ObjectiveTo examine whether psychological resilience and psychological distress serially mediate the association between fear of disease progression and quality of life (QoL) in patients with chronic heart failure (CHF).MethodsThis cross-sectional study enrolled 212 patients with CHF admitted between June 2023 and June 2025. Assessment tools included a demographic questionnaire, the Fear of Progression Questionnaire (FoP-Q), the Connor–Davidson Resilience Scale (CD-RISC), the Depression Anxiety Stress Scales-21 (DASS-21), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Correlation and serial mediation analyses were performed using IBM SPSS Statistics for Windows, version 22.0, and the PROCESS macro, with the bootstrap method (5,000 resamples) used to test the mediation effects.ResultsThe mean scores were 43.60 ± 8.32 for FoP-Q, 52.71 ± 14.28 for CD-RISC, 44.29 ± 10.68 for DASS-21, and 48.63 ± 10.85 for MLHFQ. Correlation analysis indicated that FoP was negatively correlated with psychological resilience (r = −0.775) and positively correlated with psychological distress and MLHFQ scores (r = 0.868 and 0.773, respectively; all P < 0.05). Psychological resilience was negatively correlated with both psychological distress and MLHFQ scores (r = −0.728 and −0.744, respectively), while psychological distress was positively correlated with MLHFQ scores (r = 0.745; all P < 0.05). The mediation model revealed a direct effect of FoP on QoL (effect = 0.629, 41.14%), along with three indirect pathways: via psychological resilience alone (effect = 0.508, 33.22%), via psychological distress alone (effect = 0.344, 22.50%), and via the serial pathway from psychological resilience to psychological distress (effect = 0.048, 3.14%).ConclusionPatients with CHF exhibited elevated levels of FoP and generally reduced QoL. Psychological resilience and psychological distress served as significant serial mediators in the relationship between FoP and QoL. FoP could directly reduce QoL in patients with CHF and indirectly affect it by decreasing psychological resilience and exacerbating psychological distress. Clinical attention should be directed toward assessing the psychological status of patients with CHF, improving psychological resilience, alleviating negative emotions, reducing the adverse impact of FoP, and enhancing patients’ QoL.
Craving fullness: a fullness-seeking phenotype that blurs the line between binge eating disorder and food addiction
Food addiction and binge eating disorder show striking clinical overlap that current diagnostic frameworks do not fully capture. In binge eating disorder samples, Yale Food Addiction Scale-defined food addiction has been reported in roughly half of participants. Higher symptom severity is associated with greater impairment. Within this overlap, clinicians frequently observe a subset of patients whose compulsive eating is organized around the pursuit of extreme fullness rather than palatability for specific trigger foods. Compulsive high-volume eating (CHVE) refers to recurrent, distressing episodes of consuming dangerously large volumes of food, often to the point of marked gastric distension. In some cases, the food is low-caloric or non-hedonic, and the dominant motivator is the interoceptive target state of extreme fullness rather than taste. This Perspectives article focuses on fullness-seeking as a high-volume pattern within binge eating disorder phenomenology that has received little attention in the food addiction literature. It extends prior work that framed volume addiction within compulsive high-volume eating as a public health issue. The focus here is clinical formulation, not the public health case. Evidence from reward learning, gut-brain signaling, gastrointestinal physiology, and neuroendocrinology suggests that this pattern may be rooted in binge eating disorder. It may identify a subset of patients with addiction-like dynamics. These cases may be better addressed when addiction-informed concepts and tools are integrated. It offers a physiologically grounded lens for combining eating disorder and addiction frameworks in a more coherent clinical approach.
Beyond surface acting: a mixed-methods investigation of an ACT-based intervention for promoting psychological flexibility and regulatory shift in hotel frontline emotional labor
BackgroundFrontline hotel employees in Thailand’s Eastern Economic Corridor (EEC) routinely suppress authentic emotions to meet organizational display rules—a process known as surface acting—associated with burnout, emotional exhaustion, and diminished well-being. Acceptance and Commitment Therapy (ACT), adapted within a collectivist, Buddhist-informed cultural framework, offers a theoretically grounded pathway for facilitating regulatory shift from surface to deep acting through enhanced psychological flexibility and emotional acceptance. Empirical evidence for ACT-based interventions specifically targeting emotional labor in hospitality contexts remains limited.MethodsA sequential mixed-methods design was employed across two phases. Phase 1 involved semi-structured interviews with 24 frontline hotel employees to explore emotional labor experiences and inform intervention development. Phase 2 evaluated the ACT-EL intervention—the MINNICHA Model, an 8-session culturally adapted ACT program integrating compassion-based approaches—using a quasi-experimental pre-post design with a non-equivalent control group (n = 30 per condition). Outcomes included the Emotional Labor Scale (ELS), Acceptance and Action Questionnaire-II (AAQ-II), Self-Compassion Scale (SCS), and an Emotional Go/No-Go task. Between-group differences were assessed via MANCOVA controlling for baseline scores.ResultsPhase 1 identified four themes: pervasive emotional dissonance and regulatory burden (83% routinely suppressing authentic emotions), culturally amplified display rule demands rooted in Kreng Jai, occupational dignity threats precipitating regulatory collapse, and a critical training gap in which behavioral skills were taught without psychological regulatory resources. Phase 2 showed significant post-intervention improvements in the experimental group across all outcomes. Between-group effects included greater deep acting (d = 0.741), lower surface acting (d = −0.562), improved psychological flexibility (d = 0.810), faster emotional response efficiency (d = −1.607), and higher self-compassion (d = 0.778). The control group showed no significant within-group changes (all p >.05). MANCOVA confirmed significant multivariate between-group differences (Wilks’ Λ = .42, p <.001, partial η² = .58).ConclusionsThe ACT-EL program produced large, significant improvements across cognitive, affective, and behavioral outcomes. Emotional acceptance is proposed as a central mechanism facilitating regulatory shift from surface to deep acting. Buddhist-aligned cultural adaptation with ACT’s core processes offers a replicable model for diverse service workforce contexts. Future randomized trials with active controls, long-term follow-up, and mediation analyses are needed.
