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ObjectiveChopra Wellbeing Index (CWI) was developed as a multidimensional measure of wellbeing, integrating physical, emotional, social, and spiritual domains consistent with contemporary models of human flourishing. The purpose of this study was to systematically evaluate the psychometric properties of this measure.MethodsThe psychometric properties of the CWI were assessed in 1637 participants (ages 18-83) who completed the CWI alongside established comparator measures of wellbeing, mental health, and quality of life. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to test the dimensionality of the instrument. Internal consistency was assessed using Cronbach's alpha and McDonald's omega. Criterion validity was assessed via correlations with validated scales. Measurement invariance testing was conducted with respect to several demographic dimensions to assess generalizability of the scale's underlying factor structure.ResultsThe 24-item CWI demonstrated strong internal consistency across subscales. Factor analyses supported a multidimensional structure with four correlated subscales: physical, psychological, social, and spiritual wellbeing. Evidence of criterion validity was found via positive correlations with wellbeing and life satisfaction measures along with negative correlations with measures of depression, anxiety, and negative emotions. Partial measurement invariance was supported with respect to gender, education, marital status, employment status, income, race/ethnicity, and country.ConclusionsThe Chopra Wellbeing Index is a reliable and valid tool for assessing multidimensional wellbeing in adults. Its integration of spiritual and existential domains alongside traditional health indicators distinguishes it from existing instruments, making it suitable for use in holistic health research, clinical practice, and population wellbeing monitoring.

There is large variability in speech perception outcomes across cochlear-implant (CI) users. One factor that contributes to this variation is the neural modulation encoding in the periphery, which can vary along the implant electrode array. Since temporal envelope cues are crucial for speech perception with a CI, previous studies have shown that there is potential of deactivating electrodes based on poorer behavioral measures of neural modulation processing to improve speech perception. However, behavioral measures are typically time-consuming and require active feedback from the CI recipient. A potentially useful objective measure of neural modulation processing is the electrically-evoked auditory steady-state response (eASSR). Recently, the across-array variation of eASSRs has been shown to strongly correlate with speech perception in noise in CI users. In the present study, we demonstrate feasibility to measure 40-Hz eASSRs with clinical pulse rates across multiple electrodes. Next, we investigated whether objective electrode-selection based on individual across-array eASSR patterns has the potential to improve speech perception in CI users. 40-Hz eASSRs were recorded across the whole implant electrode array by means of EEG. A custom-built EEG system with a resolution of 262 kHz was used in order to be able to remove CI-stimulation electrical artifacts. Next, the across-array variation of eASSR amplitudes was used as a basis for individualized electrode-selection. Two experimental MAPs with 11 electrodes (MAPs A and B) were created for each participant: MAP A retained electrodes that were considered better at conveying temporal envelope cues, and MAP B those that were considered poorer at it. Speech perception performance with the clinical and the two experimental MAPs was assessed using speech perception tasks in quiet and in noise, and correlated with eASSR pattern metrics after accounting for the effect of tonotopical changes on speech perception due to electrode deactivation. Results showed that MAP A consistently performed better than MAP B in all three listening conditions, but both still perform worse than the clinical MAP. Furthermore, results suggested that higher eASSR amplitudes overall and greater across-array variation were associated with better performance with MAP A, even after controlling for tonotopical effects. No such associations were observed for MAP B. These findings suggest that automatic, objective electrode-selection strategies based on local neural modulation encoding of cochlear regions along the electrode array is useful for individual clinical CI fitting, with the potential to improve speech perception outcomes in CI recipients.

