IntroductionImmersive virtual environments offer organized social contexts for the observation of communication behaviors under standardized and interactive conditions. This study adopts a VR-based observational approach to examine pragmatic social communication behaviors exhibited during structured social scenarios in autistic children, with a specific focus on social reciprocity and context-appropriate verbal communication. MethodsThe study included twenty-five children between the ages of 5 and 12 who were diagnosed with Autism Spectrum Disorder (ASD). A structured social scenario was presented by the Virtual Reality (VR) system to elicit social communication behaviors, including greeting initiation and response, attention to speakers, turn-taking, and context-appropriate verbal responses. Social communication outcomes were assessed using selected domains of the Indian Scale for Assessment of autism (ISAA). In addition, the Social Communication Questionnaire (SCQ) and a VR-based Pragmatic Social Communication Observation Checklist (VR-PSCOC) were used to assess in-scenario behaviors. ResultsThe post-VR analysis revealed measurable changes across the assessed pragmatic social communication domains during repeated exposure to the VR scenarios. Variations were observed in the ISAA social-communication related domains, including speech-language, communication, and social relationship and reciprocity scores (p<0.001). Repeated VR exposure was associated with higher observational scores, indicating observable changes in social communication behaviors within the structured virtual environment. DiscussionThe findings indicate that the structured VR-based social scenarios provide a feasible environment for observing and characterizing social communication behaviors in children with ASD within controlled interaction settings.
Academic burnout in higher education: a multimodal study of resting-state EEG microstate correlates beyond trait anxiety, depressive symptoms, and self-efficacy in Chinese undergraduates
BackgroundAcademic burnout is a mental-health-relevant outcome of higher-education stress, but its relationship with spontaneous brain dynamics remains unclear. EEG microstates are quasi-stable scalp-potential configurations indexing millisecond-level transitions between large-scale resting brain states. This study tested whether resting-state EEG microstate dynamics are associated with academic burnout beyond trait anxiety, depressive symptoms, and general self-efficacy as perceived coping capacity.MethodsParticipants were 330 Chinese undergraduates (94 men, 236 women; mean age = 18.31 years, SD = 0.84). They completed self-report measures and an eyes-closed resting-state EEG recording. Academic burnout total score was the primary outcome. Covariate-adjusted partial correlations examined burnout–microstate associations. Hierarchical regression tested the incremental value of selected microstate markers.ResultsHigher academic burnout was associated with higher trait anxiety (r = 0.539, p < 0.001), higher depressive symptoms (r = 0.526, p < 0.001), and lower general self-efficacy (r = -0.474, p < 0.001). After adjustment for age, sex, trait anxiety, depressive symptoms, and general self-efficacy, greater burnout was associated with shorter microstate D duration (partial r = -0.196, q = 0.0049), higher microstate C occurrence (partial r = 0.172, q = 0.0081), shorter mean microstate duration, and higher mean occurrence. The psychological block explained substantial variance in burnout (R² = 0.417); adding microstate D duration and microstate C occurrence produced a small but significant improvement in model fit (ΔR² = 0.025, p = 0.001). In a scale-midpoint sensitivity analysis, the higher-burnout group showed shorter class D duration after covariate adjustment (adjusted B = -3.38 ms, 95% CI [-6.12, -0.64], p = 0.016). Dimension-specific analyses indicated that microstate associations were mainly evident for dejection and low sense of accomplishment, not the behavioral (improper-behavior) component.ConclusionAcademic burnout in undergraduates was primarily linked to internalizing distress and lower perceived coping capacity. Resting-state EEG microstate dynamics, especially shorter class D duration, provided modest incremental information, suggesting reduced temporal persistence of a canonical resting-state configuration among students with higher burnout. These findings do not establish a diagnostic EEG marker or a burnout-specific neural mechanism, but support multimodal, context-sensitive research on academic stress and mental health in higher education.
Graham’s death from aortic dissection raises questions about preventing the rare disorder
Sen. Lindsey Graham’s death Saturday at age 71 following an aortic dissection has focused attention on the life-threatening condition. Details about his diagnosis and treatment are not available while a final death certificate is pending, but experts agree on both how serious it is and how suddenly it erupts after a long prelude.
One cardiothoracic surgeon had questions about the South Carolina senator’s care.
