Search Results (3,910)

Background: Aging in Western societies poses a growing challenge, placing increasing pressure on healthcare costs. Early identification of infections in elderly nursing home residents is crucial to reduce complications, mortality, and the burden on emergency departments. Methods: We performed a comparative analysis of machine learning models using XGBoost classifiers for infection detection, addressing incomplete daily physiological measurements (Heart Rate, Oxygen Saturation, Body Temperature, and Electrodermal Activity) through strict imputation protocols. We evaluated three model variants—Basic (clinical only), Air Pollution-added, and Social Media-integrated—while incorporating a novel Basal Module to personalize physiological baselines for each resident. Results: Results from the binary model indicate that physiological data provides a necessary baseline for immediate screening. Notably, social media integration emerged as a powerful forecasting tool, extending the predictive horizon to a 6-day lead time with an F1-score of 0.97. Complementarily, air pollution data ensured robust immediate detection (“nowcasting”). In the multiclass scenario, external data resolved the “semantic gap” of vital signs, improving sensitivity for specific infections (e.g., acute respiratory and urinary tract infections) to over 90%. Conclusions: These findings highlight that the strategic integration of environmental and digital signals transforms the system from a reactive monitor into a proactive early warning tool for long-term care facilities. Full article

Purpose: This study assessed the adaptations resulting from implementing an experimental, integrated training program tailored to sex-specific traits. The aim was to enhance motor abilities, aerobic capacity, and metabolic variables in female and male rugby sevens athletes. Methods: Employing a combined observational and experimental design, initial and post-intervention assessments were conducted over three months (March–June 2023) with 24 elite professional players, divided equally by sex (12 females, 12 males). The protocol consisted of 12 micro-cycles, each lasting 7 days and comprising 12 training sessions. The evaluations included sprint and jumping tests, as well as functional assessments such as resting metabolic rate and cardiopulmonary exercise testing. Results: Using one-way repeated measures ANOVA, significant improvements were noted across all performance parameters (p < 0.001), with effect sizes ranging from small to very large. Sex-specific differences were evident, with females demonstrating consistent improvements in aerobic capacity and jumping ability, while males excelled in explosive power and longer sprints. Despite initial performance disparities, both sexes improved in short-distance sprints (10 m and 40 m). Cardiovascular efficiency improved as indicated by reduced maximum heart rates and lower respiratory quotients. Conclusions: Males showed superior progress in strength and explosive power tests, reflecting distinct physiological traits. These findings underscore the need for individualized and sex-specific training programs to optimize performance in high-intensity sports, such as rugby sevens. Full article

Background: Children and adolescents are pivotal in the transmission of influenza, and vaccination remains the most effective preventive measure. Cell-based influenza vaccines offer advantages over traditional egg-based vaccines by reducing egg-adapted mutations and improving antigenic match. SKYCellflu^® quadrivalent influenza vaccine (QIV; SK bioscience, Korea), the first cell-based QIV licensed in Korea for individuals aged 6 months and older, offers potential advantages; however, its real-world effectiveness in the Korean pediatric population remains limited. Objective: This study aimed to estimate the real-world effectiveness of SKYCellflu^® QIV, a cell-based QIV, in preventing laboratory-confirmed influenza among children and adolescents aged 6 months to 18 years in Korea during the 2024–2025 influenza season. Methods: A multicenter, prospective, test-negative case–control study was conducted from October 2024 to May 2025 across 25 institutions in Korea. Children and adolescents aged 6 months to 18 years who presented within 7 days of the onset of influenza-like illness (fever ≥ 38 °C and at least one respiratory symptom) were enrolled. Influenza infection was confirmed using rapid antigen tests or polymerase chain reaction; participants who tested positive were classified as cases, and those who tested negative for influenza served as controls. All participants were further categorized as vaccinated or unvaccinated based on receipt of SKYCellflu^® QIV. Those who received other influenza vaccines during the season were excluded. Vaccination status was verified through medical records and the national immunization registry. Results: A total of 1476 participants were included (751 cases, 725 controls). The overall adjusted vaccine effectiveness (aVE) was 45.57% (95% CI, 29.38–58.04). The vaccine demonstrated the highest effectiveness in children aged 6–35 months (aVE: 88.55%; 95% CI, 60.39–96.11). Effectiveness was higher against influenza B (aVE: 61.28%; 95% CI, 35.76–76.30) than influenza A (aVE: 41.63%; 95% CI, 22.55–56.01). The vaccine’s effectiveness in adolescents was not statistically significant due to the small sample size in this age group. Conclusions: This multicenter test-negative study provides the first real-world effectiveness of SKYCellflu^® QIV in a Korean pediatric population. The results suggest substantial protection in younger children, particularly against influenza B, and support the continued use of annual influenza vaccination in this population. Further studies with larger adolescent cohorts are needed to confirm these findings in older age groups. Full article

