Two-stage models of grammatical encoding posit that sentence production unfolds in two sequential steps: the construction of a hierarchical syntactic structure, followed by its linearization into a sequence suitable for articulation. While widely accepted in psycho- and neurolinguistics, such models lack formal computational implementations. Here, we introduce a novel multinomial processing tree (MPT) model that operationalizes this two-stage framework to explain syntactic error patterns in individuals with aphasia. Drawing on discourse samples annotated for distinct error types, we fit an MPT model to estimate individual abilities at each processing stage. These ability estimates correlated with observed error rates and localized to distinct neural substrates: hierarchical encoding ability was linked to the posterior superior temporal sulcus and parietal cortex, linearization to posterior inferior frontal regions, and omission-related processes to more dorsal frontal regions and the underlying white matter. Our findings support a neurocomputational dissociation between hierarchical and linear stages of grammatical encoding, aligning with prior lesion-symptom mapping and theoretical accounts of expressive agrammatism and paragrammatism. This work represents the first computational instantiation of a two-stage model of syntactic production, bridging formal modeling and lesion analysis to advance our understanding of the architecture and breakdown of grammatical encoding.
Everyday listening often requires the auditory system to move beyond the perception of individual sound sources towards a more global representation of acoustic scenes. While auditory behaviour has been well characterised for one or a few sources, it remains unclear how listeners perceive scenes containing many simultaneous sounds. As multiple sound sources combine into a single acoustic mixture, separating individual sources becomes increasingly difficult, potentially requiring listeners to rely on summary representations rather than discrete object-based parsing. Auditory numerosity judgement, the ability to estimate how many distinct sound sources are present, can provide a way to probe how listeners perceive such complex acoustic scenes. Here, we measured numerosity judgements along the three dimensions of auditory space: azimuth, elevation, and distance, allowing each spatial axis to be examined in isolation. As these dimensions rely on markedly different spatial cues and differ strongly in spatial acuity, this design enabled the dissociation of spatial and non-spatial contributions to numerosity perception. Across dimensions, numerosity judgements showed no systematic relationship with individual spatial hearing performance. Speech intelligibility likewise exerted only a weak influence. In contrast, perceived numerosity was significantly modulated by the spectrotemporal coverage of the acoustic mixture, a summary statistic independent of spatial dimension or higher-lever linguistic factors. Together, these findings suggest that auditory numerosity judgement is largely insensitive to spatial hearing precision and instead reflects more general principles of how complex sound mixtures are represented at the scene level.
The Face-Name Associative Recognition Test (FNART) is a recognition-based measure of associative episodic memory designed to reduce retrieval demands while preserving sensitivity to hippocampal-dependent binding processes. The absence of normative data currently limits its clinical use. This study aimed to establish normative data for a Quebec French version (FNART-Q). FNART-Q performance was examined in a large sample of cognitively healthy French-speaking Quebec adults, and percentile-based normative data were developed accounting for demographic influences. A demographically stratified normative framework was developed using an overlapping stratification approach, and percentile ranks were derived to support clinical interpretation of individual scores. The FNART-Q provides clinically interpretable normative data, supporting its use as a demographically adjusted measure of associative episodic memory.
Aim: To identify discourse markers of a trauma-informed communicative model in professional medical dialogue. Materials and Methods: The empirical basis consisted of a collection of «doctor-patient» dialogues recorded between 2022 and 2025. Two samples of doctor speech were formed: in dialogues with patients being internally displaced persons (IDPs) (n=36) and with patients residing in rural regions (n=48). Content analysis was performed using the Textanz software. The study employed a set of general scientific and linguistic methods, including bibliosemantic analysis, content analysis, psychosomatic and comparative analyses, as well as discourse analysis of communicative strategies and descriptive statistics. Results: A total of 7770 statistically significant lexical units were recorded. In interactions with internally displaced persons, doctors demonstrated a higher frequency of the pronoun «you» (49.11% vs. 44.42%) and a lower proportion of the pronoun «we» (5.20%). The category «Communication and its components» dominated among verbs (33.63% vs. 30.48%). In interactions with patients from rural regions, a higher frequency of the pronoun «we» and a more even distribution of verb categories were observed, indicating a partnership model of communication; in working with IDPs, a patient-centered approach with an emphasis on individualization predominates, whereas in interactions with patients from rural regions, a shared decision-making model prevails. Conclusions: Medical communication under martial law generates a spectrum of trauma-sensitive professional discourses. The identified discourse markers can be integrated into medical university curricula and clinical communication protocols.