Strategic Planning for a Digital Health Innovation Hub at a Saudi Academic Medical Center: Qualitative Case Study
Background: Rapid digital transformation is reshaping health care, but many digital initiatives struggle to deliver sustained organizational value when they are introduced as stand-alone technologies rather than as part of an institutional strategy. In Saudi Arabia, Vision 2030 has intensified pressure on academic medical centers to strengthen digital capability, localize innovation, and reduce dependence on externally driven solutions. Objective: This study aimed to examine organizational factors shaping digital health innovation at King Saud University Medical City (KSUMC) and to develop a preliminary strategic planning framework for a digital health innovation hub tailored to that setting. Methods: We conducted a qualitative exploratory case study at KSUMC between April and June 2025. Fourteen stakeholders from clinical, administrative, research, governance, educational, and innovation-related roles were recruited using maximum variation purposive sampling. Semistructured interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis. Reporting was guided by the COREQ (Consolidated Criteria for Reporting Qualitative Research). Diffusion of innovation theory and systems thinking informed interpretation, while a context-actor-mechanism-outcome lens was used to examine how institutional conditions shaped innovation processes. No patient data were collected. Results: Five interrelated themes were identified. First, leadership support existed at a symbolic level, but middle-management translation and risk tolerance were inconsistent. Second, innovation was constrained by workload, fragmented systems, and weak operational support, which meant that project work was often treated as discretionary rather than embedded. Third, knowledge transfer and commercialization pathways were fragmented; participants repeatedly described unclear routes from idea generation to prototyping, regulatory review, and market engagement. Fourth, incentives and innovation capability were misaligned with institutional expectations, particularly for clinicians and trainees. Fifth, Vision 2030 created strategic legitimacy and momentum, but participants also cautioned that an overreliance on consultant-led or vendor-led approaches could weaken internal capability building. These findings informed a preliminary framework centered on governance, knowledge transfer, partnership structures, workforce development, and phased implementation rather than a validated institutional model. Conclusions: At KSUMC, digital health innovation is shaped not only by technology availability but also by organizational culture, intermediary structures, governance design, and the extent to which innovation work is made operationally feasible. The framework proposed here should therefore be understood as a preliminary planning model derived from one qualitative case study. Its main contribution is to specify how knowledge transfer, commercialization, and institutional capability building can be integrated into a digital health strategy within a Saudi academic medical center.
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A Self-Guided Mobile Mindfulness Intervention Embedded in Daily Routines for Adults With Mild to Moderate Psychological Distress: Randomized Controlled Trial
Background: Mobile mindfulness interventions have shown promise for reducing anxiety and depressive symptoms, but sustaining engagement remains a persistent challenge. Many digital programs still rely on formal practice that requires dedicated time, which may be difficult to integrate into daily life. Objective: This randomized controlled trial evaluated Habitual Mindfulness Practice (HMP), a self-guided mobile mindfulness intervention that embeds brief practices into recurring daily routines, among adults with mild to moderate psychological distress. Outcomes were compared with those of Traditional Mindfulness (TM), Mindfulness-Based Psychoeducation (MBP), and a waitlist control (WL). Methods: Adults aged 18 to 65 years with mild to moderate symptoms of anxiety or depression were randomly assigned in a 1:1:1:1 ratio to HMP, TM, MBP, or WL (N=686). All procedures were conducted online, and the intervention was fully self-guided, with outcomes assessed using self-report measures. The intervention lasted 21 days, with assessments conducted at baseline, postintervention, and 3-month follow-up. Primary outcomes were depressive and anxiety symptoms. Secondary outcomes included mindfulness, cognitive emotion regulation, affective balance, and interpersonal difficulties. Postintervention group differences were examined, controlling for baseline scores, and longitudinal trajectories were evaluated across the active intervention conditions. Results: At postintervention, significant group effects were observed for depressive symptoms (=28.67, <.001, ηp²=0.11) and anxiety symptoms (=30.11, <.001, ηp²=0.12). Both HMP and TM showed lower depressive and anxiety symptom scores than MBP and WL. TM showed lower postintervention anxiety than HMP (=.04), whereas depressive symptoms did not differ significantly between HMP and TM (=.63). The mindfulness practice conditions also showed more favorable postintervention outcomes for mindfulness, affective balance, interpersonal difficulties, and emotion regulation. Improvements in depressive and anxiety symptoms were generally maintained at follow-up among the active intervention conditions, although maintenance of secondary outcomes varied across measures. Postintervention outcome data were available for 55.2% (379/686) of randomized participants, and follow-up outcome data were available for 24.1% (124/515) of participants in the active intervention conditions. HMP and TM did not differ significantly in practice duration, engagement, or satisfaction. Conclusions: A routine-embedded, self-guided mobile mindfulness intervention may be a feasible approach for reducing mild to moderate psychological distress. HMP produced benefits broadly comparable to those of traditional app-delivered mindfulness, but it did not confer advantages in engagement or short-term efficacy. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400093771; https://tinyurl.com/3d6tky8v
VISUCHIR 2024 Ecological Benchmarking of French Private Centers Using a Perioperative Digital Therapeutic: Descriptive Early-Adopter Comparison
Using publicly available 2024 VISUCHIR (Visualisation de la Chirurgie) benchmarking indicators, we performed a descriptive ecological comparison of national private-sector values and 4 early-adopter French private departments implementing the Betty Coaching perioperative digital pathway; early-adopter departments showed a directionally favorable, unadjusted profile for same-day discharge, mean length of stay, and VISUCHIR-reported readmission-evolution indicators, without causal inference.
