Annals of the New York Academy of Sciences

Empathy enables individuals to attune to others' experiences through shared affective, sensorimotor, and neural representations, but its influence on higher-level decision-making and social alignment remains unknown. We examined whether empathy promotes social conformity and whether this effect depends on physiological arousal, visual attention, and socio-emotional traits. Seventy-three participants completed an empathy-for-pain task followed by a modified random-dot task in which they interacted with previously seen empathy targets, while physiological signals and eye movements were recorded. Drift-diffusion modeling showed that feedback from empathy targets increased conformity, reflected in stronger decision bias toward targets, faster evidence accumulation, and reduced decision conservatism. Visual attention to the eyes or mouth was linked to greater conformity depending on the context. Heart rate variability was unrelated to conformity, whereas phasic skin conductance was associated with smaller bias changes and greater conservatism. Alexithymia and autistic traits further shaped the empathy-conformity relationships. These findings suggest that empathic shared representation extends beyond affective resonance to influence social alignment in decision-making.

In non-verbal communication, observers infer emotions from visible facial movements, yet emotional experiences are described in internal bodily terms (e.g., "my heart skipped a beat"). This contrast highlights a tension between external sensory cues and internal signals. In this context, we examined an overlooked gap in affective science: what makes an emotional portrayal believable, and do believability judgments reflect only what observers can see or also the portraying person's internal cardiac dynamics? To test this, we created 311 scenario-driven acting clips designed to avoid prototypical posed displays. For each clip, we quantified facial movement magnitude from the video, recorded ECG during preparation and enactment, and collected actors' self-reports. Online participants (N = 371) viewed these clips and provided emotion recognition responses and continuous ratings of believability, valence, or arousal. The results show that believability decreased as movement magnitude increased, with a non-linear relationship indicating a stronger penalty as motion increased. Valence further shaped this pattern, with increasing movement reducing believability more strongly for portrayals with negative valence. This effect persisted after accounting for intended emotion, perceived arousal, and emotion recognizability. Cardiac dynamics varied during performance, and actors' higher heart rate variability was associated with higher believability for positively valenced portrayals. Together, these findings show that believability is driven by visible movement cues interpreted in relation to valence, with actors' cardiac dynamics showing selective alignment with believability. These results identify core components of believable emotional expressions and provide a basis for studying such judgments in everyday social interaction.

The photic sneeze reflex (PSR), in which exposure to bright light triggers sneezing, is widely recognised but inconsistently defined and measured. We conducted the first systematic review and meta-analysis of PSR prevalence to synthesise the epidemiological evidence, assess methodological quality, and identify priorities for future research. We included 18 articles comprising 31 study groups and extracted prevalence estimates, study characteristics, ascertainment methods, and epidemiological information. Fifteen eligible study groups classified as healthy were included in the primary meta-analysis. The pooled prevalence was 22% (95% CI, 15%-29%), with extreme between-study heterogeneity (I2 = 99.3%). Reported prevalence estimates and associations with participant characteristics varied widely, and nearly all studies were judged to be at high risk of bias. The pooled estimate should therefore be interpreted as a descriptive summary of the available evidence rather than a precise estimate of population prevalence. Future studies require a standardised operational definition, representative sampling, transparent reporting, and reproducible methods for assessing light-triggered sneezing.