This study examines the reliability and scoring bias of generative AI (Gen-AI)-based pronunciation assessment compared with human raters, addressing whether AI-generated scores can be trusted in real educational settings. Sixty students participated in a 12-week program. A total of 180 pronunciation samples were evaluated across eight subcomponents (individual phonemes, stress, rhythm, intonation, linking, reduction, fluency, and clarity) by three standardized human raters and Gen-AI using the same 7-point rubric. Quantitative analyses (intraclass correlation coefficients, paired-samples t-tests, and Pearson correlations) assessed reliability and bias, while semi-structured interviews with raters provided explanatory qualitative insights. Gen-AI demonstrated moderate reliability with human raters across most components, showing the highest agreement in fluency and the weakest in individual phonemes. However, Gen-AI consistently assigned significantly higher scores than human raters across all subcomponents. Qualitative findings revealed that discrepancies originated from Gen-AI's limited discriminative power, systematic flaws in handling missing data, decontextualized scoring approach, lack of sensitivity to L1 interference, and inability to interpret pragmatic context. While Gen-AI cannot fully replace human expertise, it can function as a complementary tool for formative assessment and autonomous practice. A hybrid assessment model integrating Gen-AI's efficiency with human raters' contextual and interpretive insights is recommended for effective foreign language pronunciation education.
Journal analyses that capture trends, debates, and dilemmas offer valuable insight into the evolution of a field. Since 1996, the Journal of Deaf Studies and Deaf Education (JDSDE) has been a central journal in the field, demonstrating notable scholarly impact. This study aims to contribute to the understanding of Deaf Education and Deaf Studies by systematically examining 961 full articles published in JDSDE over 30 years from a critical perspective. Articles were analyzed with respect to research topics, methods, and collaboration patterns. Eighteen topics were identified within educational, developmental, linguistic, and cultural categories. Literacy, language development, cognitive and social-emotional development, early intervention, and Deaf identity/culture accounted for 67.7% of the topics. Quantitative research dominated (78.8%). Interdisciplinary collaboration was satisfactory (60%). Findings indicate opportunities for greater representation of cultural topics, inclusion, early intervention, Deaf people with disabilities, and qualitative, single-case, action, mixed-methods research, and international collaboration. Future systematic analysis of all scholarly journals is anticipated to offer a more comprehensive and integrated view of Deaf Studies and Deaf Education.
Patient-reported outcome measures (PROMs) are widely used in trauma and injury research to assess health-related quality of life (HRQoL), mental health and functional recovery. However, PROMs are rarely adapted to reflect the lived experiences, cultural values and determinants of health for priority populations, particularly Aboriginal and Torres Strait Islander peoples, who experience a disproportionate burden of injury in Australia. This systematic review addressed the inclusion of health equity indicators and Indigenous knowledges for PROMs used in observational Australian trauma and injury studies for adults (≥ 18 years). A systematic search of Medline (OVID), CINAHL (EBSCO) and Scopus was performed including prospective cohort or longitudinal designs, focused on trauma-related injuries conducted in Australia. Data were extracted and appraised using the CREATE and PROGRESS-PLUS tools to assess Indigenous engagement and equity-sensitive reporting. Across the 11 included studies, 17 different PROMs were used with SF-36 and PCL-C being the most common. Physical and mental health outcomes were consistently impaired post-injury, with long-term impacts. Equity considerations were largely absent; none of the studies met all PROGRESS-PLUS criteria and Indigenous knowledges were not incorporated. Priority populations, including Aboriginal and Torres Strait Islander peoples, culturally and linguistically diverse (CALD) communities, people with disabilities and women, were frequently underrepresented or excluded. These findings highlight significant gaps in equity-sensitive PROM use and the urgent need for culturally safe and inclusive PROM development that reflects diverse recovery experiences thereby supporting equitable trauma care and follow-up. This study looked at how injury research in Australia uses patient-reported outcome measures (PROMs) to understand recovery after injury. PROMs are tools that ask patients about their health and wellbeing, but they often don’t reflect the experiences or cultural values of Aboriginal and Torres Strait Islander peoples, who are more likely to be injured and face worse outcomes. We reviewed 11 studies and found that while 17 different PROMs were used, none were designed with or for Aboriginal and Torres Strait Islander communities. Most studies didn’t include key equity factors like race, language, disability, or gender in their analysis, and Indigenous perspectives were missing entirely. This means current trauma research may not correctly capture the recovery journeys of priority populations. Our findings show an urgent need to develop culturally safe and inclusive PROMs that reflect diverse experiences and support fairer trauma care. This work can help improve health outcomes and ensure that Aboriginal and Torres Strait Islander peoples are meaningfully included in future research and healthcare planning.