Physical activity often remains low after hospitalisation for acute exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD). Although post-hospitalisation rehabilitation has shown to support recovery, its impact on daily activity levels in the early post-exacerbation phase is unclear. This study describes the changes in physical activity (PA) and clinical outcomes during an 8-week rehabilitation following hospitalisation for AECOPD. This prospective observational cohort study included patients recently discharged after AECOPD from Aalborg University Hospital, Denmark. Participants received municipality-delivered post-hospitalisation rehabilitation consisting of tailored physiotherapy and occupational therapy of individually determined frequency. PA was assessed using thigh-worn triaxial accelerometers measuring 24 h/day over 8 weeks. Clinical outcomes included lung function (FEV1% predicted), dyspnoea scores, health-related quality of life (EuroQol 5-dimension, 5-level (EQ-5D-5L); EuroQol visual analogue scale (EQ-VAS)), frailty (Clinical Frailty Scale (CFS)), functional status (Short Physical Performance Battery (SPPB)), and symptom burden (COPD Assessment Test (CAT); St. George’s Respiratory Questionnaire (SGRQ)). Changes from baseline to 8 weeks were analysed using linear mixed-effects models and bootstrap resampling. Forty-three participants with a mean age 73.4 years, 67.4% female, and moderate frailty (CFS 5.4 ± 1.3) were included. Physical activity remained largely unchanged. Gait speed and total SPPB declined, whereas self-perceived health improved (EQ-VAS Δ +7.8, p = 0.008). Lung function, dyspnoea, and health related quality of life scores showed no significant change. In this frail, recently admitted COPD population, physical activity did not increase during the rehabilitation period, and some functional parameters declined. The improvement in self-perceived health suggests a divergence between subjective and objective outcomes. These findings highlight the need for long-term, tailored, and flexible approaches to support recovery after AECOPD. Full article

Integrating physical activity into daily routines through walking and cycling supports health while promoting sustainable mobility. This assumption aligns with SDGs 3, 5 and 11. This study assessed the feasibility and health impacts of cycling within a university setting. As part of the UCicletas program at Coimbra University, sixteen participants (8 males, 8 females) used conventional or pedal-assist bicycles for eight weeks. Descriptive analyses, t-tests, and Spearman correlations were applied to anthropometric and cardiorespiratory measurements collected before and after the intervention. Weekly cycling distance was obtained through self-reported odometer values. After eight weeks, notable health improvements were observed. Body fat decreased by 1.8% overall, with a significant reduction in females (p < 0.05). VO_2max increased by 13.79% in males (p = 0.02) and 12.21% in females (p = 0.03). The Ruffier Index decreased by 18.87% in males (p < 0.05) and 14.73% in females (p = 0.03). Gender differences were evident in correlations: male BMI showed a strong negative association with respiratory recovery (ρ = −0.867, p = 0.005), whereas the female association was weak (ρ = 0.371). Correlations between cycling distance and health outcomes were weak and non-significant. Overall, the findings confirm that modest daily cycling improves health outcomes. Full article