Space-time coding metasurfaces enable dynamic control of electromagnetic waves by jointly exploiting spatial coding and temporal modulation, unlocking functionalities unattainable with static platforms. While these concepts have been widely explored in planar configurations, their extension to conformal geometries has received comparatively little attention, despite the prevalence of curved platforms in practical applications. Here, space-time coding conformal metasurfaces are examined as a platform for multifrequency beam steering and shaping on nonplanar structures. A representative cylindrical geometry, characterized by translational invariance of the supporting structure along one direction and mild curvature along the orthogonal transverse coordinate, is adopted as a physically relevant configuration that enables accessible modeling of curvature effects. The proposed design strategy combines semi-analytical modeling with hybrid synthesis techniques, including evolutionary optimization. The resulting responses are validated through experimental measurements on an X-band conformal prototype employing a segmented architecture that enables controlled cylindrical bending, showing good agreement with theoretical predictions. These results demonstrate that multifrequency beam steering and shaping can be achieved on curved surfaces, establishing space-time coding as a viable and scalable approach for dynamic wave manipulation in realistic conformal environments.

Background: Posttraumatic Stress Disorder (PTSD) treatment shows 40% of non-response rate despite the efficacy of evidence-based psychotherapies like Prolonged Exposure (PE), and Cognitive Processing Therapy (CPT). Understanding how PTSD symptoms change during treatment, and the mechanisms that precede, mediate, or moderate these changes, is essential for improving interventions.Objective: This systematic scoping review mapped how changes in PTSD have been studied during psychotherapy between 2000 and 2023, focusing on (1) research objectives, (2) PTSD conceptualization, (3) covariates and mechanisms included, (4) repeated measurement timing and frequency, and (5) statistical modelling of change.Methods: Following PRISMA guidelines, we searched scientific databases for English- and Spanish-language peer-reviewed studies. Eligible studies included adults diagnosed with PTSD, examined evidence-based psychotherapies, and incorporated at least three repeated in-treatment assessments. Excluded were pharmacological trials, case studies, and non-empirical articles. After a three-phase screening, 115 studies met inclusion criteria. Data were extracted on research objectives, measurements, demographics, and analytic methods, and summarized using descriptive statistics.Results: Most studies were conducted in the United States (82%) involving veterans or active military (50%). PE (50%) and CPT (31%) dominated the treatment landscape. A total of 207 research objectives were identified, grouped into 16 categories. The most frequent were temporal precedence, time-stable predictors, and identification of change trajectories. PTSD and depression were the most frequently measured constructs (83%), typically assessed session-by-session with an average of nine repeated measurements, aligned with protocol duration. Multilevel regression modelling was the predominant analytic strategy (48%).Conclusions: Future research should state causal aims openly and base measurement on theory and evidence rather than tradition. Exploratory studies are needed to build an accurate understanding of the timing of PTSD change. Crucially, no studies used ecological momentary assessment, and samples show limited generalizability. Finally, research efforts significantly increased since 2010, evidencing the importance of this type of research. Temporal precedence of PTSD and explanatory mechanisms, along with time-stable moderators of change, is the most frequent research question in PTSD treatment change research.Measurement of PTSD change during treatment seems to be based on practical issues (protocol length) rather than theory or empirical considerations.A clear conceptualization of change, along with adequate modelling, is necessary to answer the field's research questions.

Mangrove forests along the Iranian coast of the Persian Gulf are valuable both economically and for biodiversity. The main tree species in these forests is Avicennia marina (Forssk.) Vierh. The habitats of this species in Iran are separated by several thousand kilometers from other populations worldwide. Although introgressive hybridization is common in this species, no morphological study has evaluated this issue in Iranian populations. This study investigated the morphological variation of Iranian A. marina and used sequencing of ITS regions to infer phylogenetic relationships Iranian A. marina populations and other Avicennia species. Morphological analyses based on pollen grains and internodes have shown differences between A. marina populations which is the main species of the mangrove forests of Iran and a new population was identified, which is here described as A. marina subsp. australis. The phylogenetic analysis based on the ITS region confirmed the monophyly of Iranian populations and secondary analysis of ITS2 has moderate support from the two populations detected in the present study. Divergence time estimates suggest these lineages separated during the Pliocene-Pleistocene transition, likely due to climatic fluctuations and sea-level changes.