Competency-Based Education (CBE) has become the dominant paradigm for structuring medical training worldwide. Yet its foundational constructs (e.g., Entrustable Professional Activities (EPAs), milestones, and competencies) were conceived within resource-rich, institutionally stable, and culturally specific contexts. Their diffusion across global landscapes has not been neutral. When such frameworks travel, they carry embedded assumptions, epistemic values, and implicit universalizing authority. This article describes how The East, Central, and Southern Africa College of Paediatrics and Child Health (ECSAPACH), in partnership with the Center for Research, Innovation, and Scholarship in Health Professions Education (CRIS) at Baylor College of Medicine, reimagined CBE for African pediatric training through a process guided by design justice and implemented using knowledge brokering. Anchored in Homi Bhabha's concept of the Third Space and Culture's In-Between, we argue that the translation of CBE into new contexts is not merely a technical or linguistic act but an ethical, dialectical, and generative one. ECSAPACH's translation process demonstrates that when frameworks encounter contextual resistance and epistemic contestation, they can be reconstituted into hybrid forms that unsettle universality while deepening both global and local understanding. The resulting hybrid framework represents not a replication or simple adaptation of imported theory but a co-created, contextually anchored model for pediatric education that emerges from ongoing negotiation under conditions of asymmetrical power. We position this work as an instance of hybrid knowledge production in Bhabha's Third Space, offering lessons for equitable global partnerships and for the future evolution of CBE as a living, revisable theory.
Sub-chronic lead (Pb) exposure induces multi-organ toxicity through oxidative stress and inflammation. Dietary interventions have shown promise, but their effects are often organ nonspecific. This study investigated whether fermentation of a millet-based beverage could differentially direct its protective efficacy against Pb-induced injury in specific organs.Male Wistar rats were exposed to 1 ppm lead acetate in drinking water for 8 weeks and co-administered either: a fermented mix of skimmed milk and malted millet milk (F-Mix), fermented skimmed milk (FSM), or unfermented malted millet milk (UFMM). Hematological, hepatic, renal, inflammatory (TNF-α), hippocampal oxidative stress (Nrf2, GSH, SOD, CAT), acetylcholine, and histopathological parameters were assessed.Pb exposure significantly reduced hemoglobin, increased serum creatinine and BUN, elevated TNF-α, depleted hippocampal antioxidants, and impaired organ histology (p < 0.05 vs. control). Notably, UFMM attenuated Pb-induced hippocampal Nrf2 depletion by 63%, restored GSH by 71%, and preserved hepatic architecture with minimal necrosis. In contrast, F-Mix reduced serum TNF-α by 58% (p < 0.01 vs. Pb group), lowered creatinine by 44%, and BUN by 39%, with preserved renal tubular integrity. Fermented beverages (FSM and F-Mix) showed superior renal protection, while unfermented UFMM was more effective in liver and brain. Fermentation status critically redirects the organ-protective effects of millet-based beverages against Pb toxicity. Unfermented millet milk preferentially activates Nrf2-mediated antioxidant pathways in the brain and liver, while fermentation shifts protection toward the kidneys and systemic inflammation. These findings support the concept that food processing can be leveraged to design targeted nutritional interventions against heavy metal toxicity.