Background: Prolonged mechanical ventilation is associated with inspiratory muscle weakness and difficulty weaning from respiratory support. While decades of research have demonstrated that inspiratory strength training (IST) is beneficial in adult critical care populations, the literature on its use in pediatric cardiac critical care remains limited. We sought to evaluate the feasibility, safety, and physiologic response to IST in children in the pediatric cardiac intensive care unit (PCICU). Methods and Results: We performed a single-center retrospective cohort study of children with congenital heart disease referred for IST between January 2015 and August 2021. Feasibility was defined as completion of [≥]1 IST session following referral. Safety outcomes included physiologic events documented during IST sessions. Changes in maximal inspiratory pressure (MIP) were assessed in patients who completed [≥]2 IST sessions. Of 105 eligible patients, 93 (89%) successfully completed at least 1 IST session. Monitoring events were reviewed across 389 IST sessions and included pre-oxygenation (62%), desaturations (13%), bradycardia (7%), and hypertension (2%). All events were transient and did not require escalation of care. 84% of patients were successfully liberated from mechanical ventilation and required a median of 2 (IQR 1-4) sessions of IST. Among patients completing [≥]2 IST sessions, MIP improved signicantly over time (p>0.0001). Improvements were observed in both patients who did and did not wean from mechanical ventilation. Patients who failed to wean from mechanical ventilation had longer ventilator exposure prior to IST initiation and were more sedated at the outset of IST. Conclusions: IST was feasible and well tolerated in this medically complex PCICU cohort. High completion rates and improvements in MIP support the use of IST as a clinically deliverable intervention that can produce measurable improvements in inspiratory muscle strength during critical illness.

Background Mirror therapy (MT)-specifically paradigms using mirror visual feedback (MVF)-is widely used in neurorehabilitation; however, mechanistic implementations vary substantially in movement content, rhythmicity and attentional demands. This protocol describes an acute mechanistic, within-participant fNIRS screening study designed to compare three prespecified upper-limb mirror-therapy task paradigms and to quantify associated subjective experience after each condition in healthy adults during a single visit. Methods and analysis This is a single-centre, within-participant, randomised crossover study conducted at Wuhan Wuchang Hospital (Wuhan, China). Healthy adults aged 18-35 years will complete three task conditions once each in a counterbalanced order using a 3*3 Latin-square scheme: UMT1 (task-oriented rhythmic functional movement), UMT2 (open-ended free movement with auditory control), and UMT3 (non-functional rhythmic movement). fNIRS will be acquired using the NirSmart-6000A system during a standardised block design. The primary outcome is ROI-level HbO activation quantified as GLM-derived {beta} estimates within the prespecified primary ROIs (bilateral SM1/M1 and bilateral PMC). Secondary outcomes include ROI-level windowed {Delta}HbO (5-20 s post-onset relative to the immediately preceding rest; descriptive only), ROI-level {Delta}HbR, and post-condition subjective ratings (illusion, immersion, confusion and fatigue; 1-7 Likert). Condition effects will be analysed using linear mixed-effects models with fixed effects for condition and period and prespecified multiplicity-adjusted pairwise contrasts. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of Wuchang Hospital Affiliated to Wuhan University of Science and Technology (Approval No.: 2025-112-01; approved on 2025-08-21). The study is expected to be minimal risk. Findings will be disseminated through publication of this protocol manuscript and subsequent results manuscripts and conference presentations. Trial registration number Chinese Clinical Trial Registry (ChiCTR2600116634). This study is conducted as a prespecified mechanistic sub-study under the overarching registered project.

Developmental experience can produce lasting changes in neural function and behavior. Zebra finch offers a powerful model for identifying the molecular mechanisms underlying this process. Both juvenile male and female zebra finches perform developmental sensory song learning that influences their adult behaviors: in males, the structure of the song they sing and in female, the song preferences they exhibit (females cannot sing). The auditory forebrain, a region distinct from but connected to nodes of the male singing circuitry, is required for male sensory song learning. Song experience induces epigenetic, genomic, molecular, cellular and systems-level alterations in the auditory forebrain of males. Much less evidence is available for females. Although epigenetic and molecular data implicate the auditory forebrain in female sensory song learning, there has been no causal test of its role. Further, molecular evidence indicates the potential for distinct mechanisms for male and female sensory song learning, even though they learn during a largely overlapping developmental period. We used pharmacological manipulations of the ERK and mTOR cascades in the auditory forebrain of juvenile females during controlled tutoring, and an operant assay for adult song preference, to test the causal role of the auditory forebrain and the two cascades known to be required for male sensory song learning. We demonstrate that the auditory forebrain is required for female sensory song learning, and that while ERK signaling is necessary for both sexes, that of mTOR is sex specific. Results raise implications for alternative molecular cascade cross-talks and protein synthesis processes that successfully support the developmental learning at the same age and brain region.

