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Students from a high socioeconomic background show relatively homogeneous, high levels of educational attainment, whereas students with a low socioeconomic origin display a large variability in their educational careers. In this paper, we examine whether the varying degrees of students' academic self-efficacy can contribute to an explanation of this variation. Focusing on Germany's highly stratified educational system, we utilized the CILS4EU dataset to analyse the association between the academic self-efficacy of students from low and high socioeconomic backgrounds in 9th grade and their later educational aspirations and transitions. Our results show that students from non-academic families are much more likely to (a) aspire to an Abitur, (b) transition to upper secondary school, and (c) enter tertiary education if they exhibit a high level of academic self-efficacy. In contrast, academic self-efficacy shows no link to the educational aspirations and decisions of students who have at least one parent with an academic certificate. Our research is guided by the question 'to what extent do adolescents' educational and political efficacy beliefs influence their later educational and political behaviour?' Thus, the project seeks to examine what happens when adolescents of a disadvantaged (vs. advantaged) group (operationalized by socio-economic status and immigrant origin) experience success (vs. failure) in the education system: How are their personal, group, and system efficacy beliefs shaped by those experiences? As part of this, we utilize the CILS4EU data to follow students' educational pathways from age 14 to age 22 and analyse socioeconomic differences in the link between students' academic self-efficacy and their educational aspirations and decisions.

Unequal political participation increasingly challenges democracies. The turnout gap is particularly large among younger voters, with severe implications for future developments of democratic representation, legitimacy, and quality. This article focuses on the role of political efficacy beliefs in explaining unequal turnout among newly enfranchised citizens. We argue that internal political efficacy beliefs are particularly important for turnout among the newly enfranchised from lower-class backgrounds, as they lack alternative mobilizing factors such as politically aware and active parents, political knowledge, and mobilizing networks. Furthermore, we argue that once these voters successfully turn out in their first election, they are as likely as those from higher-class backgrounds to turn out in their second election. We empirically test these arguments using original longitudinal data on newly enfranchised citizens from three German federal states (Bundesländer). Overall, our results support the argument: Political efficacy beliefs are a stronger predictor of first turnout among young adults from disadvantaged backgrounds compared to those from more advantaged backgrounds, and those who do turn out are as likely as those with higher-class backgrounds to turn out in their second election. This highlights the relevance of political efficacy beliefs in the (re)production of persisting political inequality.

Background and aim: Patient satisfaction is a critical indicator of healthcare quality, shaping treatment adherence, continuity of care, and the allocation of resources. The Short Assessment of Patient Satisfaction (SAPS) is a brief, reliable tool that is widely used internationally, but no validated Arabic version currently exists. Therefore, this study aimed to translate, culturally adapt, and validate the SAPS into Arabic for use in primary care clinics. Methods: We conducted a cross-sectional validation study at general practice clinics of a tertiary academic hospital in Riyadh, Saudi Arabia (June–August 2025). Consecutive Arabic-speaking patients aged 18–80 were recruited post-visit and completed a self-administered electronic survey including the Arabic Short Assessment of Patient Satisfaction (Ar-SAPS), PSQ-18, and PDRQ-9, as well as demographic and visit variables. Psychometric testing included internal consistency, test–retest reliability, construct validity, and factor analysis. Results: A total of 273 participants enrolled in our study. The Ar-SAPS demonstrated good reliability (Cronbach’s α = 0.789; McDonald’s ω = 0.882) and moderate test–retest stability (ICC = 0.634, p < 0.0001). Factor analysis supported a primarily unidimensional structure, with the first factor explaining 60.2% of variance. Most inter-item correlations were moderate to strong, except for item 6. Convergent validity was supported by significant correlations with the Arabic PDRQ-9 (r = 0.623, p < 0.001, CI [0.532, 0.713]) and PSQ-18 (r = 0.662, p < 0.001, CI [0.531, 0.793]), confirming consistency with established measures of patient satisfaction. Furthermore, it demonstrated excellent discriminative ability, with areas under the curve of 0.965 for overall satisfaction and 0.955 for willingness to recommend. Conclusion: The Ar-SAPS is valid and reliable for use to assess patient satisfaction.