Digital mental health is undergoing rapid transformation through the deployment of artificial intelligence (AI) systems including conversational agents, risk-prediction tools, and clinical decision-support platforms. Despite growing enthusiasm, the field has yet to converge on an operational standard for what constitutes honest, trustworthy AI in psychiatric and psychological contexts-one that explicitly accounts for the limits, blind spots, and populations for whom deployed systems have not been validated. This Perspective draws on Richard Feynman's foundational principle of scientific integrity-articulated in his 1,974 Caltech commencement address, "Cargo Cult Science"-and Carl Sagan's dimensional metaphors to develop a practical, disclosure-oriented ethical framework for AI in digital mental health. The neurodiversity paradigm provides a critical stress test: growing empirical evidence indicates that AI tools trained on narrow behavioural and linguistic norms carry substantial risk of misrepresenting neurodivergent users, with the potential to silently re-encode stigma, misclassification, and inequity into clinical systems. Drawing on predictive processing theory and recent empirical evidence of AI bias against neurodivergent populations, this work proposes five criteria for the Feynman Honesty Standard: scope clarity, population-limit disclosure, uncertainty communication, role integrity, and participatory co-development. The analysis concludes with a forward-looking research agenda for clinicians, developers, and policymakers, arguing that the field will be judged not only by algorithmic performance but by its candour about what these systems know, miss, and cannot do.
Language forms the foundation of social interactions, allowing us to connect with family and peers. Through speech, we express our thoughts and emotions to others. Experiencing challenges in speech and language functions during development can therefore significantly affect social relationships, cognitive and affective development. In child and adolescence psychiatry, clinicians have observed that speech and language abilities may be altered in various mental (behavioral/developmental) disorders (psychiatric disorders). This review provides an overview of systematic and original investigations exploring how speech and language are affected in child and adolescent psychiatric conditions, including autism spectrum, schizophrenia, attention deficit/hyperactivity disorder, and depression. We emphasize research that utilized neuroimaging techniques (i.e., EEG, MRI, fNIRS) to investigate the neurobiological basis for alterations in speech or language in child and adolescence psychiatry. The findings indicate that each reviewed syndrome shows evidence of altered speech or language functions, along with corresponding neurobiological changes. Most available studies focus on autism spectrum, while research concerning schizophrenia and depression generally involved adults rather than children or adolescents. This highlights a considerable research gap in understanding (the neurobiological cause of) speech and language alterations in developing populations with psychiatric conditions.
Infant sleep is disrupted around the onset of motor milestones, but the causal mechanisms underlying this relationship are unclear. This study aims to corroborate prior reports of the link between locomotor milestone onset and sleep disruptions and expand the literature by asking whether language milestones are also associated with sleep disruptions. Time-series changepoint detection analyzed parent reported milestone onset data and sleep data of two age cohorts collected remotely through an online app and baby monitor system. Disruptions to sleep were found relative to the onsets of first crawling steps, first walking steps, walking mastery, babbling, cooing, expressive jargon, new word use, and object labeling. These results replicate evidence for a relationship between sleep disruption and locomotor milestone onset and offer the first evidence of disruptions to sleep associated with language milestones. To our knowledge this is the first study to show that skill acquisition affects infants' sleep prior to the expression of the skill. Changes in sleep patterns demonstrate that prior to skill onset skill-relevant behaviors are marshaled and coordinated to facilitate the emergence of new skills. After skill onset, sleep functions to consolidate new knowledge and skills and support the process of mastery.
This study investigates how Catalan-Spanish bilinguals perceive and identify vowels produced in Southern British, Northern British and Australian English. Thirty-three participants completed a perceptual assimilation task and a second-language vowel identification task using naturally produced /CVC/-syllables. Results showed that peripheral English vowels were consistently mapped onto a single Catalan category with high goodness-of-fit, while other vowel-accent pairings, particularly those involving mid-vowel categories, displayed more variable cross-language mappings. Listeners' mappings also varied across the three regional accents and did not reliably predict L2 vowel identification accuracy, likely due to high input variability and the relative instability of L2 vowel representations.