Humans seamlessly process multi-voice music into a coherent perceptual whole. Yet the neural strategies supporting this experience remain unclear. One fundamental component of this process is the formation of melody, a core structural element of music. Previous work on monophonic listening has provided strong evidence for the neurophysiological basis of melody processing, for example indicating predictive processing as a foundational mechanism underlying melody encoding. However, considerable uncertainty remains about how melodies are formed during polyphonic music listening, as existing theories (e.g., divided attention, figure-ground model, stream integration) fail to unify the full range of empirical findings. Here, we combined behavioural measures with non-invasive electroencephalography (EEG) to probe spontaneous attentional bias and melodic expectation while participants listened to two-voice classical excerpts. Our uninstructed listening paradigm eliminated a major experimental constraint, creating a more ecologically valid setting. We found that attention bias was significantly influenced by both the high-voice superiority effect and intrinsic melodic statistics. We then employed transformer-based models to generate next-note expectation profiles and test competing theories of polyphonic perception. Drawing on our findings, we propose a weighted-integration framework in which attentional bias calibrates the overall degree of integration of the competing streams. In doing so, the proposed framework reconciles previous divergent accounts by showing that, even under free-listening conditions, melodies emerge through an attention-guided statistical integration mechanism. HighlightsO_LIEEG can be used to decode spontaneous attention during the uninstructed listening of polyphonic music. C_LIO_LIBehavioural and neural data indicate that spontaneous attention is influenced by both high-voice superiority and melodic contour. C_LIO_LIAttention bias impacts the neural encoding of the polyphonic streams, with strongest effects within 200 ms after note onset. C_LIO_LIStimuli that produced a stronger attention bias aligned with monophonic-model expectations, whereas stimuli with a weaker bias aligned with the Stream-Integration model. C_LIO_LIWe propose a bi-directional influence between attention and prediction mechanisms, with horizontal statistics impacting attention (i.e., salience), and attention impacting melody extraction. C_LI

Collective social events often require coordinated action by one group to become shared experience in another, yet how this transformation is organized across multiple brains remains unclear. Live music provides a tractable model of this problem because ensemble coordination, performer-audience alignment, and shared audience integration unfold within the same event. Here we tested whether performer-audience neural coupling acts as a cross-role neural interface linking ensemble coordination to shared audience integration. We recorded brain activity from a nine-person live performance system, consisting of a fixed three-performer ensemble and four independent audience groups, using synchronized multi-device functional near-infrared spectroscopy hyperscanning across live trio performance sessions. Inter-brain neural coupling was analyzed across three relational layers: performer-performer (PP), performer-audience (PA), and audience-audience (AA) coupling. Behavioral ratings showed strong affective engagement and shared evaluative alignment. Neural coupling during live performance was not expressed as a diffuse increase across channel pairs, but was organized into task-sensitive relational components with interpretable PC-corr network modules. Crucially, path-based mediation analyses revealed that PA components statistically bridged PP coordination and AA coupling, yielding multiple complete and partial PP [->] PA [->] AA pathways. Brain-behavior analyses further suggested that mediation-related PA components were linked to shared performance evaluation and emotional alignment. These findings identify performer-audience coupling as a cross-role neural interface through which coordinated production becomes linked to shared collective reception. Significant StatementHow coordinated actions become shared experiences is a major problem in social neuroscience, yet most studies examine pairs of people. Using live music as a model of group interaction, we found that brain-to-brain alignment was organized across social roles rather than arising as a uniform response to the same event. Performer-audience alignment occupied a bridging position between coordination within the ensemble and integration within the audience. This identifies a systems-level architecture through which collective action may become linked to collective experience. The framework moves multi-brain research beyond dyads and offers a general approach for studying classrooms, public speaking, theater, rituals, and team events, where one group generates structured behavior that another group jointly receives and interprets.