People with intellectual disabilities frequently use psychotropic and other medications, sometimes inappropriately. To promote shared decision-making, they require accessible information about their medication. This study combined data from two similar intervention studies, conducted in two different settings, to assess the appropriateness of medication use and the shared decision-making process among adults with mild intellectual disabilities who used psychotropic medication. The intervention consisted of a structured, multidisciplinary medication review, including the provision of accessible psychotropic medication leaflets, and a discussion of the pharmacotherapeutic treatment plan with the patient by either a pharmacist or physician, depending on the setting. Outcomes included medication use, pharmacotherapeutic problems, implementation of recommendations, and perceived shared decision-making, measured with the Shared Decision-Making Questionnaire Q9. The 15 included participants used an average of nearly seven medications, which were mainly neurotropic, gastrointestinal, cardiovascular, and respiratory agents. On average, two pharmacotherapeutic problems were identified; the most common were overtreatment, side effects, and administration difficulties. Recommendations often involved dose reduction or tapering, and about 75% were fully or partially implemented. Both participants and clinicians reported high satisfaction with shared decision-making. Multidisciplinary, structured medication reviews, incorporating accessible medication leaflets, may enhance appropriate medication use and shared decision-making, but more research is needed. Full article

Background: Long COVID remains a challenging and heterogeneous condition, with mechanisms that are still incompletely understood. Emerging evidence suggests that patients with allergic disease may experience more persistent post-COVID symptoms, possibly due to immune dysregulation and epithelial barrier fragility. Methods: We carried out an observational, single-center study at the Allergy and Clinical Immunology Unit of Policlinico Universitario A. Gemelli IRCCS (Rome, Italy). Seventeen adults with confirmed allergic disease and long COVID were evaluated between July and December 2024. Biomarkers reflecting allergic inflammation and barrier integrity, blood eosinophil count, total immunoglobulin E (IgE), eosinophil cationic protein (ECP), and serum free light chains (FLCs), were measured and analyzed for interrelationships and symptom correlations. Results: Participants (10 men, 7 women; mean age 43.7 years) showed variable biomarker profiles, consistent with the heterogeneity of allergic inflammation. Mean eosinophil count was 179 ± 72 cells/µL, total IgE 165.4 ± 140.6 kU/L, ECP 64.2 ± 48.5 ng/mL, and the kappa/lambda FLC ratio 1.20 ± 0.69. Notably, elevated kappa FLC levels (>19.4 mg/L) were significantly associated with high ECP (>20 ng/mL) (χ² = 10.6, p = 0.001) and increased IgE (>200 kU/L) (χ² = 6.0, p = 0.015). Individuals with higher ECP and FLCs more often reported respiratory and systemic symptoms, especially fatigue, dyspnea, and cognitive fog, that persisted beyond six months. Conclusions: These findings suggest that biomarkers of allergic inflammation and barrier dysfunction, particularly ECP and FLCs, may contribute to the persistence of long-COVID symptoms in allergic patients. The observed links between humoral activation, eosinophilic activity, and prolonged symptom burden support a model of sustained inflammation and delayed epithelial recovery. Larger, longitudinal studies including non-allergic controls are warranted to confirm these associations and to explore whether restoring barrier integrity could shorten recovery trajectories in this vulnerable population. Full article

Human adenovirus type 3 (HAdV-3) in the species Mastadenovirus blackbeardi is a frequent cause of hundreds of respiratory infections in Japan, with outbreaks varying in clinical severity. Such a high frequency of cases could be due to regular migration of novel variants or persistent circulation of endemic strains. Either scenario would require different measures to ameliorate the burden on public health. We designed a new cost-effective whole-genome sequencing protocol based on tiled amplicons and nanopore sequencing to clarify the circumstances behind the frequent outbreaks. This protocol was used with clinical samples collected between 2011 and 2020 from Japanese patients with acute respiratory illness (n = 110), resulting in near whole-genome sequences (~99% length) for 105 samples with high read coverage (~262.6 ± 192 reads). Phylogenetic analysis indicated sustained circulation of endemic strains in Japan during the analyzed decade and their relation to other strains worldwide with publicly available genome sequences. However, a comparison with other Japanese HAdV-3 strains circulating since 2023 suggested the public health measures introduced during the COVID-19 pandemic (2020–2022) indirectly affected the prevalence of circulating HAdV-3 variants. Additionally, our approach enabled the detection and partial sequencing (~71% completion) of co-infecting strains from the species Mastadenovirus caesari (n = 4) in the examined samples. The detection of adenoviruses belonging to different species in the same sample highlights how our protocol enhances the distinction of circulating viruses. In conclusion, these results and the introduced protocol will enable timely characterization and clinical interventions to mitigate this virus. Full article