Conversational agents for women's health often fail to meet user needs, offering either clinically sterile advice or unreliable peer anecdotes. This limitation creates a tension between the need for factual safety and emotional resonance in sensitive health contexts. We aimed to address this gap by developing and conducting a formative evaluation of HerCare, a conversational agent built on a novel dual-source retrieval-augmented generation architecture. The system integrates expert medical knowledge with peer narratives and makes the provenance of each response visible to users, enabling trust calibration through transparent source attribution. We conducted a remote, web-based single-session field study (December 2024 to January 2025; North Dakota State University Institutional Review Board Protocol #IRB0005368) with 243 completers (from 335 eligible, consenting visitors) recruited via social media (Facebook [Meta], Reddit, and Instagram [Meta]) and university mailing lists. Eligible participants self-identified as women aged 18-45 years with English proficiency and internet access. We used a quantitative multimethod evaluation, combining standardized self-report metrics-the Chatbot Usability Questionnaire and net promoter score (NPS)-with computational linguistic analyses (VADER [Valence Aware Dictionary and Sentiment Reasoner] sentiment analysis and NRC [National Research Council] Emotion Lexicon) of 1191 conversational turns. Among the 243 participants who completed the protocol, reported usability was high (Chatbot Usability Questionnaire median 78.1, IQR 65.2-87.5; mean 75.67, SD 15.50) and advocacy was strong (NPS 60.0; 171/243, 70.4% promoters, 25/243, 10.3% detractors), though this NPS reflects completers only. Postinteraction ratings were high (all facets median 4-5 on a 5-point scale; helpfulness, ease of use, and clarity median 5, IQR 4-5). Computational analysis revealed a consistent polarity shift from neutral to negative user queries (compound -0.18 to +0.15) to strongly positive agent responses (compound +0.55 to +0.83), with a recurring validate-then-redirect empathy pattern in which the agent acknowledges user distress before pivoting to constructive guidance. Among completers, the dual-source architecture was associated with high perceived empathy and trust, suggesting it can combine clinical accuracy with emotional support. These formative findings indicate the feasibility of weaving clinical sources with lived experiences toward safer, more resonant health AI and surface a candidate design pattern for future empathy-attuned systems that warrants controlled evaluation.
Auditory processing is widely understood to occur differently in autism, though the patterns of brain activity underlying these differences are not well understood. The diversity of autism also means brain-wide networks may change in various ways to produce similar behavioral outputs. We used larval zebrafish to investigate auditory habituation in three genetic lines relevant to autism: fmr1, mecp2, and cntnap2 In free-swimming behavioral tests, we found each line had a unique profile of auditory hyper-responsiveness and/or reduced habituation compared to wild types. Combining the optical transparency of larval zebrafish with genetically encoded calcium indicators and light-sheet microscopy, we then observed brain-wide activity at cellular resolution during repeated sound stimuli. Each line showed unique alterations in brain-wide spontaneous activity, auditory processing, and adaptation in response to repetitive acoustic stimuli. We also observed commonalities in activity across our genetic lines that indicate shared circuit changes underlying certain aspects of their behavioral phenotypes. These were predominantly in regions involved in sensory integration and sensorimotor gating rather than primary auditory areas. Overlapping phenotypes include differences in the activity and functional connectivity of the telencephalon, dopaminergic regions, and the locus coeruleus. Unique phenotypes include increased activity in auditory regions and excitatory/inhibitory imbalance in the cerebellum in fmr1, and differences in network activity over time in mecp2 and cntnap2 Comparing these distinct but overlapping brain-wide auditory networks suggests that diverse genetic factors may contribute to similar behavioral effects through a range of circuit- and network-scale mechanisms.Significance statement Wilde et al. compare auditory habituation phenotypes in three genetic zebrafish models of autism. Of particular interest, several lines had overlapping behavioral phenotypes despite distinct patterns of brain-wide activity and network organization. Rather than pointing to a single mechanism underlying altered sensory responses, the data instead suggest there may be multiple neural routes to superficially similar sensory behaviors. This fits with growing discussions in human research that auditory processing in autism is unlikely to reflect one unified phenotype, but instead a diverse set of sensory profiles and underlying neural processes. Comparing across multiple genetic models and levels of neural organization may therefore help strengthen links between mechanistic animal work and the variability described in human sensory research in autism.