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enDigital Postpartum Support for Early Risk Identification Among Postpartum Women: Formative Randomized Evaluation and Exploratory Predictive Modeling Study
Background: The postpartum period represents a critical window for maternal health, yet many individuals lack sustained support and timely identification of physical and mental health risks. Digital health interventions offer a scalable approach to extend care beyond clinical settings. Yet, key elements, including real-world challenges, usability, and effectiveness of such platforms, are insufficiently characterized in this literature. Objective: This study aimed to conduct a formative randomized evaluation to assess the feasibility, engagement, and preliminary signals of impact of the Joyuus platform and to examine the potential for early identification of postpartum health risks. Methods: We conducted a 12-week randomized evaluation with postpartum participants recruited through community-based organizations. Participants were randomized to either the Joyuus intervention or standard postpartum care. Primary and secondary outcomes included the Barkin Index of Maternal Functioning, the Edinburgh Postnatal Depression Scale (EPDS), the State-Trait Anxiety Inventory, and the Connor-Davidson Resilience Scale. Analyses were conducted using an intention-to-treat approach with linear regression models adjusting for baseline values. Engagement metrics (ie, sessions, time on site, and feature use) were captured through in-app analytics. An exploratory predictive model was developed using baseline clinical, behavioral, and demographic variables to identify individuals at risk for postpartum depression. Results: Baseline characteristics were generally balanced across arms, and no statistically significant differences were observed in education, income, or marital status. No statistically significant differences were found between treatment and control groups in the 12-week changes for the primary or secondary outcomes. Mean EPDS scores were 9.7 in the intervention group and 9.3 in the control group. In the sample, 60 (45.5%) of the 132 participants met the criteria for elevated depression (EPDS score ≥11 or a positive response to question 10 on self-harm), indicating a high burden of symptoms within the study population. Engagement with the platform was highest during the first 4 weeks. Among intervention participants, 80% created an account. Participants reported high levels of perceived usefulness, ease of use, and relevance of content. Qualitative analysis of open-ended survey responses highlighted limited awareness of postpartum-specific resources and a preference for simple, accessible information. An exploratory predictive model demonstrated a recall of 0.89 and a precision of 0.73 in identifying individuals at risk for postpartum depression, suggesting the feasibility of early risk identification using integrated data inputs. Conclusions: Joyuus demonstrated feasibility and acceptability but did not produce statistically significant improvements in maternal functioning or maternal health outcomes over 12 weeks. Joyuus identified high rates of depressive symptoms and early engagement patterns, which suggest an opportunity for earlier identification of risk and intervention during the postpartum period. Exploratory modeling results indicate the potential for data-driven approaches to support earlier detection. Future work includes optimizing engagement strategies and expanding validation of predictive detection to improve postpartum surveillance and outcomes. Trial Registration: ClinicalTrials.gov NCT05876559; https://clinicaltrials.gov/study/NCT05876559?cond=postpartum%20joyuus&viewType=Card&rank=1
STAT+: At key hearing, Kennedy’s ouster of former CDC director looms over nominee to replace her
The fates of two top health officials — Robert F. Kennedy Jr. and Susan Monarez — loomed over a Wednesday Senate hearing, though neither of them was in the room.
