Search Results (401)

Mucus plugs are airway-obstructing accumulations of inspissated secretions frequently observed in obstructive lung diseases (OLDs), including chronic obstructive pulmonary disease (COPD), severe asthma, and cystic fibrosis. Their presence on chest CT is strongly associated with airflow limitation, reduced lung function, and increased mortality, making them emerging imaging biomarkers of disease burden and treatment response. However, manual delineation of mucus plugs is labor-intensive, subjective, and impractical for large cohorts, leading most prior studies to rely on coarse segment-level scoring systems that overlook lesion-level characteristics such as size, extent, and location. Automated plug-level quantification remains challenging due to substantial heterogeneity in plug morphology, overlap in attenuation with adjacent vessels and airway walls on non-contrast CT, and pronounced size imbalance in clinical datasets, which are typically dominated by small distal plugs. To address these challenges, we developed and validated a simulation-driven, annotation-free deep learning framework for automated detection and segmentation of airway mucus plugs on non-contrast chest CT. A total of 200 COPD CT scans were analyzed (98 plug-positive, 83 plug-negative, and 19 uncertain). Synthetic mucus plugs were generated within segmented airways by transferring voxel-intensity statistics from adjacent intrapulmonary vessels, preserving realistic morphology and texture while enabling controlled sampling of plug phenotypes. An nnU-Net trained exclusively on synthetic data (S-Model) was evaluated on an independent, expert-annotated test set and compared with an nnU-Net trained on manual annotations using 10-fold cross-validation (M-Model). The S-Model achieved significantly higher detection performance than the M-Model (sensitivity 0.837 [95% CI: 0.818–0.854] vs. 0.757 [95% CI: 0.737–0.776]; 1.91 false positives per scan vs. 3.68; p < 0.001), with performance gains most pronounced for medium-to-large plugs (≥6 mm). This simulation-driven approach enables accurate, scalable quantification of mucus plugs without voxel-wise manual annotation in thin-slice (<1.5 mm) non-contrast chest CT scans. While the framework could, in principle, be extended to other annotation-limited medical imaging tasks, its generalizability beyond this COPD cohort and imaging protocol has not yet been established, and future work is required to validate performance across diverse populations and scanning conditions. Full article

Problem Statement: Two global trends, including aging populations and the acceleration of global warming, are increasing the risk of heat-related illness, challenging the health of populations, and the sustainability of healthcare systems. Global warming refers to the increase in the Earth’s average surface temperature, generally attributed to the greenhouse effect, which is occurring at three times the rate of the pre-industrial era. The global population of older adults, defined here as individuals aged 60 and over, is expected to reach over 2 billion by mid-century. This population is particularly vulnerable to heat-related illness, specifically disruption of thermoregulation from excessive exposure to environmental heat due to metabolic and cognitive changes associated with aging. Objectives: This review examines heat-related illness and its impact on older adults within a socio-ecological framework, considering both drivers and mitigation strategies related to global warming, the built environment, social determinants of health, healthcare system responses, and the individual. The authors were motivated to create a conceptual model within this framework drawing on their lived experiences as healthcare providers interacting with older adults in a large urban area of the southwestern US, known for its extreme heat and extensive heat island effects. Based on this framework, the authors suggest actionable strategies supported by the literature to reduce the risks of morbidity and mortality. Methods: The literature search utilized a wide lens to identify evidence supporting various aspects of the hypothesized framework. In this sense, this review differs from systematic and scoping reviews, which seek a complete synthesis of the available literature or a mapping of the evidence. The first author conducted the literature search and synthesis, while the second and third authors reviewed and added publications to the initial search and conceptualized the socio-ecological framework. Discussion: This study is unique in its focus on a global trend that threatens the well-being of a growing population. The population health focus underscores social determinants of health and limitations of existing healthcare systems to guide healthcare providers in reducing older adults’ vulnerability to heat-related illness. This includes patient education regarding age-related declines in extreme heat tolerance, safe and unsafe physical activity habits, the impact of prescription drugs on heat tolerance, and, importantly, identifying the symptoms of heatstroke, which is a medical emergency. Additional strategies for improving survivability and quality of life for this vulnerable population include improved emergency response systems, better social support, and closer attention to evidence-based treatment for heat-related health conditions. Full article