Background/Objectives: Cardioneuroablation (CNA) is used to treat reflex syncope by parasympathetic denervation of the cardiac conduction system. Respiratory heart rate variability (RespHRV) constitutes an important physiological mechanism that optimizes lung perfusion. The impact of CNA on various components of RespHRV remains unclear. Methods: Eleven subjects (36.8 ± 14.1 years) undergoing CNA for the treatment of cardioinhibitory, vagally mediated syncope were enrolled. For the RespHRV assessment, we used continuous respiratory flow measurement and an electrocardiogram. RespHRV analysis included the following: (a) amplitude, reflecting the overall magnitude of changes in RR interval during the respiratory cycle (RespHRVpv, ms); and (b) efficiency, defined as the percentage of inspirations accompanied by RR shortening (short-RRi inspirations, %), and expirations accompanied by RR prolongation (long-RRi expirations, %). Baroreflex sensitivity (BRS, ms/mmHg) was assessed with a sequential method using a noninvasive hemodynamic monitor. Both RespHRV and BRS were captured 48 h apart, before and after CNA. Results: A significant reduction was observed in RespHRVpv (57 [30–131] vs. 13 [7–16] ms, p = 0.003), short-RRi inspirations (97.0 [77.8–100.0] vs. 36.0 [14.3–63.2] %, p = 0.003), and long-RRi expirations (88.0 [78.1–97.6] vs. 31.1 [21.4–65.8] %, p = 0.008). Moreover, we found a strong relationship between ΔBRS and ΔRespHRVpv (r = 0.77, p = 0.005) following CNA. Conclusions: Our results indicate a substantial role of the cardiac parasympathetic system in RespHRV development, including both its amplitude and efficiency. The marked decrease in key RespHRV measures after CNA highlights the need for further research into its long-term clinical effects. Full article

Precision livestock farming (PLF), by integrating multimodal sensor data, provides opportunities to enhance welfare monitoring and management in small ruminants. This study evaluated whether environmental, physiological, and behavioral measurements—including the temperature–humidity index (THI), carbon dioxide (CO₂) and ammonia (NH₃) concentrations measured at the barn level, body condition score (BCS), rectal and ocular temperatures, GPS-derived locomotion metrics, accelerometry data, and fixed animal traits—can serve as key predictors of welfare and productivity in dairy sheep. Data were collected from 90 ewes: all animals underwent the same repeated welfare assessments, while 30 of them were additionally equipped with GPS–accelerometer sensor collars; environmental conditions were continuously recorded for the entire flock, generating 773 complete multimodal records. All predictive models were developed using data from all 90 ewes; collar-derived behavioral variables were included only for individuals equipped with GPS–accelerometer collars. Nine regression methods (linear regression (LR), partial least square regression (PLSR), elastic net (EN), mixed-effects models, random forest (RF), extreme gradient boosting (XGBoost), support vector regression (SVR), neural networks (multilayer perceptron, MLP), and an ensemble of RF–XGBoost–EN were evaluated using a combination of nested cross-validation (CV) and leave-one-animal-out CV (LOAOCV) to ensure robustness and generalization at the individual animal level. Nonlinear models—particularly RF, XGBoost, SVR, and the ensemble—consistently delivered superior performance across traits. For behavioral (e.g., daily distance movement) and thermal indicators (e.g., medial canthus temperature), the highest predictive capacity (R² ≈ 0.60–0.70) was achieved, while moderate predictive capacity (R² ≈ 0.40–0.50 and ≈0.35–0.45), respectively, was observed for respiratory rate and milk yield, reflecting their multifactorial nature. Feature importance analyses underscored the relevance of THI, CO₂, NH₃, concentrations, and BCS across results. Overall, these findings demonstrate that multimodal sensor fusion can effectively support the prediction of welfare and productivity indicators in intensively reared dairy sheep and emphasize the need for larger and more diverse datasets to further enhance model generalizability and model transferability. Full article