Almost a year after Kennedy ousted Monarez as director of the Centers for Disease Control and Prevention over vaccine policy, senators pressed the administration’s new pick to run the CDC on whether she’d face a similar fate, and how she’d deal with what many of them characterized as Kennedy’s political interference in the agency.
The nominee, Erica Schwartz, repeatedly demurred on the question, never quite saying whether she would stand up to the health secretary.
Increased Levels of Micro- and Nanoplastics Found in the Blood of Heart Attack Patients
The results of a newly reported study have shown that people who suffered a serious heart attack had higher levels of micro- and nanoplastics (MNPs) in their blood, compared with MNP levels in patients diagnosed with chronic ischemic heart disease and those who have normal blood vessels supplying the heart. The study findings also revealed that people who smoke and people exposed to higher levels of air pollution had higher levels of micro- and nanoplastics in their blood.
Headed by teams at Sapienza University of Rome, at the University of Verona, and at the Research Centre on Environmental Pollution and Cardiovascular Diseases at the University of Campania “Luigi Vanvitelli,” the study included 61 patients at Sant’Andrea University Hospital or Azienda Ospedaliera Universitaria Integrata of Verona, diagnosed with either a heart attack, chronic ischemic heart disease, or normal coronary arteries.
The researchers say their study adds to growing evidence that environmental pollution may affect cardiovascular health. Research lead Emanuele Barbato, MD, PhD, at Sapienza University of Rome, said, “These findings do not prove that microplastics cause heart attacks, but they reveal a strong association between environmental exposures, microplastics in the blood and cardiovascular disease. In our study, smoking history was strongly linked to microplastics in the blood. Our findings suggest that smoking might make it easier for micro and nanoplastics to enter the blood stream via the lungs. Air pollution may act in a similar way.”
Barbato is director of the Cardiology Unit of Sant’Andrea University Hospital, Rome, Italy, and senior author of the team’s published paper in European Heart Journal, titled “Micro- and nano-plastics in the coronary circulation and air pollution exposure in ischemic heart disease presentation.”
Cardiovascular diseases are increasingly related to lifelong environmental exposures, the authors noted. Among such exposures, MNPs are ubiquitous environmental pollutants, and evidence is increasing that they accumulate in human tissues following exposure and are emerging as a risk factor for health. Pasquale Paolisso, MD, PhD, at Sant’Andrea Hospital Sapienza University of Rome, said, “Micro and nanoplastics are tiny plastic particles that are found virtually everywhere in the environment, including the air we breathe, the water we drink, and many foods we consume. In recent years, scientists have begun to detect these particles in human tissues and organs, raising concerns about their potential health effects.”
Research findings have raised concerns about the potential role that MNPs may play in cardiovascular diseases. “Emerging evidence indicates that MNPs, once considered inert contaminants, are biologically active pollutants contributing to the pathophysiology of cardiovascular diseases, particularly by promoting the development and progression of atherosclerotic plaques and potentially triggering adverse cardiovascular events,” the team stated.
However, as Paolisso further noted, “… very little was known about whether these particles are present in the coronary circulation—the blood flowing through the arteries that supply the heart—or whether environmental exposures such as smoking and air pollution might influence their presence.” As the authors explained, “… current knowledge is predominantly based on in vitro experiments and preliminary ex vivo findings, highlighting the need for in vivo and clinical investigations.”
For their newly reported study the team measured MNPs in coronary and peripheral blood, in 61 patients at Sant’Andrea University Hospital or Azienda Ospedaliera Universitaria Integrata of Verona, who were undergoing coronary angiography for suspected coronary artery disease (CAD). Patients were stratified as those with ST-segment elevation myocardial infarction (STEMI), chronic coronary syndromes (CCS) and controls with normal coronary arteries.
As well as taking blood samples from the vessels supplying the heart and from elsewhere in the body, the team collected data on whether the patients were smokers and their exposure to pollution, both on the day of testing and over the preceding two years. Coronary micro and nanoplastics were analyzed at the Research Centre for Environmental Pollution and Cardiovascular Diseases, University of Campania ‘Luigi Vanvitelli,’ a center dedicated to understanding how environmental pollutants influence cardiovascular health.