Accurate classification of focal liver lesions is an important part of liver disease diagnostics. In clinical practice, the lesion type is often determined from the abdominal MR examination, which includes T2-weighted and dynamic contrast enhanced (DCE) MR images. To date, only T2-weighted images are exploited for automatic classification of focal liver lesions. In this study additional MR sequences and risk factors are used for automatic classification to improve the results and to make a step forward to a clinically useful aid for radiologists. Clinical MRI data sets of 95 patients with in total 125 benign lesions (40 adenomas, 29 cysts and 56 hemangiomas) and 88 malignant lesions (30 hepatocellular carcinomas (HCC) and 58 metastases) were included in this study. Contrast curve, gray level histogram, and gray level co-occurrence matrix texture features were extracted from the DCE-MR and T2-weighted images. In addition, risk factors including the presence of steatosis, cirrhosis, and a known primary tumor were used as features. Fifty features with the highest ANOVA F-score were selected and fed to an extremely randomized trees classifier. The classifier evaluation was performed using the leave-one-out principle and receiver operating characteristic (ROC) curve analysis. The overall accuracy for the classification of the five major focal liver lesion types is 0.77. The sensitivity/specificity is 0.80/0.78, 0.93/0.93, 0.84/0.82, 0.73/0.56, and 0.62/0.77 for adenoma, cyst, hemangioma, HCC, and metastasis, respectively. The proposed classification system using features derived from clinical DCE-MR and T2-weighted images, with additional risk factors is able to differentiate five common types of lesions and is a step forward to a clinically useful aid for focal liver lesion diagnosis.

Dense and aligned Collagen I fibers are associated with collective cancer invasion led by protrusive tumor cells, leader cells. In some breast tumors, a population of cancer cells (basal-like cells) maintain several epithelial characteristics and express the myoepithelial/basal cell marker Keratin 14 (K14). Emergence of leader cells and K14 expression are regarded as interconnected events triggered by Collagen I, however the underlying mechanisms remain unknown. Using breast carcinoma organoids, we show that Collagen I drives a force-dependent loop, specifically in basal-like cancer cells. The feed-forward loop is centered around the mechanotransducer Yap and independent of K14 expression. Yap promotes a transcriptional program that enhances Collagen I alignment and tension, which further activates Yap. Active Yap is detected in invading breast cancer cells in patients and required for collective invasion in 3D Collagen I and in the mammary fat pad of mice. Our work uncovers an essential function for Yap in leader cell selection during collective cancer invasion. Aligned collagen I is associated with the emergence of leader cells that are responsible for collective invasion. Here, the authors show that Collagen I and Yap signalling are in a feed-forward loop to drive the collective invasion of basal-like tumour cells.

Tumor protein p53 ( TP53 ) is the most frequently mutated gene in cancer 1 , 2 . In patients with myelodysplastic syndromes (MDS), TP53 mutations are associated with high-risk disease 3 , 4 , rapid transformation to acute myeloid leukemia (AML) 5 , resistance to conventional therapies 6 – 8 and dismal outcomes 9 . Consistent with the tumor-suppressive role of TP53 , patients harbor both mono- and biallelic mutations 10 . However, the biological and clinical implications of TP53 allelic state have not been fully investigated in MDS or any other cancer type. We analyzed 3,324 patients with MDS for TP53 mutations and allelic imbalances and delineated two subsets of patients with distinct phenotypes and outcomes. One-third of TP53 -mutated patients had monoallelic mutations whereas two-thirds had multiple hits (multi-hit) consistent with biallelic targeting. Established associations with complex karyotype, few co-occurring mutations, high-risk presentation and poor outcomes were specific to multi-hit patients only. TP53 multi-hit state predicted risk of death and leukemic transformation independently of the Revised International Prognostic Scoring System (IPSS-R) 11 . Surprisingly, monoallelic patients did not differ from TP53 wild-type patients in outcomes and response to therapy. This study shows that consideration of TP53 allelic state is critical for diagnostic and prognostic precision in MDS as well as in future correlative studies of treatment response. Clinical sequencing across a large prospective cohort of patients with myelodysplasic syndrome uncovers distinct associations between the mono- and biallelic states of TP53 and clinical presentation

Silicon is indisputably the most advanced material for scalable electronics, but it is a poor choice as a light source for photonic applications, due to its indirect band gap. The recently developed hexagonal Si 1− x Ge x semiconductor features a direct bandgap at least for x  > 0.65, and the realization of quantum heterostructures would unlock new opportunities for advanced optoelectronic devices based on the SiGe system. Here, we demonstrate the synthesis and characterization of direct bandgap quantum wells realized in the hexagonal Si 1− x Ge x system. Photoluminescence experiments on hex-Ge/Si 0.2 Ge 0.8 quantum wells demonstrate quantum confinement in the hex-Ge segment with type-I band alignment, showing light emission up to room temperature. Moreover, the tuning range of the quantum well emission energy can be extended using hexagonal Si 1− x Ge x /Si 1− y Ge y quantum wells with additional Si in the well. These experimental findings are supported with ab initio bandstructure calculations. A direct bandgap with type-I band alignment is pivotal for the development of novel low-dimensional light emitting devices based on hexagonal Si 1− x Ge x alloys, which have been out of reach for this material system until now. Authors demonstrate the synthesis and characterization of direct bandgap quantum wells in the hexagonal Si 1− x Ge x system. Photoluminescence experiments show light emission up to room temperature, and the emission wavelength can be tuned by thickness of the wells and the Si composition.