This study aimed to validate the Voice Handicap Index-10 adapted into Algerian Arabic (VHI-10-AA) and to evaluate its psychometric properties. A secondary objective was to determine the optimal cutoff score for distinguishing dysphonic patients from healthy controls. This was a cross-sectional validation study. A total of 150 Algerian Arabic-speaking participants were recruited, comprising 90 healthy controls and 60 patients diagnosed with dysphonia of various etiologies and severity. The VHI-10-AA items were derived from the previously validated VHI-30-Algerian Arabic (Kaddour et al, 2025).17 Test-retest reliability was assessed using the intraclass correlation coefficient (ICC [2,1]). Discriminant validity was evaluated through the Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis. The VHI-10-AA demonstrated excellent test-retest reliability, with ICC values of 0.94 for controls, 0.96 for dysphonic patients, and 0.95 for the combined sample. A highly significant difference was found between groups (U = 345.5, P < 0.001), with median scores of 4.0 for controls versus 24.0 for dysphonic patients. ROC curve analysis yielded an area under the curve of 0.94 (95% CI: 0.91-0.97). The optimal cutoff score of 12.5 provided a sensitivity of 88.3% and a specificity of 91.1%. Finally, the internal consistency of the VHI-10-AA was excellent for the total sample (α = 0.95) and dysphonic patients (α = 0.91), and good for controls (α = 0.84). The VHI-10-AA is a valid, reliable, and clinically useful instrument for assessing voice-related handicap in Algerian Arabic-speaking individuals. The established cutoff score of 12.5 offers an evidence-based threshold for screening dysphonia in clinical and research settings.
In vision-language models (VLMs), visual tokens usually bear a significant amount of computational overhead despite sparsity of information in them when compared to text tokens. To address this, most existing methods learn a network to prune redundant visual tokens using certain training data. Differently, we propose a text-guided training-free token optimization mechanism dubbed SparseVLM without fine-tuning costs. Given that visual tokens complement text tokens in VLM's linguistic reasoning, we select relevant text tokens to rate the significance of visual tokens using self-attention matrices and, then, prune visual tokens using the proposed strategy to maximize sparsity while retaining information. In particular, we introduce a rank-based strategy to adaptively determine the sparsification ratio for each layer, alongside a token recycling method that compresses pruned tokens into more compact representations. However, the Attention Gravity and Attention Sink phenomena undermine the sparsification reference of SparseVLM: text-visual alignment. To address this, we introduce improved text-visual attention patterns to enhance the fidelity of query-aware vision token selection. First, we correct the Attention Gravity effect, where positional encodings induce disproportionately high attention to vision tokens positioned near textual tokens. We further mitigate the Attention Sink by selecting priority attention heads that suppress the excessive attention absorbed by semantically irrelevant vision tokens. The two parts refine the text-visual alignment from both the token and head perspectives. Finally, for video understanding tasks, we propose Temporal-Balanced Sparsification, complementing spatial relevance with temporal diversity to reduce cross-frame redundancy. Extensive experiments on 23 widely used image and video understanding tasks across 7 vision-language models demonstrate the effectiveness of our SparseVLM+ framework. For example, equipping LLaVA with SparseVLM+ yields a 57.1% reduction in FLOPs and a 38.4% decrease in CUDA latency, while preserving 99.6% of its original accuracy on average. Our code is available at https://github.com/Gumpest/SparseVLMs.