Obstructive sleep apnea (OSA) is a prevalent disorder characterized by repeated upper airway collapse during sleep, significantly impacting quality of life. Orthodontists are increasingly recognized for their role in screening and managing anatomical factors contributing to airway obstruction. One such intervention is rapid maxillary expansion (RME), originally developed to address transverse maxillary deficiencies but now also studied for its influence on nasal and oropharyngeal airway dimensions. This literature review evaluates the effects of maxillary palatal expansion on airway volume and respiratory function. Evidence consistently shows increases in nasal cavity volume and reductions in nasal airway resistance, particularly in patients treated before the peak of skeletal growth. Some studies reported improvements in sleep outcomes and enhanced oxygen saturation following MARPE in adults with OSA. Results regarding changes in oropharyngeal volume were more variable, with several studies showing significant expansion. Factors influencing outcomes include patient age, skeletal maturity, appliance type, and aging modality. Hybrid and bone-borne expanders generally demonstrated greater skeletal effects compared to tooth-borne devices, though statistical significance was not always reached. While MARPE has shown promising results in non-obese adults with OSA, long-term stability of airway improvements and translation into consistent functional respiratory benefits remain uncertain. Overall, maxillary expansion demonstrates measurable skeletal and airway changes, with the greatest respiratory improvements in growing patients and selected adult populations. Incorporating patient-reported outcomes and standardized polysomnographic measures in future trials will be critical to determine whether these structural gains consistently translate into durable improvements in sleep-disordered breathing and quality of life. Full article

Effective classroom ventilation is essential for indoor environmental quality (IEQ), comfort and health of schoolchildren, who spend substantial time indoors. This controlled observational study compared manual window airing (WA) with decentralized mechanical ventilation (DV) in six classrooms of two elementary schools during the winter infection period. Symptoms of upper respiratory tract infections, salivary biomarkers, well-being, perceived comfort, and classroom-level IEQ were assessed through questionnaires, saliva samples and long-term monitoring. Ninety-eight schoolchildren participated (64 WA, 34 DV). Symptom-based outcomes of the WURSS-K questionnaire showed consistently lower illness burden in group DV, with several parameters reaching statistical significance and an absolute risk reduction of 7.8%. Salivary immunoglobulin A (sIgA) concentrations were also significantly lower in group DV (approximately 39–59%, p ≤ 0.01). Sensitivity analyses showed positive associations of CO₂ and PM_2.5 with sIgA and indicated that PM_2.5 exposure accounted for group differences. Comfort perceptions mirrored measured IEQ: DV classrooms exhibited warmer, more stable thermal conditions, lower CO₂ and PM_2.5, and slightly better thermal and draught-related impressions. Overall, decentralized mechanical ventilation supported favorable IEQ and comfort and may influence mucosal immune activity through reduced particulate exposure, complementing the observed reduction in symptom burden. A multidimensional approach integrating medical outcomes with continuous IEQ monitoring proved valuable and should be expanded in larger, balanced cohort studies. Full article

Background: Carbon dioxide (CO₂) is traditionally regarded as a metabolic by-product; however, growing evidence indicates that it plays an active regulatory role across multiple physiological systems. Acute hypercapnia elicits respiratory, cardiovascular, metabolic, immune, and neurocognitive responses, some of which may transiently influence exercise performance. This narrative review summarizes current evidence on CO₂ inhalation in healthy individuals and critically evaluates whether controlled hypercapnia may serve as a targeted stimulus in sport and exercise contexts. Methods: A narrative review of peer-reviewed English-language articles indexed in PubMed and Web of Science was conducted. A narrative approach was chosen due to the marked heterogeneity of study designs, hypercapnia-induction methods (e.g., CO₂ inhalation, voluntary hypoventilation, increased respiratory dead space), participant characteristics, and outcome measures, which precluded systematic synthesis. The review focused on studies involving healthy or physically active individuals and examined acute or short-term hypercapnic exposure. No strict publication date limits were applied. Studies conducted exclusively in clinical populations were excluded. Results: Short-term, controlled hypercapnia reliably increases ventilation, sympathetic activation, cerebral and muscular blood flow, and metabolic stress. Certain hypercapnia-based interventions—such as voluntary hypoventilation or added respiratory dead space—may enhance buffering capacity, reduce lactate accumulation and improve maximal oxygen uptake (VO₂max) during submaximal efforts and repeated-sprint performance during high-intensity, short-duration exercise. However, CO₂ inhalation frequently induces dyspnea, anxiety, and cognitive disruption, and higher concentrations pose clear safety risks. Current evidence does not support long-term improvements in VO₂max or long-duration endurance performance following hypercapnia-based interventions. Conclusions: Controlled, intermittent hypercapnia may provide a targeted metabolic and ventilatory stimulus that enhances tolerance to high-intensity exercise, yet its application remains experimental and context-dependent. The risks associated with CO₂ inhalation in healthy individuals currently outweigh its potential benefits, and safe, effective training protocols have not been fully established. Further research is needed to clarify the mechanisms, long-term adaptations, and practical utility of hypercapnia-based training strategies. Full article