The spin-up flow dynamics of ferrofluids provides reliable predictions for understanding the rheological behavior, heat-transfer characteristics, and stress management of ferrofluids. These properties are practically useful in applications such as magnetic cooling systems, biomedical drug targeting, seals and dampers, rotating machinery with ferrofluid lubrication, and heat-transfer devices. This study develops a theoretical framework to study the spin-up flow of a ferrofluid over an off-centered rotating rough surface under the influence of a magnetic field. Along with the conservation of mass, momentum, and energy equations, the spin-up flow equation is incorporated into the theoretical model. These equations incorporate the micropolar rheological effects of ferrofluids, including the bulk spin viscosity, shear spin viscosity, and vortex viscosity. Due to the misalignment of the center of the disk, the induced flow components are also considered in the model. The governing equations are first nondimensionalized, and then, a finite element method is used to solve them numerically. Proper validation of the numerical solution is presented in a separate section. The results for the velocity functions, induced flow, microrotation velocity function, and temperature profiles are demonstrated for various physical parameters. In addition, a comparison table for stress and heat-transfer characteristics is provided to determine the influence of different physical parameters on these quantities.

Here we present, for the first time, a light-encoded, dual-zone, single optical fiber (Zonal@OF)-based photoelectrochemical (PEC) microelectrode for the simultaneous and spatially resolved quantification of multiple biomarkers. To overcome the limitations of external light sources and rigid electrodes in conventional PEC biosensors, a single optical fiber was precisely etched to create two independent sensing zones (Zone I and Zone II). Each zone was sequentially functionalized with a gold nanoparticle conductive layer, a zone-specific light-harvesting material (BiOI nanoflakes for Zone I; methylene blue for Zone II), and a corresponding target-specific aptamer (for NT-proBNP and cTnI, respectively). The core innovation enables wavelength-resolved operation: upon separate excitation at 450 and 650 nm, the two zones generate distinct, noninterfering photoelectrochemical signals, allowing for the simultaneous, cross-talk-free detection of NT-proBNP and cTnI. The developed Zonal@OF-PEC sensor demonstrates high sensitivity at the pg mL-1 level, excellent specificity. By leveraging self-guided illumination and the miniaturized dimensions of optical fibers, along with achieving spatial-photonic encoding on a single fiber, this work demonstrates the potential of PEC biosensor to be further explored for real-time, multianalyte tracking. This capability bridges a critical gap toward their clinical translation in precision medicine.

A 43-year old man presented with fever and cough and was initially treated for community-acquired pneumonia. Within 24 h, he deteriorated and was admitted with type 1 respiratory failure. A recent history of exposure to waterlogged fields, along with progressive decline in haemoglobin, platelet counts and deranged liver function tests, raised suspicion for leptospirosis, later confirmed by positive IgM serology. With progressive clinical and radiological worsening, severe pulmonary haemorrhagic syndrome was considered. He was managed with oxygen, noninvasive ventilation (NIV), ceftriaxone, doxycycline, cotrimoxazole, and pulse methylprednisolone. He showed significant improvement and was successfully weaned off NIV and oxygen. This case highlights the importance of early recognition and timely initiation of steroid therapy in severe leptospiral pulmonary involvement.