Infertility affects 10–30% of couples globally, with significant psychological and social impacts in sub-Saharan Africa, where fertility is closely tied to identity and social status. To explore how couples’ understanding of infertility causes influences their treatment-seeking behaviours and healthcare decision-making processes in Ghana, this cross-sectional qualitative study used in-depth interviews with 24 married participants (nine dyads and six individuals) experiencing current or past infertility in Greater Accra, Ghana, from August to October 2023. Data were analysed using thematic analysis with NVivo version 15. Couples demonstrated comprehensive knowledge of infertility causes spanning medical, spiritual, cultural, and lifestyle factors, although they lacked knowledge of clinical diagnostic criteria. Three main treatment pathways emerged: medical/orthodox, herbal, and spiritual interventions, pursued either sequentially or concurrently. Decision-making was influenced by internal factors (treatment effectiveness, financial constraints, and safety concerns) and external factors (family influence and peer testimonials). Four distinct navigation strategies were identified: informed notification, trial periods and evaluation, parallel relationship management, and strategic sequencing. Couples experiencing infertility are sophisticated healthcare consumers who skilfully navigate pluralistic healthcare systems through strategic decision-making. Rather than representing non-compliance, their multimodal approaches reflect rational responses to structural constraints and cultural values. Healthcare systems should recognise and accommodate these navigation strategies to improve therapeutic relationships and outcomes. Full article

Sepsis is a life-threatening condition characterized by a dysregulated host response to infection, often resulting in multiorgan dysfunction. Among affected systems, the gastrointestinal tract plays a central role in sepsis progression by promoting systemic inflammation through impaired barrier function, immune imbalance, and microbiome alterations. Recent research has identified selected medical gases and gasotransmitters as promising therapeutic candidates for preserving gut integrity in sepsis. In particular, hydrogen, carbon monoxide, and hydrogen sulfide exhibit antioxidative, anti-inflammatory, and cytoprotective properties. These gases act through defined molecular pathways, including activation of Nrf2, inhibition of NF-κB, and preservation of tight junction integrity, thereby supporting intestinal barrier function. In addition, they influence immune cell phenotypes and autophagy, with indirect effects on the gut microbiome. Although most supporting evidence derives from preclinical models, translational findings and emerging safety data highlight the potential of gut-targeted gas-based strategies. This review summarizes current mechanistic and translational evidence for gut-protective medical gases in sepsis and discusses their integration into future organ-specific and mechanism-based therapeutic approaches. Full article

In recent decades, the burden of TB has been gradually declining; however, with the emergence of COVID-19 and ongoing political conflicts, including the war in Ukraine, the proper functioning of healthcare services and TB control programs has been jeopardized. Recently, research has emphasized the importance of hematological parameters associated with inflammation, which can be easily analyzed through routine blood tests. Combining these parameters may have predictive value for various diseases, including pulmonary tuberculosis and even help monitor the effectiveness of treatment. Since there is no single hematological or inflammatory biomarker that provides precise and dynamic information about the success or failure of treatment, identifying individual markers or sets of biomarkers with higher sensitivity and specificity is essential. This is particularly important since sputum culture conversion at two months remains insufficiently sensitive and microscopy conversion has limited sensitivity and specificity in detecting treatment failure. Also, the analysis of the impact of the standard directly observed treatment, short-course regimen on pathogenic mechanisms also focuses on how it influences the interaction between inflammation and oxidative tissue degradation, by measuring plasma levels of glutathione. Utilizing a combination of hematological, inflammatory, and antioxidant biomarkers offers significant insights into systemic inflammatory responses in pulmonary tuberculosis patients, both before commencing treatment and during the entire duration of antituberculosis therapy. Combining different inflammatory parameters into a multiple biomarker can significantly enhance the accuracy of predicting prognosis and response to antibiotic chemotherapy. Identifying an optimal combination of biomarkers with predictive value is crucial for assessing treatment response and evaluating the effectiveness of anti-TB medication. Rather than developing or testing a composite prediction model, this review summarizes reported performance metrics from individual studies and highlights priorities for future prospective validation of integrated biomarker panels. Full article

