This study compared dosimetric outcomes of craniospinal irradiation (CSI) using volumetric-modulated arc therapy (VMAT) from TrueBeam (TB) and Halcyon, and intensity-modulated proton therapy from ProBeam.

Fifteen CSI cases prescribed 2340 cGy in 13 fractions were optimized. Dose coverage of the clinical target volume (CTV), organs at risk (OARs), conformity index (CI), homogeneity index (HI), total normal tissue volume (%TNTV), and beam-on time were evaluated.

Significant differences in D95% were observed among the three techniques. ProBeam plans achieved the best CI, while Halcyon plans demonstrated superior HI. ProBeam resulted in the lowest %TNTV dose, followed by Halcyon and TB. Among 16 evaluated OARs, 10 received significantly lower doses with ProBeam compared to photon techniques. ProBeam also showed the shortest beam-on time (4.2±0.1 minutes) but required the highest total monitor units due to its delivery method. Compared with Halcyon, TB delivered lower doses to 11 OARs, with significant differences in seven. However, Halcyon reduced beam-on time by approximately half (6.1±0.8 vs. 12.1±0.5 minutes).

Although ProBeam provided the best overall dosimetric performance, Halcyon represents an effective alternative for CSI, offering good plan quality, acceptable OAR sparing, improved %TNTV dose, and shorter treatment times compared to TrueBeam, potentially enhancing clinical efficiency.

Parenthood is consistently identified as a protective factor for suicidal behavior. However, it remains unclear whether this relationship varies as a function of sex, age, time since birth, number of children, and other risk/protective factors.

We used Cox proportional hazards models to describe the relationship between the birth of up to four children and suicide attempt (SA) risk in Swedish individuals born between 1960 and 1980. Models were stratified by sex and controlled for a range of covariates. We tested whether the relationship between parenthood and SA risk varies based on age at first birth and explored whether SA risk differed based on education, genetic liability, cohabitation with one’s co-parent, and geographic proximity to one’s mother (the child’s grandmother).

The first year following childbirth was associated with reduced SA risk in mothers (hazard ratios [HRs] = 0.34–0.64) and fathers (HRs = 0.60–0.86). However, later time periods following the birth of one’s third and fourth children were associated with elevated risk (HRs = 1.02–1.26). Moreover, age at first birth moderated the association between parenthood and SA: individuals who became parents at age 15 exhibited increased risk for SA (HRs = 2.81–5.30), while individuals with an older age at first birth (30+ years) experienced a reduction in risk (HRs = 0.31–0.92). The effect of parenthood also varied based on cohabitation and proximity to one’s mother.

These findings underscore the complexity of the relationship between parenthood and SA, indicating that there are some subgroups for whom the transition to parenthood is not protective. Clinical outreach may be warranted as a preventative measure.

The impact of absent ductus arteriosus in fetuses with Tetralogy of Fallot remains uncertain with concerns for the lack of prostaglandin responsiveness and compromised pulmonary blood flow. This study evaluated early postnatal outcomes in fetuses with Tetralogy of Fallot-absent ductus arteriosus compared to matched controls with a ductus arteriosus and assessed the predictive value of fetal and neonatal echocardiographic parameters for early intervention.

A retrospective matched cohort study was performed using a single-centre fetal echocardiography database (2000–2024). Fetuses with Tetralogy of Fallot-absent ductus arteriosus confirmed by neonatal echocardiography were matched 1:1 to Tetralogy of Fallot-ductus arteriosus cases by fetal pulmonary valve Z-score and gestational age. Early intervention was defined as any surgical or transcatheter procedure to augment pulmonary blood flow within six weeks of life. Comparative analyses evaluated predictors of early intervention within each cohort.

Among 253 fetuses with Tetralogy of Fallot and antegrade outflow, 27 had confirmed absent ductus arteriosus and were matched to 27 Tetralogy of Fallot-ductus arteriosus controls. Despite similar fetal pulmonary valve Z-scores, Tetralogy of Fallot-absent ductus arteriosus patients had significantly lower neonatal pulmonary valve and main pulmonary artery Z-scores and main pulmonary artery-to-aorta ratios. Early intervention occurred in 26% of Tetralogy of Fallot-absent ductus arteriosus and 41% of Tetralogy of Fallot-ductus arteriosus (p = 0.25); surgical intervention was more frequent in Tetralogy of Fallot-absent ductus arteriosus (86 vs 36%, p = 0.066). In Tetralogy of Fallot-ductus arteriosus, lower fetal and neonatal pulmonary valve/aortic valve ratios predicted early intervention. No fetal or neonatal markers were predictive in Tetralogy of Fallot-absent ductus arteriosus.

Fetal absent ductus arteriosus was not linked to higher early intervention rates in Tetralogy of Fallot, but when intervention was required, surgical palliation predominated. Conventional fetal echocardiographic predictors were not reliable in Tetralogy of Fallot-absent ductus arteriosus, complicating prenatal counselling.