Goal-directed walking involves regulating foot placements to achieve specific tasks. This requires visuomotor integration. Perceptual, cognitive, and contextual salience guide attention and motor planning for navigation. Here, we quantified how perceptual salience informs lateral foot placement while walking. Participants walked along prescribed virtual paths (straight or winding), thus keeping contextual salience (the task itself) constant. We manipulated perceptual salience by systematically altering environment richness (rich vs. sparse) and path color contrast (high vs. low). We quantified head pitch angle to approximate gaze direction. We quantified lateral stepping regulation from a Goal Equivalent Manifold framework. Our guiding hypothesis was that stepping arises from continuous decision-making action-perception processes: each step taken affects the decision of where to step next. This generated three testable predictions. First, that contextual salience alone (merely "seeing" the path) is sufficient for people to regulate stepping. However, while substantial between-path differences largely supported this, within-path differences in both head angle and stepping demonstrated that visual information (perceptual salience) also informs stepping. Second, we predicted perceptual salience of task-relevant visual information (here, of the path itself) is sufficient to guide stepping. However, while changing path color contrast did elicit more and greater changes than manipulating environmental richness, path visual saliency alone was not sufficient. Third, we predicted perceptual salience from peripheral vision also contributes to stepping. This prediction was supported, though less strongly than manipulating path visual saliency or contextual salience (straight vs. winding paths). Thus, both contextual and perceptual salience interact to influence step-to-step control of walking.

Before entering the nucleus, the HIV capsid core [composed of capsid (CA) proteins] must translocate through the Nuclear Pore Complex (NPC). This process relies on direct interactions between CA and the phenylalanine-glycine (FG) repeats in nucleoporins (NUPs) within the NPC. FG repeats are generally classified into three canonical motifs: FG, GLFG, and FxFG, which are differentially distributed along the NPC axis: FG and FxFG motifs are predominantly at the cytoplasmic periphery and in the nuclear basket, whereas GLFG motifs are primarily in the central channel of the NPC. We demonstrate that the capsid engages the diverse FG repeats with markedly different affinities. Notably, GLFGs of NUP98 located in the central channel display significantly increased affinity to CA than conventional FGs/FxFGs. NUP153, which is located at the nuclear basket, contains an atypical FxFG that is adjacent to a PSGV sequence, thus forming additional favorable interactions. We designate this nonconventional FxFG motif as an "FG super-motif." In addition, the C-terminus of NUP153 also contains a cluster of basic residues that serve as an enhancer of the NUP153 FG super-motif, dramatically increasing CA affinity by ~1,000-fold. Other binding enhancers for FG motifs were also identified in NUP58 and POM121 that are in the central channel and its nuclear boundary, respectively. Affinities of NUP58, POM121, and NUP153 enhancers to CA increase with proximity to the nuclear basket. Thus, we propose that the diverse FG repeats and their binding enhancers create an affinity gradient that potentiates HIV capsid translocation through the NPC.

Novel heteroanionic tripraseodymium pentachloride orthosilicate, Pr3Cl5[SiO4], was synthesized from a stoichiometric mixture of Pr2O3, PrCl3, and SiO2 using a self-flux-assisted high-temperature reaction under vacuum-sealed conditions. Single-crystal X-ray diffraction revealed that the compound crystallizes in the orthorhombic space group Pnma (No. 62) with unit-cell parameters a = 16.0012 (10), b = 4.1766 (2), and c = 14.0348 (9) Å (Z = 4). The structure consists of discrete [SiO4]4- tetrahedra within the anionic sublattice, embedded within a three-dimensional network of distorted [PrCl7O3] polyhedra, in which each Pr3+ cation is ten-coordinated in a distorted tetracapped trigonal prismatic or bicapped square-antiprismatic fashion. Refinement revealed coupled positional splitting of the Si atom and the apical O atom aligned approximately along the crystallographic b axis, corresponding to two mirror-related `up-down' orientations of the discrete [SiO4]4- tetrahedra in the average Pnma structure. Electronic structure calculations based on a symmetry-lowered disorder-free model generated using ISODISTORT predict an indirect bandgap of ca 4.53 eV, classifying Pr3Cl5[SiO4] as a wide-bandgap insulator. The density of states (DOS) analysis indicates that the valence band is dominated by O 2p and Cl 3p states, while the conduction band is primarily derived from Pr 5d orbitals. Crystal orbital Hamilton population (COHP) and crystal orbital bond index (COBI) analyses establish a clear hierarchy of bonding strengths: Si-O (-iCOHP = 7.35 eV, iCOBI = 0.72) ≫ Pr-O (3.18 eV, 0.48) > Pr-Cl (1.62 eV, 0.27), highlighting the strongly covalent nature of Si-O bonds and weaker, but still appreciable, polar Pr-Cl and Pr-O interactions. These findings provide new insights into the crystal and electronic structure characteristics of rare-earth (RE) chlorosilicates, extending the structural chemistry of the RE3Cl5(SiO4) family.