Head-eye coordination during ball interception depends on both task demands and motor experience. The purpose of this study is to determine how these factors influence head-eye contributions to gaze control. Twenty-five female university students (novices with no ball sport experience, n = 13; experienced softball players, n = 12) performed two tasks: visually tracking an approaching ball (tracking task) and, in addition, moving the hand to the ball's landing position (reaching task). Head, eye, and gaze velocities, cross-correlation coefficients between gaze and head velocity, and gaze-head lag time were analyzed using linear mixed models. The results showed that although gaze velocity remained unchanged regardless of tasks or groups, decomposing gaze into head and eye components revealed task-dependent contributions. Compared with the tracking task, the reaching task showed significantly larger head velocity and smaller eye velocity, indicating complementary adjustments that were not revealed by gaze movements alone. The cross-correlation between head and gaze was significantly higher in the reaching task than the tracking task, indicating stronger temporal coupling under greater task demand. Furthermore, the experienced group showed greater task-dependent modulation of eye velocity than the novice group, demonstrating greater flexibility in adjusting the magnitude of head-eye movements to task demands. In addition, the experienced group showed a consistently near-zero gaze-head lag regardless of task, whereas the novice group showed a prolonged gaze-leads-head interval. These findings suggest that ball sport experience shapes two distinct aspects of head-eye coordination: task-dependent flexibility in movement magnitude, and stable, temporally synchronized gaze-head control.

Musical training produces behavioral gains that extend beyond the practiced context. Yet, it is unclear whether such generalization is accompanied by broadly transferable neural changes or whether training-induced plasticity remains tied to the specific features of the learned material. In this study, 80 musically naive adults completed four piano-training sessions and underwent functional MRI before and after training. Twenty untrained participants served as passive controls. Participants performed a passive listening task in which they listened to the trained melody (Fur Elise) and an untrained melody (Ode to Joy), each played on a trained musical instrument (piano) and an untrained musical instrument (saxophone). Following training, participants demonstrated improved accuracy and rhythmic performance when playing an unfamiliar melody, indicating behavioral generalization. Training-induced neural changes, however, were predominantly associated with the learned melodic content. Listening to Fur Elise elicited increased activity in the intraparietal and supplementary motor cortex and in the cerebellum, as well as decreased activity in the superior temporal cortex. Consistently, pre- and post-training scans were most accurately classified based on brain activity to Fur Elise played on piano or saxophone, rather than brain response to Ode to Joy, suggesting that neural reorganization was driven more strongly by the practiced melody than by the trained instrumental timbre. Training also enhanced the neural separability of both melodic and instrumental information. Critically, pre-training responses to Fur Elise played on the piano predicted subsequent playing accuracy, whereas pre-training sensitivity to instrumental timbre predicted rhythmic performance in a novel melodic context. Together, these findings suggest that while acquired musical skills behaviorally transfer to novel material, practice-induced functional plasticity remains predominantly melody-specific. We conclude that musical skill acquisition reflects complementary contributions of pre-existing neural characteristics and learning-induced plasticity, with baseline auditory representations potentially supporting successful behavioral transfer.

