p ≤.05). Associations between gender, stillbirth, and psychological outcomes remained at follow-up, although these did not reach conventional levels of statistical significance (β = .24–.40, p ≤.073). These findings highlight the psychological impact of perinatal loss on partners and underscore the importance of improving access to support for this group. Avoidant coping may represent a key target for intervention. Future research should further investigate factors influencing grief trajectories and identify effective forms of support for bereaved partners.
Oxytocin promotes socially triggered cataplexy
Nature Neuroscience, Published online: 14 July 2026; doi:10.1038/s41593-026-02352-7
In people with narcolepsy, cataplexy is often triggered by strong emotions in social situations. Mahoney et al. show that such cataplexy is mediated by oxytocin-responsive neurons in the amygdala that target brainstem regions regulating motor tone.
A framework for comparative analysis of human and mouse cortical neuron dendrites in corresponding brain regions
Nature Neuroscience, Published online: 14 July 2026; doi:10.1038/s41593-026-02376-z
This study establishes a region-matched framework for comparing single-neuron dendritic morphology in human and mouse cortex, revealing more compact local dendrites and stronger lobe-level morphological specialization in humans.