Background/Objectives: Emergency department short-stay units (ED SSUs) manage patients requiring short-term observation and treatment. For a small number of patients, a longer hospital admission is required. Care for these patients is provided by an inpatient team and the responsibility for managing acute clinical deterioration falls to a rapid response team, activated by an emergency call. While emergency calls have primarily been a feature of the inpatient setting, admitted patients are increasingly boarding within ED SSUs and the occurrence and impact of emergency calls in this setting remains largely unreported. This study aimed to determine the incidence and characteristics of emergency calls within an ED SSU, describing patient demographics, clinical triggers, and outcomes. Methods: This retrospective cohort study utilised the Tasmanian Emergency Care Outcomes Registry (TECOR) to analyse emergency calls in the ED SSU of a tertiary emergency department between 1 February 2024 and 28 February 2025. Inclusion criteria were defined as adult patients (≥14 years) admitted to an inpatient service who had emergency calls whilst in the ED SSU. Descriptive statistics were used to characterise this cohort. Results: Of 83,238 ED presentations, 11,775 adult patients were transferred to the ED SSU. 1464 (12.4%) of these patients were subsequently admitted under an inpatient service but remained boarding in the ED SSU, with 54 emergency calls occurring in 38 unique patients (2.6%). The median age was 81.5 years (IQR 65–86), older than both the main ED cohort with a median age of 71 years, and median ages of 65 to 69.5 years reported in ward-based cohorts. Most calls were medical emergency team (MET) activations (52, 96.30%) with only 2 (3.7%) code blues. The most common triggers were hypotension (20, 37.04%), reduced level of consciousness (7, 12.96%) and serious concern (7, 12.96%). Delays occurred in 18.52% of calls (mean 82 min). The median ED SSU length of stay for patients having an emergency call was 40.15 h, substantially exceeding the intended ED SSU admission criteria threshold of 24 h. Goals of care remained incomplete in 33.33% of calls, even after emergency team review. Conclusions: ED SSU emergency calls are infrequent but clinically significant, involving an elderly, vulnerable population with late sign triggers and prolonged boarding. These findings highlight fundamental mismatches between patient acuity and ED SSU environment capabilities, emphasising the need for improved monitoring, more selective admission criteria, and enhanced systems for recognising deterioration for patients boarding in ED SSUs. Full article

Objective: Dynamic allocation of emergency medical resources is a critical task in the prevention and control of respiratory infectious diseases (RIDs). This study aims to address the challenge of a “run on the healthcare system” by proposing an effective resource allocation strategy to curb the spread of RIDs. Methods: Considering the infection severity of RIDs, the capacity of emergency medical resources (hospitalization rate), and vaccination status, we construct an S_VIⁿR dynamic model of RIDs that considers vaccine failure. Under the constraint of emergency medical resources and with the goal of minimizing the basic reproduction number, we propose a dynamic allocation strategy for distributing emergency medical resources among different types of infected individuals. Results: Simulation results demonstrate that improving the hospitalization efficiency of emergency medical resources significantly contributes to the effective control of RIDs. The model shows that targeted dynamic allocation helps reduce disease transmission. Conclusions: Validation using real-world data confirms that the model is effective and practical. It offers theoretical guidance for dynamically allocating emergency medical resources and supports informed decision-making in response to major emerging RIDs. Full article

Extended Reality (XR) technologies have matured into powerful tools for training in high-stakes domains, from emergency response to search and rescue. Yet current systems often struggle to balance real-time AI-driven personalisation with the need for human oversight and calibrated trust. This article synthesizes the programmatic contributions of a multi-study doctoral project to advance a design-and-evaluation framework for trustworthy adaptive XR training. Across six studies, we explored (i) recommender-driven scenario adaptation based on multimodal performance and physiological signals, (ii) persuasive dashboards for trainers, (iii) architectures for AI-supported XR training in medical mass-casualty contexts, (iv) theoretical and practical integration of Human-in-the-Loop (HITL) supervision, (v) user trust and over-reliance in the face of misleading AI suggestions, and (vi) the role of interaction modality in shaping workload, explainability, and trust in human–robot collaboration. Together, these investigations show how adaptive policies, transparent explanation, and adjustable autonomy can be orchestrated into a single adaptation loop that maintains trainee engagement, improves learning outcomes, and preserves trainer agency. We conclude with design guidelines and a research agenda for extending trustworthy XR training into safety-critical environments. Full article