Mental imagery is viewed as a fundamental component of human cognition, supporting memory, emotional processing, future simulation, and conscious experience. Although mental imagery vividness has traditionally been attributed to differences in sensory processing, emerging evidence suggests that internally generated images are also shaped by ongoing bodily and interoceptive signals. Here, we investigated whether cardiovascular physiology contributes to individual differences in mental imagery vividness using a virtual reality paradigm in which participants encoded and reconstructed emotional and neutral scenes during a tilt-table-induced autonomic challenge. Acute autonomic changes induced by a tilt table did not alter imagery vividness. However, elevated diastolic blood pressure during the tilt-up condition predicted reduced mental imagery vividness, with the strongest effects observed for disgust and neutral imagery. Our findings provide direct evidence that the vividness of the "minds eye" is linked to cardiovascular physiology and support interoceptive accounts of consciousness in which mental imagery emerges from dynamic interactions between neural and bodily systems. More broadly, these results identify cardiovascular function as a potential physiological contributor to altered imagery experiences, including those observed in aphantasia and related clinical conditions. Significance statementVisual mental imagery has traditionally been explained as a top-down process driven by the brain. We investigated whether bottom-up physiological signals from the cardiovascular system also contribute to imagery vividness. An autonomic challenge revealed a hidden relationship between diastolic blood pressure and the vividness of emotional mental imagery, indicating that ongoing cardiovascular signals influence internally generated visual experiences. These findings identify bottom-up autonomic physiology as a previously unrecognized contributor to mental imagery and broaden current understanding of how top-down and bottom-up processes interact to shape conscious mental imagery experience.

Purpose: Lower-limb prosthesis use involves interacting physical, psychosocial, and device-related outcomes that may not be fully captured by conventional clinical assessment. This study aimed to develop and evaluate a stakeholder-informed framework of outcome domains relevant to meaningful everyday prosthesis use. Materials and Methods: A mixed-methods participatory design comprised a structured synthesis of selected clinically relevant content from five established patient-reported outcome measures; semi-structured interviews and importance and actionability ratings with 18 contributors (12 prosthesis users, four clinicians, and two industrial partners); and integration of the synthesis, qualitative, and rating findings. Interview records were analysed using reflexive thematic analysis, and ratings were analysed descriptively. Results: The resulting framework comprised four interrelated domains: Mobility, Physical Function, Psychosocial Wellbeing, and Prosthesis Experience. Mobility showed the clearest convergence across stakeholder perspectives. Prosthesis users showed the largest importance actionability gap for Prosthesis Experience (4.5 vs 3.0), whereas clinicians showed the largest gap for Psychosocial Wellbeing (5.0 vs 3.0). Interviews highlighted day-to-day variability in prosthesis use and the influence of confidence, fatigue, comfort, environmental conditions, social context, and device usability. Conclusions: Meaningful outcome assessment in prosthetic rehabilitation should extend beyond mobility alone to consider physical function, psychosocial wellbeing, and prosthesis experience within everyday contexts. The proposed framework provides a stakeholder-informed foundation for multidimensional outcome assessment in prosthetic rehabilitation.

Wayfinding in hospitals is often hindered by ineffective signage; however, the cognitive mechanisms of healthcare wayfinding symbols comprehension remain under-researched. This study utilized eye-tracking and spatial gaze mapping to examine how visual complexity, abstraction, and human figuration modulate perception in 40 healthy adults viewing 24 hospital-related healthcare wayfinding symbols. Results indicate that pupil size is a sensitive physiological marker of cognitive load, significantly influenced by visual complexity ({chi}2 = 11.32, p = .022) and abstraction ({chi}2 = 7.49, p = .027). Human figuration reduced fixation duration and increased saccade amplitude, facilitating efficient semantic integration. Furthermore, human-centric healthcare wayfinding symbols elicited streamlined gaze trajectories, whereas abstract/complex designs induced chaotic scanpaths. These findings suggest that human figuration acts as a cognitive scaffold, reducing mental effort. We provide evidence-based guidelines for optimizing healthcare wayfinding symbols by prioritizing human body representations and balancing abstraction levels. HighlightO_LIPupil size indexes cognitive load during symbol comprehension. C_LIO_LIHuman figuration cuts fixation duration, boosting wayfinding efficiency. C_LIO_LIAbstract symbols increase pupil dilation, raising cognitive load. C_LI