The results showed that micro and nanoplastics were detected in 84% of patients diagnosed with heart attack, compared with 40% of patients with chronic ischemic heart disease and 32% of patients with normal coronary arteries. “The observation that IL-6 and TNF-α concentrations were highest in STEMI patients, particularly within the coronary circulation, and were more elevated in the presence of detectable MNPs supports an exploratory association between MNP burden and a localized pro-inflammatory milieu in patients with obstructive CAD,” the investigators suggested.
Heart attack patients also had a greater variety of plastic types in their blood. The most common type of plastic was polyethylene (PE), which is commonly used in packaging and consumer products. “Across all study cohorts, PE was the most frequently identified polymer, being present in 97% of the patients with detectable MNPs,” the investigators added.
Patients exposed to higher long-term levels of air pollution (PM2.5; particles measuring 2.5 μm or less in diameter) were more likely to have microplastics in their blood, and smokers were six times more likely to have microplastics in their blood. All patients who were smokers and were exposed to higher air pollution levels had plastics in their blood, compared with only 12.5% of patients who did not smoke and were not exposed to higher levels of air pollution. “MNPs, PM2.5, and smoking constitute potentially modifiable environmental risk factors for cardiovascular diseases, with significant implications for public health and cardiovascular disease prevention,” the scientists stated. “Future research should aim to quantify individual MNP exposure, assess combined pollutant burden, and validate interventions that target this expanded network of environmental cardiovascular hazards.”
Barbato added, “The results highlight the need to consider microplastic pollution as part of the broader environmental determinants of health. Policies that reduce air pollution, tobacco exposure, and environmental plastic contamination could have benefits that extend beyond environmental protection and potentially improve cardiovascular health.”
In an accompanying editorial Andreas Daiber, PhD, at University Medical Centre of the Johannes Gutenberg University, Mainz, and colleagues pointed to the observation by Paolisso et al. of an association between NMP levels and exposure to air pollution and tobacco smoking. “While the underlying mechanisms remain unclear, this finding underscores a key principle: environmental exposures rarely occur in isolation,” Daiber and colleagues stated. “Individuals are exposed to multiple environmental stressors simultaneously, including air pollution, noise, chemical contaminants, plastics, and climate-related stressors, especially in the urban setting. These exposures may interact through shared biological pathways, leading to additive or synergistic effects on cardiovascular risk.”
And while substantial uncertainties remain, “the convergence of epidemiological, clinical, and mechanistic evidence suggests that plastic pollution may represent a previously underestimated cardiovascular risk factor,” Daiber et al. continued. “Addressing this challenge will require coordinated efforts across disciplines and policy domains. In the era of the Anthropocene, protecting cardiovascular health will increasingly depend on reducing not only traditional risk factors but also the growing burden of environmental pollutants (the detrimental part of the exposome), among which plastics may soon play a central role.”
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Specialist Rehabilitation Providers’ Experiences With an Online Self-Compassion Course: Reflexive Thematic Analysis
Background: Rehabilitation health care providers (HCPs) report high levels of burnout. Self-compassion interventions have shown beneficial effects on HCP burnout, but they have never been explored in specialist rehabilitation settings where challenges may differ. Objective: This study aimed to explore the experiences of specialist rehabilitation HCPs with an online Self-Compassion for Healthcare Communities (SCHC) course aimed at providing tools to regulate emotional well-being, including burnout. Methods: Semistructured qualitative interviews (n=20) with specialist rehabilitation HCPs were used to explore experiences with the SCHC course. A reflexive thematic analysis study design was chosen to highlight participants’ insights, and inductive coding was undertaken to analyze data and organize findings into themes. Results: Six themes that reflected HCPs’ experiences with the course were constructed: (1) the nature of working in rehabilitation; (2) different perspectives on burnout in specialist rehabilitation; (3) a new perspective, less self-criticism, more self-compassion; (4) growing recognition of the importance of compassion for oneself and others; (5) challenges engaging with the SCHC course; and (6) challenges to sustaining self-compassion in specialist rehabilitation. Conclusions: Specialist rehabilitation HCPs who participated in the SCHC course developed a new understanding of the importance of fostering self-compassion and compassion for others. This shift may have supported HCPs in navigating workplace challenges, and HCPs described experiencing changes that could help with burnout, improve their care of patients and relationships with colleagues. Trial Registration: ClinicalTrials.gov NCT05997082; https://clinicaltrials.gov/study/NCT05997082?cond=self%20compassion%20rehab&viewType=Card&rank=1