Background/Objectives: Emergency medical services (EMSs) are essential for reducing mortality among critically ill patients. This study aims to evaluate the influence of temporal factors, such as time of day, day of the week, month, and year, on mortality in EMS activations, comparing health systems in the U.S. and Spain. Methods: This multicenter observational study, which is based on two databases (Spain’s Sacyl and the U.S.’s NEMSIS), analyzed EMS activation in high-priority adult patients (>18 years) between 2018 and 2023. Demographic variables, transport characteristics, and response times were included. Short-term mortality was the primary outcome. Results: A total of 54,981 EMS activations (11,713 from the Sacyl dataset and 43,268 from the NEMSIS dataset) were analyzed. Mortality was higher among older patients and males, with significant increases during shifts from 06:00 to 12:00 and from 18:00 to 24:00. Mortality also varied by year, with higher rates in 2022 and 2023 than in 2018. Notable differences were observed between the U.S. and Spain, especially in shifts and months, with higher mortality during the 12:00 to 18:00 shift and in October in the NEMSIS cohort. Conclusions: These findings have direct implications for emergency medical service operations, suggesting that resource allocation, staffing models, and clinical protocols should be strategically optimized based on temporal risk patterns to improve patient outcomes during identified high-risk periods. Full article

Viper envenomation in dogs represents a significant medical emergency in regions where vipers are endemic. Despite its clinical relevance, detailed data on the haematological and biochemical alterations in canine viper envenomation remain limited. This study aimed to evaluate the clinical presentation and haematological, biochemical and coagulative changes occurring in dogs following bites from the Vipera aspis species, and to assess their diagnostic and prognostic significance. Twelve dogs with suspected Vipera aspis envenomation were encompassed in the study. Clinical data were gathered and blood samples were collected at hospital admission (T1), 24 h (T2) and 48 h later (T3). Complete blood counts, biochemical profiles and coagulation parameters were analysed using standard automated systems. Common clinical signs included local pain and swelling, depression, fever, haematuria and melena. Haematological evaluation revealed progressive anaemia, leucocytosis and thrombocytopenia. Biochemical findings showed elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and creatine kinas (CK), indicating hepatic and muscular injury; however, no consistent evidence of renal failure was found. Coagulation analysis revealed a significant shortening of activated partial thromboplastin time (aPTT) and prothrombin time (PT) over time, alongside marked increases in fibrinogen and antithrombin III. This indicates an inflammatory rather than consumptive coagulopathy. Viper envenomation in dogs induces complex haematological and biochemical alterations, reflecting both direct venom toxicity and systemic inflammatory responses. Early recognition, supportive care and continuous laboratory monitoring are essential for improving prognosis. Full article

Despite the increasing number of older Syrian refugees in Canada, little is known about how they manage their health care needs while contending with language barriers, cultural dissonance, and systemic inequities. This qualitative study explored how older Syrian refugees in the Greater Toronto Area (GTA) navigate healthcare across Canadian and transnational contexts. The study was guided by the transnational circulation of care framework and used an interpretive descriptive design. Following research ethics approval, 20 older Syrian refugees were interviewed by bilingual research assistants. In-depth individual interviews were conducted in Arabic and analyzed using reflexive thematic analysis. Four interrelated themes emerged: (1) Navigating a New System; (2) Living in Two Worlds; (3) Medication Portability, Herbal Practices, and Supplement Culture; and (4) Digital Health Across Borders. Findings demonstrate that older Syrian refugees actively construct hybrid care pathways that integrate biomedical, cultural, and transnational practices. These strategies reflect resilience and adaptability but also expose gaps in the healthcare system. The study underscores the need for culturally responsive and age-friendly healthcare practices that acknowledge transnational realities. By illuminating how care circulates across borders, this study provides actionable guidance for designing responsive health systems. Full article

Cardiac arrest is a life-threatening emergency requiring immediate intervention, with bystander-initiated Cardiopulmonary resuscitation (CPR) being critical for survival, especially in out-of-hospital situations where medical help is often delayed. Given that over 70% of out-of-hospital cases occur in private residences, there is a growing imperative to provide widespread CPR training to the public. However, conventional instructor-led CPR training faces inherent limitations regarding spatiotemporal constraints and the lack of personalized feedback. To address these issues, this paper proposes an AI-integrated XR-based CPR training system designed as an advanced auxiliary tool for skill acquisition. The system integrates vision-based pose estimation with multimodal sensor data to assess the trainee’s posture and compression metrics in accordance with Korean regional CPR guidelines. Moreover, it utilizes a Large Language Model to evaluate verbal protocols, including requesting an emergency call that aligns with the guidelines. Experimental validation of the proof-of-concept reveals a verbal evaluation accuracy of 88% and a speech recognition accuracy of approximately 95%. Furthermore, the optimized concurrent architecture provides a real-time response latency under 0.5 s, and the automated marker-based tracking ensures precise spatial registration without manual calibration. These results confirm the technical feasibility of the system as a complementary solution for basic life support education. Full article