Kinaesthetic motor imagery (kMI) is widely used in sport to enhance motor performance by engaging cortical sensorimotor networks. Neurofeedback may further support kMI, but the optimal neural target to reinforce remains unclear. Maximal sensorimotor event-related desynchronisation (SMR-ERD) represents a relevant target as it may index sensorimotor cortex engagement, yet sport expertise has been associated with reduced SMR-ERD, potentially reflecting neural efficiency. The optimal neurofeedback target may therefore depend on sport expertise, movement expertise, and individual kMI ability. This study examined how these factors influence sensorimotor activity during kMI. We compared 17 basketball players (Experts) and 16 individuals without formal basketball training (Novices). kMI ability and frequency of use were assessed using questionnaires, while SMR-ERD was quantified using electroencephalography (EEG) during kMI. Participants imagined either a basketball-specific movement (Free throw), for which only Experts had extensive experience, or a generic movement (Box lifting), familiar to both groups. Experts reported greater kMI ability and more frequent kMI use than Novices. Only Experts exhibited significant and sustained SMR-ERD during kMI. Moreover, SMR-ERD was stronger in Experts than Novices specifically during Free throw kMI, corresponding to their movement of expertise. Nonetheless, within the Expert group, higher kMI ability was associated with reduced SMR-ERD. These findings suggest that sport expertise initially enhances voluntary recruitment of sensorimotor networks during kMI, whereas greater kMI ability may subsequently promote neural efficiency, resulting in reduced overall sensorimotor cortical activation. These results highlight the need to tailor kMI-based neurofeedback training to users' sport expertise and kMI ability levels.

[Purpose] By pairing repeated peripheral muscle fatigue induction with a functional and ADL-based assessment, this study tests whether hand muscle fatigue alone is sufficient to im pair fine motor performance in healthy adults performing ADL-inspired tasks. [Participants and Methods] Thirty healthy male and female university students performed 11 tasks twice, once in the pre-fatigue condition and once in the post-fatigue condition. The performance of each task was graded on a 0-4 scale. The score and the time to finish the task (TTFT) were recorded twice, for both the pre- and post-fatigue phases. Maximum force gen eration (MFG) of each participant's grip was recorded prior to the tasks in the pre-fatigue phase and again in the fatigue condition after performing the fatigue protocol. [Results] Muscle fatigue did not have a significant effect on the fine motor performance of the thirty participants, neither (TTFT) nor the scores of each task (p > 0.05) (r=0.08). In contrast, hand muscle fatigue led to a significant decrease in the mean (MFG) for both males and females (p<0.01). [Conclusion] Hand muscle fatigue led to a significant decrease in the mean grip MFG for both sexes. However, this reduction did not translate into impaired fine motor performance during ADL-like tasks. Consequently, under muscle fatigue, hand grip changes during fine tasks tested are rare and have minor to no impact on hand performance. This study suggests that acute peripheral muscle fatigue can coexist with preserved fine motor performance in healthy populations.

Early life adversity is a recognised risk factor for poor health in later life, but its relationship with allostatic load (AL; a measure of cumulative physiological stress) remains underexplored across populations around the world. This study builds evidence to test a life course approach to AL using harmonised data from six longitudinal ageing cohorts: Health and Retirement Study (US, N=2,427), English Longitudinal Study of Ageing (England, N=2,038), The Irish Longitudinal Study on Ageing (Ireland, N=8,184), Survey of Health Ageing and Retirement in Europe (Europe, N=4,079), China Health and Retirement Longitudinal Study (China, N=5,220), and Indonesia Family Life Survey (Indonesia, N=1,243). Childhood information at aged ten to sixteen was collected retrospectively from adults aged 65 on average. An AL score is constructed using biomarker data and a latent construct of early life adversity constructed to address recall bias. Results show that early life poverty is significantly associated with raised AL in Ireland, China, and Indonesia, supporting the impact of early life experiences on older adulthood. However, studies from other countries do not confirm statistical significance. These findings document that experiencing poverty during development phase in some settings is associated with higher AL in later life, however further analyses are required to explore possible variations across different populations and their social and economic context. These results add further evidence that social determinants of health, including child poverty, in some settings, contribute to cumulative physiological stress across the life course, and that policies and actions to reduce child poverty can have beneficial effects not only as children, but also as older adults.