Anhedonia and rumination, a form of repetitive negative thinking (RNT), are key features of depression associated with poor treatment outcomes, chronic disease progression, and an increased risk of suicidality. Although their interaction is thought to sustain depressive states, the state-level mechanisms linking these symptoms remain poorly understood.

In this multilevel, randomized within-subjects study, 62 individuals (n = 38 females) with varying levels of depressive symptoms completed the Probabilistic Reward Task (PRT) under two conditions: experimentally induced RNT and an active control. Concurrent electroencephalography was employed to assess electroencephalographic markers of reward functioning.

RNT significantly attenuated both reward response bias and feedback-related positivity (FRP) amplitudes, with the most pronounced effects in individuals with more severe depressive symptoms. These effects were not attributable to differences in task difficulty or perceptual cortical processing of PRT stimuli, supporting the specificity of RNT’s impact on reward-related processes.

RNT may transiently disrupt behavioral and neural indicators of reward functioning. These findings suggest that cognitive states such as RNT can exacerbate or reveal the latent reward-processing deficits typically observed in individuals with anhedonia. This state-dependent sensitivity highlights the potential utility of targeting RNT to restore reward processing in depression.

Limited data exist on how trainers are trained in paediatric cardiology training centres in Europe.

A cross-sectional study employing a structured and approved questionnaire was circulated to educationalists/trainers in 95 Association for European Paediatric and Congenital Cardiology training centres.

Trainers provided complete data for 46 centres in 20 countries. The median number of trainers in each centre was 6 (range 1–16). The median number of years trainers were in a training role was 20 years (range 2–32 years). Sixty-six per cent of trainers received some training in being a trainer, most commonly a course by a local governing college (almost 50%). Almost 78% found such courses helpful as trainers. Sixty-eight per cent of trainers felt their education in training was optimal to be an effective trainer. Assessment of trainees varies from daily to monthly between centres. Workplace assessments (used by >90% trainers) with combined formative and summative feedback were the most common type of assessment. Only one-third of trainers understood or used entrustable professional activities. Time constraints in providing training were reported by 54% of trainers as the greatest challenge in providing training. The majority of trainers expressed a need for formal “training the trainers” courses and development of standards in training.

There is a marked variation in the level of training of trainers across Europe. A wide mix of assessment tools is used. Feedback is provided by the majority of trainers. Adopting a basic training programme for trainers may promote the training skills of paediatric cardiology trainers.

Subjective cognitive complaints are poor predictors of neurodegenerative disease and future dementia. Errors in metacognition, positive or negative differences between actual and perceived performance, may partially explain this. We aimed to assess whether hypothesized indicators of underlying neurodegenerative factors (e.g. hippocampal atrophy) in mild cognitive impairment (MCI) were associated with overestimation of actual cognitive performance, and hypothesized non-degenerative factors (e.g. depression) were associated with underestimation of performance.

Metacognitive error was estimated from paired subjective and objective cognitive assessments using the Multifactorial Memory Questionnaire and Addenbrooke’s Cognitive Examination – Revised, respectively. A normative model was developed with cognitively healthy older adults (n = 36), and applied to individuals with suspected MCI due to Alzheimer’s disease (AD) or MCI with Lewy bodies (total n = 88). Theorized predictors of subjective overestimation or underestimation of performance (metacognitive error) were assessed, including demographics, AD biomarkers, and mental and physical ill health. Metacognitive error was also assessed as a predictor of conversion to dementia.

Underestimation of cognitive function was associated with depressive symptoms, anxiety, and self-reported autonomic symptoms. Overestimation of cognitive function was associated with age, hippocampal atrophy, plasma glial fibrillary acidic protein, and subsequent dementia conversion.

Underestimation of cognitive function may reflect functional cognitive changes linked to mental and physical ill health, while overestimation of function may be a marker of neurodegenerative changes. Quantifying metacognitive error may provide a noninvasive screening tool for progressive MCI, requiring investigation in an independent sample.

Adult major depression (MDD) studies implicate reward- and control-network dysconnectivity in suicidality, but it is unclear whether analogous alterations characterize adolescents, whose neural systems are still maturing.

Resting-state fMRI was obtained from 102 adolescents (12–17 years): 21 MDD with suicidal ideation (SI), 33 MDD without SI, and 48 matched healthy controls. Seed-based analyses targeted bilateral nucleus accumbens (NAc), ventral tegmental area (VTA), and bilateral dorsolateral prefrontal cortex (DLPFC).

Between-group effects were specific to NAc circuitry. Adolescents with SI showed reduced coupling of the left NAc with the left superior parietal lobule (BA7) versus controls, and diminished connectivity between the right NAc and right frontal pole (BA47) versus depressed peers without SI. No significant differences emerged for DLPFC- or VTA-seeded connectivity.

The identified functional dysconnectivities in reward-related circuits, particularly the FCs between the NAc and both the frontal pole and superior parietal lobule, may be implicated in the manifestation of suicidality among adolescents with MD. However, the lack of significant associations for DLPFC- and VTA-seeded FC in adolescent MDSI requires further elucidation.