Background Preclinical models that resemble the clinical setting as closely as possible are essential in translating promising therapies for the treatment of acute myocardial infarction. Closed chest pig left anterior descending coronary artery (LAD) ischemia reperfusion (I/R) models are valuable and clinically relevant. Knowledge on the influence of experimental design on infarct size (IS) in these models is a prerequisite for suitable models. To this end, we investigated the impact of several experimental features (occlusion and follow-up time and influence of area at risk (AAR)) on IS. Methods A total of fifty-one female Landrace pigs were subjected to closed chest LAD balloon occlusion and evaluated in three substudies with varying protocols. To assess the relationship between time of occlusion and the IS, 18 pigs were subjected to 60-, 75- and 90 min of occlusion and terminated after 24 h of follow-up. Influence of prolonged follow-up on IS was studied in 18 pigs after 75 min of occlusion that were terminated at 1, 3 and 7 days. The relation between AAR and IS was studied in 28 pigs after 60 min of occlusion and 24 h of follow-up. The relation between VF, number of shocks and IS was studied in the same 28 pigs after 60 min of occlusion. Results Increasing occlusion time resulted in an increased IS as a ratio of the AAR (IS/AAR). This ranged from 53 ± 23% after 60 min of occlusion to 88 ± 2.2% after 90 min ( P  = 0.01). Increasing follow-up, from 1 to 3 or 7 days after 75 min of occlusion did not effect IS/AAR. Increasing AAR led to a larger IS/AAR (r 2  = 0.34, P  = 0.002), earlier VF (r 2  = 0.32, P  = 0.027) and a higher number of shocks (r 2  = 0.29, P  = 0.004) in pigs subjected to 60 min of occlusion. Conclusions These experiments describe the association of occlusion time, follow-up duration, AAR and VF with IS in closed chest pig LAD I/R models. These results have important implications for future I/R studies in pigs and can serve as a guideline for the selection of appropriate parameters and the optimal experimental design.

Background: Ischemia-reperfusion and cardiac remodeling is associated with cardiomyocyte death, excessive fibrosis formation, and functional decline, eventually resulting in heart failure (HF). Glucagon-like peptide (GLP)-1 agonists are reported to reduce apoptosis and myocardial infarct size after ischemia-reperfusion. Moreover, mineralocorticoid receptor antagonists (MRAs) have been described to reduce reactive fibrosis and improve cardiac function. Here, we investigated whether combined treatment with GLP-1R agonist exenatide and MRA potassium canrenoate could minimize cardiac injury and limit HF progression in animal models of chronic HF. Methods and Results: Forty female Topigs Norsvin pigs were subjected to 150 min balloon occlusion of the left anterior descending artery (LAD). Prior to reperfusion, pigs were randomly assigned to placebo or combination therapy (either low dose or high dose). Treatment was applied for two consecutive days or for 8 weeks with a continued high dose via a tunneled intravenous catheter. Using 2,3,5-Triphenyltetrazolium chloride (TTC) staining we observed that combination therapy did not affect the scar size after 8 weeks. In line, left ventricular volume and function assessed by three-dimensional (3D) echocardiography (baseline, 7 days and 8 weeks), and cardiac magnetic resonance imaging (CMR, 8 weeks) did not differ between experimental groups. In addition, 36 C57Bl/6JRj mice underwent permanent LAD-occlusion and were treated with either placebo or combination therapy prior to reperfusion, for two consecutive days via intravenous injection, followed by continued treatment via placement of osmotic mini-pumps for 28 days. Global cardiac function, assessed by 3D echocardiography performed at baseline, 7, 14, and 28 days, did not differ between treatment groups. Also, no differences were observed in cardiac hypertrophy, assessed by heart weight/bodyweight and heart weight/tibia length ratio. Conclusion: In the current study, combined treatment with GLP-1R agonist exenatide and MR antagonist potassium canrenoate did not show beneficial effects on cardiac remodeling nor resulted in functional improvement in a small and large animal chronic HF model.

The current study examined the effectiveness of respiratory biofeedback in lowering subjective and objective arousal after stress. Participants were presented with a meditation session in virtual reality while subjective and objective arousal were measured, the latter measured through ECG and EEG. Three conditions were used: (a) a respiratory biofeedback condition, in which visual feedback was paired to breathing; (b) a control feedback placebo condition, in which visual feedback was not paired to breathing; and (c) a control no-feedback condition, in which no visual feedback was used. Subjective and objective arousal decreased during meditation after stress in all conditions, demonstrating recovery after stress during meditation in virtual reality. However, the reduction in arousal (on all outcome measures combined and heart rate specifically) was largest in the control feedback placebo condition, in which no biofeedback was used, indicating that respiratory biofeedback had no additional value in reducing arousal. The findings of the current study highlight the importance of including a control feedback placebo condition in order to establish the exact additional value of biofeedback and offer insights in applying cost-effective virtual reality meditation training.