Factors influencing the sensory profile in patients with autism spectrum disorder from 16 months to 14 years: results of an observational study
IntroductionSensory processing abnormalities represent a high-impact clinical feature in individuals with Autism Spectrum Disorder (ASD). Sensory alterations can be classified by modality and behavioral responses to stimuli. The literature presents conflicting results regarding the association between the sensory profile and other clinical elements. Therefore, this study aimed to characterize the clinical variables that influence sensory anomalies in subjects with ASD.MethodsThis single-center retrospective observational study selected 159 subjects with a confirmed ASD diagnosis, aged 16 months to 14 years. Data collected included clinical assessments (developmental profile, intelligence quotient, adaptive profile and autistic symptom severity) and sensory evaluations using the Sensory Profile-2. A Bayesian cumulative logit model was implemented to assess the impact of clinical variables on sensory profiles.ResultsThe analysis identifies adaptive functioning as the most consistent predictor of sensory outcomes, where higher functioning correlates with a reduction in atypical patterns, particularly sensory sensitivity. Conversely, autism severity and sex generally showed no significant impact, though higher cognitive functioning was specifically linked to increased sensory avoiding behaviors. Furthermore, the Bayesian analysis revealed a modifying effect of age on the sensory profile, characterized by a non-monotonic trend clustered around two distinct age peaks. The preschool period is characterized by a predominance of sensory seeking behaviors and auditory processing challenges, whereas the 8-to-12-year developmental window marks a significant shift toward hypersensitivity and avoidant patterns, particularly within the visual and oral modalities.DiscussionOverall, the analysis revealed that the adaptive profile has a significant impact on the sensory profile, consistent with existing literature. Age emerged as a key modifying factor with a non-monotonic trajectory, contrasting with previous studies that typically highlight either improvement or stability over time. Study main limitations include its retrospective and non-longitudinal nature. Therefore, further prospective longitudinal studies are necessary to explore these dynamic associations between the sensory profile and other clinical variables over time.
Low-dimensional population dynamics in the brainstem gate REM sleep
Nature Neuroscience, Published online: 25 May 2026; doi:10.1038/s41593-026-02314-z
Lozano et al. show that REM sleep is gated by low-dimensional brainstem network dynamics, in which opposing neuron populations across the midbrain and pons determine when transitions into REM sleep can occur.
Fixation duration on natural scenes is explained by memory encoding not processing demand
Nature Neuroscience, Published online: 25 May 2026; doi:10.1038/s41593-026-02285-1
By combining magnetoencephalography and eye tracking, this study sheds light on why people fixate on some parts of natural scenes longer than others. Rather than visual complexity, fixation durations are affected by memory encoding.
<![CDATA[Curiosity, rapport, and understanding lived experience can strengthen schizophrenia care and treatment engagement, according to Tracy Hicks, DNP.]]>
Opinion: How the perimenopause movement is hurting women
Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Patricia Bencivenga and Adriane Fugh-Berman. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.
Torie Bosch: Brain fog and weight gain and hair loss and insomnia — those are the calling cards of perimenopause. At least that’s what the new perimenopause awareness movement claims. But what’s real and what’s just social media misinformation?