Contemporary advances in bioengineering and materials science have substantially improved the viability of medical implants. The demand for optimized implant technologies has led to the development of advanced coatings that enhance biocompatibility, antimicrobial activity, and durability. Implant manufacturers and surgeons must anticipate both biological and mechanical challenges when implementing devices for patient use. Key areas of concern include infection, corrosion, wear, immune response, and implant rejection; regulatory and economic considerations must also be addressed. Materials science developments are optimizing the integration of established materials such as biometrics, composites, and nanomaterials, while also advancing fabrication-based innovations including plasma functionalization, anodization, and self-assembled monolayers. Emerging smart and stimuli-responsive surface technologies enable controlled drug delivery and real-time implant status communication. These innovations enhance osseointegration, antimicrobial performance, and overall device functionality across orthopedic, dental, and cardiovascular applications. As implant design continues to shift toward personalized, responsive systems, advanced coating technologies are poised to deliver significantly improved long-term clinical outcomes for patients. Full article

Out-of-hospital cardiac arrest (OHCA) is a major cause of death during mountain activities in the Alpine regions. Due to the time-critical nature of these emergencies and the logistical challenges of remote terrain, emergency medical services (EMS) are investigating the use of unmanned aerial vehicles (UAVs) to deliver automated external defibrillators (AEDs). This study presents a geospatial strategy for optimising AED delivery by UAVs in mountainous environments, using the Province of South Tyrol, Italy, as a model region. A Geographic Information System (GIS) framework was developed to identify suitable sites for vertical drone ports based on terrain, infrastructure, and regulatory constraints. A Low-Altitude-Flight Elevation Model (LAFEM) was implemented to generate obstacle-avoiding, regulation-compliant 3D flight paths using least-cost path analysis. The results identified 542 potential vertical-port locations, covering approximately 49% of South Tyrol within ten minutes of flight, and demonstrated significant time savings for AED delivery in field tests compared with manual and Euclidean routing. These findings show that integrating GIS-based vertical-port placement and terrain-adaptive UAV routing can substantially improve AED accessibility and response times in mountainous regions. The LAFEM model aligns with U-space airspace regulations and supports safe, automated AED deployment for improved outcomes in OHCA emergencies. Full article

Background/Objectives: Individuals with type 2 diabetes (T2D) achieve less total body weight loss (TBWL) with obesity medications compared to those without T2D. The individualized metabolic surgery (IMS) score, originally developed to predict T2D remission after bariatric surgery, inversely correlates with TBWL response to semaglutide. IMS reflects T2D severity, incorporating HbA1c and T2D duration and medication use. This study aims to evaluate TBWL with tirzepatide across IMS severity categories and identify predictors of response in a real-world cohort. Methods: This retrospective analysis included 717 adults with T2D using tirzepatide for overweight or obesity within the Mayo Clinic Health System. Patients were stratified by IMS severity (mild, moderate, severe) and quartiles. Primary endpoint: TBWL% at 15 months. Secondary endpoints: categorical thresholds (≥5%, ≥10%, ≥15%, ≥20%) and predictors of TBWL%. Linear mixed-effects models and regression models were employed. Results: At 15 months, TBWL was greater in mild versus severe IMS groups (14.8% vs. 11.0%, p = 0.015), with similar trends across quartiles. The proportion achieving ≥ 20% TBWL was nearly two-fold higher in mild versus severe IMS (27% vs. 14%, p = 0.03). Female sex independently predicted greater TBWL, whereas insulin use, higher T2D medication burden (particularly weight-promoting agents), and HbA1c > 7% were associated with less TBWL. Conclusions: Tirzepatide produced clinically meaningful TBWL across all IMS categories, although TBWL declined with increasing IMS severity. Glycemic control and T2D medication use emerged as strong predictors of TBWL. The IMS score may serve as a practical tool to anticipate weight-loss trajectories, guide personalized treatment decisions, and inform patient counseling. Full article