Major depressive disorder is increasingly conceptualized as a condition involving brain network dysfunction, neuroimmune imbalance, sleep-circadian disruption, hypothalamic-pituitary-adrenal (HPA)-axis dysregulation, monoaminergic arousal instability, and impaired synaptic plasticity. In parallel, the glymphatic system has emerged as a plausible integrative mechanism linking these domains, because it is a glia-dependent pathway supporting cerebrospinal fluid-interstitial fluid exchange and metabolic-waste clearance, with activity strongly modulated by deep non-rapid eye movement (NREM) sleep. This narrative review synthesizes evidence that glymphatic-related magnetic resonance imaging (MRI) proxies, particularly diffusion tensor imaging along the perivascular space (DTI-ALPS), are altered in depression, while emphasizing that DTI-ALPS is an indirect marker of perivascular diffusion rather than a direct measure of glymphatic flow. We define four key research gaps: scarcity of treatment-resistant depression (TRD)-specific cohorts, regional and technical heterogeneity across MRI studies, and uncertainty about causal direction relative to sleep disturbance and inflammation. Altered indices appear to relate to fatigue, psychomotor retardation, cognitive impairment, rumination, suicidality, systemic inflammation, oxidative stress, and HPA-axis dysregulation. We integrate opposite-direction findings, including elevated ALPS in drug-naive somatic depression, into a state- and subtype-dependent working model rather than a unidirectional dysfunction framework. Therapeutic implications are organized by target specificity, including sleep-dependent clearance, perivascular exchange, aquaporin-4 (AQP4) polarization, vascular pulsatility, and neuroimmune modulation. We propose falsifiable predictions and negative-control analyses to distinguish a glymphatic-related model from additive effects of insomnia, inflammation, and vascular risk. Overall, the current evidence supports a cautious translational framework for biomarker-informed trials in TRD-relevant phenotypes rather than a validated diagnostic biomarker.

Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Tranexamic acid may reduce blood loss by inhibiting fibrinolysis. To evaluate the efficacy and safety of prophylactic intravenous tranexamic acid administered before skin incision for prevention of atonic postpartum hemorrhage during cesarean section. This single-center randomized controlled study included 240 women undergoing cesarean delivery. Participants were randomized to receive either 1 g intravenous tranexamic acid or 10 mL normal saline before skin incision, along with standard active management of the third stage of labor. The primary outcome was calculated estimated blood loss. Secondary outcomes included atonic postpartum hemorrhage, additional uterotonic requirement, blood transfusion, percentage fall in hemoglobin, and adverse events. Mean calculated estimated blood loss was significantly lower in the tranexamic acid group than in the placebo group (578 ± 291 mL vs. 684 ± 245.26 mL; P = 0.002). The incidence of postpartum hemorrhage, need for additional uterotonics, blood transfusion, and percentage fall in hemoglobin were lower in the tranexamic acid group, but these differences were not statistically significant. Minor adverse effects were comparable between groups, and no thromboembolic events or visual disturbances were observed. Prophylactic intravenous tranexamic acid administered before skin incision significantly reduces blood loss during cesarean delivery without increasing adverse effects TXA appears to be a safe and useful adjunct to routine uterotonic therapy in women undergoing cesarean section. Résumé Contexte:L’hémorragie du post-partum demeure une cause majeure de morbidité et de mortalité maternelles. L’acide tranexamique peut réduire les pertes sanguines en inhibant la fibrinolyse.Objectif:Évaluer l’efficacité et la sécurité de l’administration prophylactique intraveineuse d’acide tranexamique avant l’incision cutanée pour prévenir l’hémorragie du post-partum par atonie utérine lors d’une césarienne.Méthodes:Cette étude randomisée contrôlée monocentrique a inclus 240 femmes bénéficiant d’une césarienne. Les participantes ont reçu soit 1 g d’acide tranexamique intraveineux, soit 10 mL de sérum physiologique avant l’incision cutanée, en plus de la prise en charge active standard du troisième stade du travail. Le critère principal était la perte sanguine estimée calculée.Résultats:La perte sanguine estimée calculée moyenne était significativement plus faible dans le groupe acide tranexamique que dans le groupe placebo (578 ± 291 mL contre 684 ± 245,26 mL ; P = 0,002). L’incidence de l’hémorragie du post-partum, le recours à des utérotoniques supplémentaires, la transfusion sanguine et la baisse du taux d’hémoglobine étaient plus faibles dans le groupe acide tranexamique, sans différence statistiquement significative. Aucun événement thromboembolique ni trouble visuel n’a été observé.Conclusion:L’administration prophylactique intraveineuse d’acide tranexamique avant l’incision cutanée réduit significativement les pertes sanguines lors d’une césarienne sans augmenter les effets indésirables.