Prediction of 30-Day All-Cause Hospital Readmissions Using Limited Structured Electronic Health Record Data: Retrospective Comparative Study
Background: Unplanned hospital readmissions represent a critical operational and financial challenge for health care systems in the United States, with 3.8 million 30-day all-cause readmissions in 2018 at an average cost of US $15,200 each, totaling US $58 billion in costs. Many published prediction models rely on comprehensive information (eg, full billing abstractions, discharge summaries, laboratory tests, and vitals) that becomes available only late in the encounter, limiting usefulness for real-time, in-hospital intervention. This creates a timeliness-accuracy trade-off: models that are most accurate retrospectively may arrive too late to act upon. Objective: This study tests whether a clinically meaningful predictive signal for 30-day all-cause readmission is present within a limited set of structured clinical codes recorded during the patient’s hospital stay. This approach evaluates whether predictive signals are retained when using a restricted set of structured clinical codes. Methods: We conducted a retrospective comparative modeling study using a large, deidentified electronic health record dataset of 50,000 inpatient encounters from the 2019 New York State Emergency Department Database. Two feature sets were constructed: (1) a limited set consisting of the first 5 () diagnosis codes, the first 5 Current Procedural Terminology (CPT) codes, and Charlson Comorbidity Index (CCI; 11 input features); and (2) a rich set using all available and CPT codes plus CCI (up to 135 input features). We trained 4 models: random forest, CatBoost, multilayer perceptron, and DistilBERT (a distilled Bidirectional Encoder Representations from Transformers [BERT] model; structured codes mapped to text and tokenized with DistilBERT-base-uncased). Evaluation used an untouched hold-out set of 10,000 encounters, preserving the natural 21.1% readmission prevalence. Primary metrics were area under the receiver operating characteristic curve (AUROC), -score, and accuracy. To address class imbalance, the training split only was balanced via undersampling of the majority class and bootstrap oversampling of the minority class; validation/test distributions were left unchanged. Results: Models trained on the limited feature set achieved AUROC values ranging from 0.5369 to 0.5596 and -scores from 0.2555 to 0.3434. Across 3 of 4 architectures, models trained on the limited feature set matched or exceeded the discrimination of their rich counterparts. The best model (random forest, limited) achieved an area under the curve AUROC 0.5596 (95% CI 0.5440‐0.5739) compared to the best performing rich model (DistilBERT) at 0.5703 (95% CI 0.5565‐0.5842), an absolute difference of 0.0107. The highest -score (0.3434) was achieved by DistilBERT on the limited feature set. Differences across architectures were small in absolute terms, with threshold-dependent metrics (eg, -score) being comparable. Conclusions: The findings suggest that models using a limited set of structured clinical codes can achieve performance comparable to those using more comprehensive coding information.
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Neuromotor and Cognitive Outcomes of Preterm Infants at 3 Months of Corrected Age in a Northeastern Region of Brazil: Longitudinal Feasibility Study
<strong>Background:</strong> Preterm infants (PTIs) are at increased risk of neurodevelopmental impairment, particularly in socioeconomically vulnerable regions, where access to early intervention services is limited. However, little is known about the feasibility of longitudinal developmental monitoring in such contexts. <strong>Objective:</strong> This study aimed to evaluate the feasibility of recruiting, retaining, and assessing preterm infants in a resource-limited setting in Northeastern Brazil and to generate preliminary data on early neurodevelopmental outcomes. <strong>Methods:</strong> This longitudinal feasibility study was conducted at a referral maternity hospital in Northeastern Brazil between October 2023 and March 2024. PTIs born at ≤32 weeks of gestational age were recruited during hospitalization. Feasibility outcomes included recruitment rate, retention rate, and completeness of assessments. Development was assessed at three time points: (1) Neonatal Intensive Care Unit discharge, (2) Kangaroo Neonatal Intermediate Care Unit discharge, and (3) at 3 months of corrected age (CA), using the Motor Optimality Score (MOS), Test of Infant Motor Performance (TIMP), and Bayley Scales of Infant Development III (BAYLEY-III). Caregiver-infant interaction was assessed using the Recorded Interaction Task (RIT). <strong>Results:</strong> Of 45 eligible infants, 20 (44.4%) were enrolled, and 10 (50%) completed follow-up in 3 months CA. A total of 67 assessments were conducted. Attrition was due to death (n=5), loss of contact (n=2), withdrawal (n=2), and transfer to another service (n=1). Among infants assessed at 3 months CA, 60% (n=6) of infants had MOS <25, indicating increased risk of neurological impairment. At TIMP, 80% (n=8) showed motor performance below expected levels in 3 months. BAYLEY-III assessments (n=8) indicated below-average motor performance in 50% (n=4) of the infants and below-average cognitive performance in 50% (n=4). All caregiver-infant dyads assessed at follow-up (n=10) demonstrated adequate interaction on RIT (mean score 57.9, SD 12.3). <strong>Conclusions:</strong> Longitudinal developmental monitoring of PTIs in a resource-limited setting was feasible, although retention remained a major challenge. Preliminary findings indicated frequent motor and cognitive vulnerabilities after hospital discharge, underscoring the importance of structured follow-ups in early infancy. These findings support the need for larger studies to refine follow-up strategies and evaluate early intervention in similar contexts.