Physiological mirror activity (pMA) is the increase in involuntary muscle activity observed on the contralateral side during unilateral voluntary movement in neurologically healthy participants. This cross-sectional study aimed to explore the relationship between pMA and corticomuscular coherence (CMC) during finger dexterity tasks in young and older adults. Thirty-one right-handed young adults and 24 older adults performed a left-hand finger dexterity task. Electroencephalogram (EEG) signals were recorded from C3 and C4, and electromyogram (EMG) signals were collected from bilateral finger flexors and extensors. pMA was quantified as the change in right-hand EMG from rest to task. Gamma-band CMC was calculated from task-related EEG-EMG pairs, and its association with pMA was analyzed. In young adults, greater pMA was associated with lower CMC (C3- and C4-right flexors), whereas in older adults, greater pMA was associated with higher CMC (C3-left flexor). Young adults may suppress pMA emergence by appropriately monitoring and inhibiting activity, in the hand not performing the task. Conversely, in older adults, the mobilization of the ipsilateral motor cortex may have contributed to pMA emergence. This study suggests that the neuromuscular mechanisms involved in pMA during finger dexterity tasks differ between young and older adults.

Abstract Introduction Selecting an appropriate sham control is a key challenge in trials of mirror therapy, specifically paradigms using mirror visual feedback (MVF), because visually similar control conditions may still elicit mirror-related cortical responses. This protocol describes an acute mechanistic, within-participant fNIRS screening study designed to identify the sham mirror-therapy material condition with the most "neutral" neural signature relative to true MVF during a single exposure. Methods and analysis This is a single-centre, within-participant, randomised crossover study conducted at Wuhan Wuchang Hospital (Wuhan, China). Healthy adults aged 18-35 years will complete four conditions in one visit: C1 true MVF and three prespecified sham-material conditions (C2-C4), with condition order counterbalanced using a Latin-square schedule. fNIRS will be acquired during a standardised grasping task. Online acquisition-time quality control (SCI and CV thresholds) will be applied with prespecified re-acquisition rules. The primary outcome is ROI-level task-evoked change in oxygenated haemoglobin (Delta HbO) within prespecified ROIs (PMC and SM1/M1), estimated primarily using GLM-derived beta estimates. Condition effects will be analysed using linear mixed-effects models with prespecified contrasts and Holm multiplicity adjustment to rank sham conditions by a prespecified neutrality decision rule. Ethics and dissemination Ethics approval was obtained from the Ethics Committee of Wuchang Hospital Affiliated to Wuhan University of Science and Technology (Approval No.: 2025-112-01). Findings will be disseminated through publication of this protocol manuscript and a subsequent results manuscript, with key supplementary materials provided as online appendices/supplements as required by the target journal. Trial registration number Chinese Clinical Trial Registry: ChiCTR2600116634. Strengths and limitations of this study - Within-participant randomised crossover design reduces between-participant variability and is well suited for acute mechanistic screening of sham conditions. - Prespecified sham conditions and neutral-ranking decision rule, including prespecified ROIs, contrasts, and Holm multiplicity control, help limit analytic flexibility and support transparent interpretation. - Operational reproducibility safeguards are specified, including standardised task timing/instructions, acquisition-time QC thresholds with re-acquisition rules, and frozen channel-to-ROI mapping and material-definition records in the Supplementary materials. - Single-centre, healthy-participant, single-session paradigm may limit generalisability to clinical stroke populations and to longer-term therapeutic effects. - Blinding may be imperfect because perceptual differences between materials can affect expectancy and attention; blinding assessment is included but residual bias is possible. - fNIRS is susceptible to motion, scalp-coupling variability and physiological noise; despite prespecified QC and preprocessing, residual artefacts may remain and can reduce sensitivity.

