The evolving field of digital mental health:current evidence and implementation issues for smartphone apps, generative artificial intelligence, and virtual reality

The expanding domain of digital mental health is transitioning beyond traditional telehealth to incorporate smartphone apps, virtual reality, and generative artificial intelligence, including large language models. While industry setbacks and methodological critiques have highlighted gaps in evidence and challenges in scaling these technologies, emerging solutions rooted in co-design, rigorous evaluation, and implementation science offer promising pathways forward. This paper underscores the dual necessity of advancing the scientific foundations of digital mental health and increasing its real-world applicability through five themes. First, we discuss recent technological advances in digital phenotyping, virtual reality, and generative artificial intelligence. Progress in this latter area, specifically designed to create new outputs such as conversations and images, holds unique potential for the mental health field. Given the spread of smartphone apps, we then evaluate the evidence supporting their utility across various mental health contexts, including well-being, depression, anxiety, schizophrenia, eating disorders, and substance use disorders. This broad view of the field highlights the need for a new generation of more rigorous, placebo-controlled, and real-world studies. We subsequently explore engagement challenges that hamper all digital mental health tools, and propose solutions, including human support, digital navigators, just-in-time adaptive interventions, and personalized approaches. We then analyze implementation issues, emphasizing clinician engagement, service integration, and scalable delivery models. We finally consider the need to ensure that innovations work for all people and thus can bridge digital health disparities, reviewing the evidence on tailoring digital tools for historically marginalized populations and low- and middle-income countries. Regarding digital mental health innovations as tools to augment and extend care, we conclude that smartphone apps, virtual reality, and large language models can positively impact mental health care if deployed correctly.</p

Outcomes of Surgical Myectomy and Mitral Valve Repair for Hypertrophic Cardiomyopathy With vs Without Marked Septal Hypertrophy

Background: This study reports a single institution's clinical and echocardiographic outcomes for septal myectomy with vs without concomitant mitral valve interventions in patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction. Methods: Consecutive patients who underwent transaortic septal myectomy with vs without subvalvular mitral apparatus intervention for HCM between October 2019 and March 2024 were included. All patients underwent transesophageal echocardiography and cardiac magnetic resonance imaging to confirm the pathology, measure intracavitary gradients, and assess mitral valve morphology. Patients were analyzed as an entire cohort and stratified by the presence of marked (&gt; 15 mm) or only mild (≤ 15 mm) septal hypertrophy. Results: A total of 61 patients (32 male) were included, of whom 28 (45.9%) had mild septal hypertrophy. The follow-up assessment was 100% complete and averaged 26.9 ± 16.2 months. In addition to septal myectomy, 32 patients (52.5%) underwent concomitant papillary muscle realignment, and aberrant chordae were resected in 40 patients (65.6%). All patients with a septal thickness ≤ 15 mm had a mitral valve repair intervention. The 30-day and 2-year mortality were 1.6% and 3.3%, respectively. No postoperative ventricular septal defects occurred, including in the thin septum subgroup. Peak LVOT gradients were significantly reduced with surgery, both at rest (47.8 ± 34.7 mm Hg preoperatively vs 8.8 ± 12.3 mm Hg postoperatively, P &lt; 0.001) and under stress (114.2 ± 58.7 mm Hg preoperatively vs 17.6 ± 18.5 postoperatively, P &lt; 0.001). Conclusions: In patients with symptomatic HCM, even in those without marked septal hypertrophy, septal myectomy with a concomitant mitral valve apparatus intervention is safe and provides excellent relief of LVOT obstruction.</p

Developing the Inpatient Mental Health Pharmaceutical Assessment and Care Tool (IMPACT) for use by UK mental health pharmacy teams—a modified Delphi study

AimsTo develop an evidence- and consensus-based patient prioritization tool for use by UK mental health inpatient pharmacy teams.MethodsA modified-Delphi technique was used to obtain experts' agreement on the content, design and practical use of the patient prioritization tool. Two sequential Delphi questionnaires were prepared based on published evidence concerning risk factors for drug-related problems in mental health hospitals and current prioritization practices used by UK mental health inpatient pharmacy teams. Questionnaires were discussed and agreed upon with a group of 5 stakeholders including 3 mental health pharmacy experts and 2 patient representatives. Pharmacy professionals, psychiatrists and academics were recruited through a previous study and professional networks. Agreement was achieved if ≥75 or ≥85% of the panel rated 6–7 or 5–7 in the Likert scale respectively.ResultsIn Delphi 1 questionnaire, 29 experts agreed to include 82 risk indicators in the tool and to categorize patients into 3 risk groups using a traffic light system (red = high-risk, amber = medium-risk, green = low-risk). In Delphi 2 questionnaire, 30 experts agreed on 13 statements guiding practical use of the tool and the preferred frequency of review was every 1–2 day for the high-risk group, every 2–4 days for the medium-risk group and once every working week for the low-risk group.ConclusionThis study developed the Inpatient Mental Health Pharmaceutical Assessment and Care Tool (IMPACT) for use by UK mental health pharmacy teams. Feasibility and acceptability testing should be carried out to refine the tool and support preparations for formal evaluation of its impact on patient care and service delivery