Identifying protein binding sites in protein-protein complexes is a central challenge in structural biology. Binding sites, consisting of groups of residues, govern how proteins recognize, and interact with protein partners. Thus, identifying them is essential for understanding biological function and guiding the design of effective biomolecules and even drug molecules. Despite major progress in computational approaches, their performance remains limited because most models underrepresent the combined influence of surface properties and residue-level information, leaving room for improvement. Recent advances in state-space models and vision-based deep learning offer an opportunity to address these limitations by efficiently modeling long-range spatial dependencies on protein surfaces. Here, we introduce BiMba (protein Binding site prediction using Vision Mamba), a state-space-driven deep learning framework that leverages the efficient long-range modeling capability of the Vision Mamba architecture to learn from three-dimensional (3D) protein surfaces represented as two-dimensional (2D) geometric or physicochemical grids. BiMba integrates complementary sources of information, capturing geometric and physicochemical determinants of molecular recognition as surface patches, encoded as 2D images, along with residue-level descriptors, yielding a unified representation that couples spatial topology with biochemical context. BiMba demonstrates competitive performance across diverse and specialized benchmark datasets, often outperforming existing state-of-the-art methods. In addition, BiMba incorporates perturbation-based and gradient-based interpretability analyses by extracting hidden attentions from Mamba layers, enabling visualization of feature relevance and biologically meaningful residue clusters. Overall, our findings establish state-space models as efficient, interpretable, and scalable architectures for molecular surface learning, advancing the application of deep learning in structural bioinformatics. The BiMba source code, training, test, and benchmark datasets are available at https://github.com/Azam-Shi/BiMba.

Clear cell renal cell carcinoma (ccRCC) exhibits heterogeneity in immune infiltration and clinical outcomes, but the mechanisms governing recruitment and organization of tumor-reactive CD8+ T cells remain incompletely defined. We investigated the role of the CXCL13-CXCR5 axis in shaping CD8+ T cell recruitment, differentiation, and immune organization in high-risk, non-metastatic ccRCC. Human tumor, plasma, and matched adjacent kidney specimens were analyzed using ELISA, quantitative PCR, migration assays, multiplex immunofluorescence, single-cell RNA sequencing, spatial transcriptomics, and a syngeneic mouse model. CXCL13 was among the most upregulated chemokines in ccRCC relative to matched normal kidney and was embedded within a CD8+ T cell-associated inflammatory transcriptional program. In transwell and microphysiological system (MPS) assays, CXCL13 promoted CD8+ T cell migration, enriched CXCR5+ cells among migrating CD8+ T cells and showed reduced migration after CXCL13 or CXCR5 blockade. Single-cell analyses identified CXCR5 expression within stem-like CD8+ T cell states associated with TCF7 and IL7R, whereas CXCL13 associated with later cytotoxic/exhausted states along a continuous differentiation landscape. Spatial transcriptomics demonstrated that stem-like CD8+ T cells localized within structured lymphoid aggregates enriched for B cells, coordinated CXCL13/CXCR5 expression, and signaling programs. In vivo, tumor-derived CXCL13 suppressed tumor growth, increased intratumoral CD8+ T cell infiltration, and enriched CXCR5+TCF1+CD8+ stem-like T cells. In human tumors, higher CXCL13 expression correlated with increased CXCR5+CD8+ T cell infiltration and improved recurrence-free survival. These findings identify CXCL13 as a regulator of immune recruitment and niche organization and support the CXCL13-CXCR5 axis as a biomarker and possible therapeutic target in ccRCC.