Polar questions play a fundamental role in communication and have been investigated across a wide range of spoken languages, from which we know that polar question forms may vary considerably across varying contexts. Much less is known about polar question forms in different contexts in sign languages. This paper concentrates on one particular sign language, namely Dutch Sign Language (NGT). It investigates (i) which polar question forms exist in NGT, (ii) in which types of context these different forms are used, and (iii) what the semantic contribution is of specific elements that may occur in polar questions. We present a production experiment in which two contextual factors are manipulated through role play between the participant and two confederates: (i) the prior expectations of the person asking the question with respect to the truth of the proposition that the question is about, and (ii) the evidence available in the immediate context of utterance with respect to the truth of this proposition. We identify a broad range of polar question forms, differing in terms of polarity marking (positive, negative, null), the presence or absence of question tags, and use of non-manual markers. We observe that each question form has a distinct distribution across the different contexts of use under consideration. With regard to non-manuals, a notable finding is that, contrary to expectation given the previous literature on polar questions in sign languages, raised eyebrows are not consistently used in the polar questions in our dataset; in fact, brow lowering is also rather common. This leads us to suggest that a head or body forward position - not raised eyebrows - is the main polar question marker in NGT. We suggest that raised and lowered eyebrows mark a broad range of other functions that may be relevant in (non-canonical) polar questions.
The term sepsis is commonly used in surgical and critical care settings, yet its linguistic and emotional impact on patients' families is underexplored. Misinterpretation can influence perception, critical decision, and heighten fear. This work examines how the diagnosis of sepsis functions as both a physiologic and communicative event, and to propose the SEPSIS Dialogue; a novel, structured framework for family-centered communication in acute surgical care. Narrative reflection and synthesis integrating surgical physiology, health literacy, and communication ethics. This framework was developed by mapping common communicative friction points in the ICU and perioperative setting against established principles of serious illness conversations. Families frequently interpret sepsis as a fixed, catastrophic outcome, whereas clinicians view it as a dynamic spectrum. In surgical contexts, this "comprehension gap" is often widest at critical decision points, such as the need for re-operation. The SEPSIS Dialogue (State mechanism, Explain source, Present the spectrum, Speak to uncertainty, Invite questions, Support emotions, Demonstrate understanding) provides a structured pathway to bridge the gap in ways that respect comprehension, emotional experience, and clinical context. Structured, plain-language communication can transform sepsis conversations from fear-driven moments into opportunities for partnership, clarity, and informed, values-based care.
To document and characterize headache and dizziness provocation during mental imagery of real-life symptom-provoking movements in patients with persistent postconcussive symptoms (PPCS). Outpatient rehabilitation department at Reuth Rehabilitation Hospital, Tel Aviv, Israel. Thirteen adults (7 females; mean age 34.3 ± 12.6 years) undergoing multidisciplinary rehabilitation for PPCS with functional decline after mild traumatic brain injury. All were ≥3 months postinjury, reported both headache and dizziness, and had a known real-life symptom trigger (eg, movements, activity). Patients with cognitive, linguistic, or psychiatric impairments were excluded. Case series. The primary outcome was the result of mental imagery testing of symptom-provoking movements for headache and dizziness, routinely performed as part of vestibular evaluation protocol at the facility. Secondary outcomes included demographics, medical history, clinical trajectory, imaging results, current medications, symptom questionnaires scores (Brief Pain Inventory, Dizziness Handicap Inventory), and vestibular bedside assessments findings. Headache was provoked in 9 out of 13 patients (69.2%), and dizziness in 11 out of 13 patients (84.6%) during mental imagery of real-life symptom-provoking movements. Five of the 13 patients (38.5%) had oculomotor and vestibular abnormalities (eg, benign paroxysmal positional vertigo, vestibular asymmetry, oculomotor deficits). Symptom reproduction occurred regardless of vestibular pathology in 3 out of 5 cases with oculomotor or vestibular abnormalities. All patients reported additional symptoms, such as musculoskeletal pain, fatigue, and sleep disturbances. This case series identifies a novel clinical phenomenon in patients with PPCS, where mental imagery of symptom-provoking movements provokes headache and dizziness. These findings suggest a potential link between mental imagery and symptom exacerbation, supporting the notion that PPCS may reflect functional rather than structural mechanisms. This perspective underscores the need for further research to elucidate underlying mechanisms and explore potential therapeutic interventions.