Travelling in the margins:Impacts of transport poverty on travel attitudes and behaviours

Transportation researchers have long used social-psychological theories to understand the impacts of travel attitudes on travel behaviour, especially in relation to the built environment and residential location choice. However, there has been limited research on whether social and transportation inequities impact the formation and change of travel attitudes and behaviour. In this paper, we used qualitative research to explore whether people’s experiences of transport poverty, defined as the combined effect of social and transportation disadvantages, contributes to the formation and change of their travel attitudes and behaviour. If transport poverty influences travel attitudes, then, according to the social-psychological theories, inequities impact travel behaviour not only through material deprivation but also by influencing travel attitudes. To examine such a relationship, we propose a framework integrating transport poverty, the Theory of Planned Behaviour (TPB), the Theory of Cognitive Dissonance (TCD) and Habit Theory (HT). We also empirically test our framework using retrospective and qualitative data collected in the Rexdale neighbourhood in Toronto. We found that consistent with our hypothesis, experiences of transport poverty influence people’s travel attitudes via perceived behavioural control and past travel behaviour, which is also influenced by transport poverty. Furthermore, transport poverty impacts the relationship between travel intention and behaviour. Moreover, daily travel behaviours of individuals living in marginalized conditions are often ad-hoc and dynamically adapted. We also explain travel behaviour adaptations in the context of transport poverty by integrating a framework for intention with social-psychological theories. Finally, we suggest research and policy implications of our framework based on our findings

DEIS Implications of Using AI for Recruitment and Selection

Recruiting and selecting employees with the knowledge and skills to both facilitate the achievement of organizational objectives and support diverse workplaces is critical. The use of artificial intelligence (AI) for this purpose is proliferating. Amidst this rapid advancement of AI, a new conversation has emerged that calls for an exploration of the implications of these tools for diversity, equality, and inclusion (DEI). Therefore, this article explores these implications, presenting benefits, risks, and suggestions from a DEI perspective. DOI: https://doi.org/10.1007/978-3-031-32257-

Exploring the impact of work-related stress and professional wellbeing with practitioners in homes for children

This study examines experiences of staff wellbeing in homes for cared-for children and theoretically considers how staff wellbeing influences the care children receive. Staff in these settings often experience high levels of stress and burnout, due to the demanding nature of their roles and the lack of professional support. Personal accounts and approaches to coping were collected through an anonymous online platform, then explored through descriptive statistics, a correlation matrix, three separate multiple regression analyses, a multiple linear regression, and thematic analysis. Staff wellbeing is significantly influenced by coping strategies, self-compassion, and support systems. Participants who reported higher levels of compassion satisfaction exhibited lower levels of burnout. Conversely, avoidant coping strategies and unprocessed secondary traumatic stress were associated with increased burnout. The study also underscores the importance of a supportive work environment, including regular supervision, professional development, and access to mental health resources, in enhancing staff resilience and reducing turnover. Recommendations for the homes for children sector include implementing comprehensive support systems to enhance staff wellbeing, and integrating trauma-informed care training and principles. By addressing these areas, the sector can improve care quality and better support the developmental needs of vulnerable children through enhanced placement stability and therapeutic value

A national survey of current discharge planning and aftercare arrangement practices for those returned to prison from secure psychiatric services in England and Wales

BackgroundLittle is known about the transition process for those returned to prison following treatment in secure psychiatric services. This study is the first internationally to explore the process of discharge/aftercare planning for this population.AimTo identify the current national discharge and aftercare planning procedures for people returned to prison in England and Wales.MethodsA national survey of current service discharge planning and aftercare arrangement practices in low- and medium-secure psychiatric services and prison mental health teams in England and Wales.ResultsWe had a 72% response rate across prison-based and secure mental health services. A summative contents analysis highlighted that outstanding priority areas for improvement, include (a) relationship building to improve communication and understanding between secure psychiatric services, prison mental health services, and the prison estate and (b) significant reform and additional resources to achieve the expected standard of care and to provide people returned to prison with a care package tailored to meet their specific needs.ConclusionEffective care planning and management of return to prison from secure psychiatric services has the potential to improve patient health and well-being in prison and up to and beyond their subsequent prison release, with far-reaching effects on prevention of relapse, hospital readmission, reoffending and other adverse events

Syriac Galen Palimpsest Processed Images

The Graeco-Arabic translation movement has been well studied, but Syriac, the vital connection between these two languages, is often ignored. This is partly the result of a lack of surviving Syriac texts. One such text, a sixth-century translation of Galen's On Simple Drugs by Sergius of Rēš ʿAynā, exists in the undertext of an eleventh-century liturgical work, known as the Syriac Galen Palimpsest. This palimpsest contains part of this translation. By using pioneering philological and imaging techniques, the team deciphered most of the undertext of books 6–9 and collated it with other direct and indirect witnesses. We present our digital critical edition here for the first time.See read me file for details of the images