Microbial communities play vital roles in diverse ecosystems and are key drivers of numerous industrial or health-related applications. In many cases, the functional properties microorganisms contribute to these processes cannot be explained by simply adding up the activities of individual strains, but they result from complex interactions among several community members. While it is clear that these so-called emergent functions (EFs) are important for determining collective behaviors of microbial communities, thus far, a systematic framework to identify, classify, and experimentally dissect them has been lacking. Here, we aim at filling this gap by proposing a conceptual framework that defines EFs as community-level traits, which deviate from additive expectations. Depending on the direction of deviation, we distinguish positive from negative emergence. In addition, we define cases of a de novo emergence as those where the focal function is absent in monocultures and only arises upon cocultivation, while modulated functions are already detectable in monocultures, yet shift quantitatively through interaction. We then classify the underlying ecological mechanisms along the two main axes, contact-dependence and regulation, and propose diagnostic experiments to assign microbial systems to these categories. Finally, we address the evolutionary origin of EFs by distinguishing cases that arise spontaneously as by-products from those that have been favored by natural selection and discuss experimental procedures to tell them apart. Together, this new framework will help to identify and characterize emergent functions, thus advancing our mechanistic understanding of microbial community function.

Empathy is key to successful psychotherapy. However, how it is experienced and communicated in teletherapy remains poorly understood despite the widespread use of this modality. The current study compared how psychologists and patients view empathy and its communication in teletherapy. A convergent mixed-methods design was used with separate samples of psychologists (n = 92) and adult patients (n = 80) who completed online questionnaires on empathy, alliance, telepresence, and attitudes, along with open-ended questions on empathy and its communication. Quantitative and qualitative strands were merged through a side-by-side joint display analysis. Patients perceived significantly more empathy than psychologists reported feeling during teletherapy. Psychologists found videoconference therapy to be more demanding, particularly due to technical issues and unfamiliarity. Patients more strongly believed that telepresence and a strong alliance help compensate for the shortcomings of this modality. Despite these differences, members of both groups broadly agreed on the definition of empathy and on the best ways to communicate it during teletherapy, identifying compensatory strategies and key markers of empathy. Although they shared similar views on empathy, patients rated their psychologists as more empathic than psychologists rated themselves in teletherapy. This pattern emerged at a time when this modality was being rapidly integrated into clinical practice, and both samples had limited experience with it. These findings reinforce the value of this modality and highlight the need to support clinicians unfamiliar with it. Understanding how patients interpret empathy can help psychologists tailor their communication to meet those expectations. Training and peer support could help reduce psychologists' perceptions of added burden and better target the skills that strengthen empathic communication in teletherapy. Priorities include using salient nonverbal cues, making explicit verbal checks, inviting routine patient feedback, and allowing more time to build attunement to patient expectations.

