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.
Reliability and Safety of Smartwatch Blood Pressure and Oxygen Saturation Measurements in Older Adults: Instrument Validation Study
Background: Hypertension is a significant risk factor for cardiovascular diseases and premature mortality, with its prevalence increasing due to population aging and lifestyle factors. Accurate measurement of blood pressure (BP) and arterial oxygen saturation is crucial for disease prevention and monitoring, and wearable devices have emerged as a promising alternative. However, their clinical reliability requires validation, particularly in older populations. Objective: The aim of this research was to evaluate and compare the measurement of BP and arterial oxygen saturation in older people using a smartwatch in comparison with reference devices. Methods: We recruited 50 participants aged between 50 and 89 years (mean 70.60, SD 12.03 y), including 34 female participants and 16 male participants. A total of 3 BP measurements were taken simultaneously using the smartwatch and an ambulatory BP monitoring device (reference device). Arterial oxygen saturation was measured simultaneously using the smartwatch and the oximeter. The paired-sample test (2-tailed) was used to compare variables, and the intraclass correlation coefficient (ICC) was used to verify the correlation. Results: When averaged values were considered, no significant differences were observed between the Samsung Galaxy Watch 6 and the reference device for systolic BP (=.31) or diastolic BP (=.88), with good agreement for both parameters (systolic BP ICC=0.88; diastolic BP ICC=0.88). Arterial oxygen saturation showed no significant difference between devices (=.10), with moderate agreement (ICC=0.68). Heart rate measurements also showed no significant differences between devices (=.54), demonstrating good agreement. Conclusions: The Samsung Galaxy Watch 6 demonstrated acceptable agreement with reference devices for BP and arterial oxygen saturation measurements in older adults without decompensated clinical conditions, evaluated under controlled resting conditions. These findings indicate that the device provides reliable measurements within this specific population and context when measurements are obtained under standardized and physiologically stable conditions.
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Older Adults’ Motivators and Barriers to Using Mindfulness Apps for Stress Management in Brain Health Interventions: Interview Study
<strong>Background:</strong> Population aging is driving a rapid rise in dementia cases worldwide, posing a major challenge for health care systems around the globe, including in the Netherlands. Digital multidomain lifestyle interventions, which target multiple lifestyle domains simultaneously, can protect against cognitive decline in at-risk older adults but struggle to sustain engagement. Addressing stress in these interventions is crucial, as it can directly increase dementia risk and may promote unhealthy behaviors in other domains targeted in these interventions, including physical activity, diet, and sleep. <strong>Objective:</strong> This study explores the motivators and barriers for Dutch adults aged 60 years and older to use mindfulness apps for stress management within digital multidomain lifestyle interventions. Despite their potential, it remains unclear which stress-related needs would motivate older adults to use mindfulness apps in these interventions and whether these apps effectively address those needs. Moreover, little is known about how older adults practice mindfulness independently in everyday settings alongside other lifestyle priorities. <strong>Methods:</strong> We conducted 15 semistructured interviews with former participants of a 26-week multidomain lifestyle intervention study (the “HELI” [Hersenfuncties na Leefstijlinterventie] study) that included a mindfulness app for stress management. Participants (8 females; age range 61-73 years) were first invited to describe their practices to improve brain health to see whether stress and mindfulness emerged spontaneously. Follow-up questions and scenarios explored experiences with stress and mindfulness before these concepts were explicitly introduced midway through the interview, providing insight into their roles in participants’ lives free from associations with the terms. Data were analyzed using template analysis. <strong>Results:</strong> Older adults reported experiencing fewer minor daily stressors than earlier in life and having developed effective coping strategies with age. These strategies often included elements associated with mindfulness, such as acceptance and deliberate attention to the present moment. However, many frequently worried at night about major concerns, including personal health, the well-being of loved ones, and global issues. These findings suggest that older adults may be more motivated to use mindfulness apps to cope with nighttime worry than with minor daily stressors. At the same time, older adults reported barriers to using mindfulness apps, including negative associations with the term “mindfulness” (eg, perceived as too spiritual) and challenges in maintaining focus during exercises. <strong>Conclusions:</strong> We discuss how older adults develop mindfulness skills with age and how these skills help older adults cope with daily stressors but not with nighttime rumination. Specifically, we argue that diminished cognitive resources at night, fewer distractions, and metacognitive patterns may sustain worry before sleep. This study highlights the importance of tailoring multidomain lifestyle interventions to the unique challenges of older adults. We also offer recommendations to present mindfulness in ways that help older adults stay focused during practice.