Background Rising antimicrobial resistance (AMR) in the African region contributes to high morbidity and mortality. Continuous national AMR surveillance is critical in understanding the spread of AMR and informing policies on containment. We present results of national AMR surveillance in Kenya Methods Passive surveillance was prospectively conducted in 20 sites in Kenya between 2021 and 2025. Sites included national and sub-national level tertiary public and private hospital laboratories. Non-duplicate isolates of WHO priority Gram-negative and Gram-positive pathogens were included in this analysis. Bacterial isolates were identified using either conventional identification methods, Analytical Profile Index or automated systems while antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method or automated systems and interpreted using the Clinical and Laboratory Standards Institute guidelines. The primary outcomes were the proportions of various priority bacteria isolated and the proportions resistant to commonly used antibiotics. Results Between 2021 and 2025, there were 15,124 priority pathogens isolated with 7,592 (50.2%) from urine, 5,430 (35.9%) from blood (35.9%), and 1,784 (11.8%) from respiratory specimens. Escherichia coli and Klebsiella pneumoniae accounted for 76.3% of the priority pathogens. Resistance to 3rd generation cephalosporins was 63.2% for Escherichia coli and 79.1% for Klebsiella pneumoniae for the period 2021 to 2025 while carbapenem-resistance was 30.4% for Klebsiella pneumoniae and 7.2% for Escherichia coli. Resistance to carbapenems by Klebsiella pneumoniae increased from 17.9% in 2021 to 35.9% in 2025 while Methicillin resistance in Staphylococcus aureus increased from 36.5% in 2021 to 56.4% in 2025. Conclusion Resistance to critical antibiotics is a significant problem in Kenya, with alarming rates of Methicillin Resistant Staphylococcus aureus and carbapenem resistant Klebsiella pneumoniae. Ugent and sustained infection prevention and control measures and appropriate antimicrobial stewardship activities should be instituted across all health facilities in the country. There is need for improved access to antibiotics with activity against these resistant pathogens.

PurposeSpeech perception is a fundamental part of everyday communication that relies on more than simple identification of words and sentences. Attention and listening engagement both contribute to speech perception, while representing distinct aspects of the listening experience. Attention is typically associated with cognitive focus, whereas listening engagement additionally involves cognitive and affective immersion in sound. Despite their importance, these states remain difficult to disentangle, behaviorally and physiologically. Both have been linked to interpersonal synchronization (the synchronization of biobehavioral signals across individuals), raising questions about what this synchronization actually reflects. MethodIn this study, we disentangled attention and listening engagement by independently manipulating both factors within a single experiment. Thirty participants listened to two simultaneously presented streams of meaningful speech and were instructed to focus on only one. Both attended and unattended stimuli were designed to be either engaging or non-engaging. Neural activity was recorded using EEG, while physiological responses were measured using heart rate and electrodermal activity. ResultsInterpersonal synchronization was computed from neural and bodily signals, alongside a self- report measure of listening engagement and auditory attention decoding (AAD), a neural measure of selective attention. Interpersonal synchronization of all three modalities significantly predicted listening engagement, whereas neural interpersonal synchronization was the only measure that significantly predicted attention. These findings suggest that attention is primarily driven by cognitive processes represented in the brain, while listening engagement additionally involves affective processes that are more strongly reflected in bodily responses. ConclusionsOverall, this study demonstrates that different forms of interpersonal synchronization reflect distinct dimensions of the listening experience and supports interpersonal synchronization as a potential objective marker of listening engagement.