This study aimed to clarify the incidence and outcomes of distant metastasis (DM) in patients with major salivary gland cancer who received upfront surgery followed by adjuvant postoperative radiation therapy. We analyzed 214 patients from a multicenter study. The importance of histologic subtypes on distant metastasis-free survival (DMFS) was analyzed, along with other clinicopathologic prognostic factors. Median total doses and fractional doses were 61 (range, 26-70) Gy and 1.8 (range, 1.8-2.5) Gy, respectively. With a median follow-up of 74 (range, 4-174) months, DM developed as a first (n&#xa0;=&#xa0;44) or second relapse event (n&#xa0;=&#xa0;4) in a total of 48 (22.4%) patients. In univariate analysis, histologic subtype (P&#xa0;<&#xa0;.001), salivary gland subsite (P&#xa0;=&#xa0;.002), pT stage (P&#xa0;=&#xa0;.001), pN stage (P&#xa0;<&#xa0;.001), perineural invasion (P&#xa0;=&#xa0;.001), extracapsular extension (P&#xa0;=&#xa0;.001), lymphovascular invasion (P&#xa0;=&#xa0;.001), resection margin status (P&#xa0;=&#xa0;.009), and tumor grade (P&#xa0;=&#xa0;.005) significantly affected DMFS. The 5-year DMFS rates were as follows: 100% (acinic cell carcinoma), 100% (basal cell carcinoma), 100% (epithelial myoepithelial carcinoma), and 96.6% (mucoepidermoid carcinoma) in the low-risk group and 62.5% (adenoid cystic carcinoma), 62.5% (adenocarcinoma), 72.6% (carcinoma-ex-pleomorphic adenoma), 68% (salivary duct carcinoma), and 54.5% (squamous cell carcinoma) in the high-risk group. DM risk after postoperative radiation therapy varies substantially by histologic subtype in salivary gland cancer patients. High-risk subtypes demonstrate inferior DMFS, indicating a potential need for improved systemic treatment strategies.

The transition from hospital to home is a critical period for patients with coronary heart disease (CHD), and inadequate post-discharge care can adversely affect recovery. Continuing care models have been proposed to address these challenges, but their relative effectiveness compared with standard care still requires further evaluation. Therefore, this study evaluated the impact of continuing care on quality of life and recovery of cardiac function in patients with CHD. This single-center, retrospective cohort study included 135 discharged CHD patients. Based on nursing plans, patients were allocated into two groups: a Continuing Care Group (n = 61) and a Routine Care Group (n = 74). The Continuing Care Group received a structured, nurse-led 3-month program, while the Routine Care Group received standard post-discharge instructions. Various parameters, including cardiac function, quality of life, psychological well-being, self-care capacity, medication adherence, overall comfort, and nursing satisfaction, were compared between groups at 3-month follow-up. At 3 months, the Continuing Care Group showed significantly greater improvement in left ventricular ejection fraction (LVEF, 58.31% vs. 54.88%), six-minute walk distance (6MWD, 399.34 m vs. 382.25 m), 36-Item Short-Form Health Survey Physical Component Summary (SF-36 PCS, 67.94 vs. 63.92), and 36-Item Short-Form Health Survey Mental Component Summary (SF-36 MCS, 71.46 vs. 66.87). Patients in the Continuing Care Group also reported lower Depression Anxiety Stress Scales-21 (DASS-21, 17.24 vs. 18.31) and Perceived Stress Scale-10 (PSS-10) scores (22.01 vs. 23.14), higher Psychological General Well-Being Index (PGWBI, 85.95 vs. 83.47), Exercise of Self-Care Agency Scale (ESCA, 116.03 vs. 113.72), and Post-Traumatic Growth Inventory (PTGI) scores (74.81 vs. 72.31), along with superior medication adherence (84.16 vs. 82.35), comfort (87.06 vs. 84.91) and nursing satisfaction (86.94 vs. 84.89). At 3-month follow-up, Seattle Angina Questionnaire (SAQ) scores improved significantly from baseline in both groups, but no significant between-group difference was observed. Continuing care is associated with potential improvements in cardiac function, quality of life, psychological well-being, self-management, medication adherence, and patient-reported experiences compared with routine care in patients with CHD.