Healthcare professionals face numerous challenges when analyzing data and providing treatment, including determining which parameters to measure, the frequency of measurement, i.e., how frequently to measure them, and the responsibility for monitoring patient health with new medical devices. Machine learning (ML) techniques are efficient predictive models used to improve early prediction of patient care and reduce the cost of implementing healthcare systems. This study proposes a new model (data prediction and labeling using a negative feature based on a multi-agent system (PLPF-MAS)) that provides a smart city-based healthcare system for the continuous monitoring of patients’ vital signs, such as heart rate, blood pressure, respiratory rate, and blood oxygen saturation. It also predicts future states and provides suitable recommendations based on clinical events. The MIMIC-II database of the MIT physio bank archive is used, which contains 1023 patient records. Additionally, the EHR dataset is used, which contains 10,000 patient records. The models were trained and evaluated for six bio-signals. The PLPF-MAS model is distinguished from traditional methods in its advanced system, which combines the activities of several agents and the intelligent distribution of responsibilities among them. The LR agent measures the model’s reliability in parallel with the AE-HMM agent to predict the Prisk; it then sends the data to a coordinator and a supervisory agent to monitor and manage the model. Our model is characterized by strong flexibility and reliability, the ability to deal with large datasets, and a short response time. It provides recommendations and warnings about risks, and it can predict clinical states with high accuracy. The new model achieved an accuracy of 98.4%, a precision of 95.3%, a sensitivity of 99.2%, a specificity of 99.1%, an F1-Score of 97.1%, and an $R^2$ of 98%, when the MIMIC-II dataset was used. Conversely, it achieved an accuracy of 93%, a precision of 92%, a recall of 94%, an F1-Score of 93%, an AUC-ROC of 94%, and an AUC-PR of 89% when the EHR dataset was used. Full article

Background: Weaning failure remains a major challenge in intensive care practice, often reflecting the interplay between systemic catabolism and skeletal muscle wasting. The blood urea nitrogen-to-creatinine (BUN/Cr) ratio is a routinely available biochemical index influenced by renal handling, hemodynamic status, protein metabolism, and muscle mass, and has been associated with adverse outcomes in critical illness. This study aimed to evaluate the association between BUN/Cr ratio, weaning outcomes, and ultrasound-based rectus femoris thickness. Methods: This retrospective observational study included 42 mechanically ventilated adults admitted to the medical ICU of Marmara University between December 2024 and September 2025. Rectus femoris thickness was measured via bedside ultrasonography at the time of the spontaneous breathing trial (SBT). Weaning success was defined as extubation without reintubation, death, or need for NIV/HFNO due to respiratory distress within 7 days. Laboratory and clinical variables—including BUN/Cr ratio, SOFA, APACHE II, mNUTRIC, and albumin—were recorded. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed. Results: Weaning failure occurred in 13 patients (31.0%). These patients had higher BUN/Cr ratios (58.7 [44.6–76.9] vs. 39.7 [23.8–49.2], p = 0.007) and lower rectus femoris thickness (6.2 [5.4–7.0] vs. 7.8 [6.9–8.6] mm, p = 0.021). The BUN/Cr ratio independently predicted weaning failure (OR 1.07; 95% CI 1.01–1.14; p = 0.024). ROC analysis identified a BUN/Cr cut-off of 44.6 (AUC = 0.76) for weaning failure. An exploratory composite metabolic–muscle indicator (MMI), combining BUN/Cr ratio and rectus femoris thickness, demonstrated higher discriminative performance in this cohort (AUC = 0.81). Conclusions: An elevated BUN/Cr ratio was independently associated with weaning failure and lower rectus femoris thickness in this cohort. Given the observational design and potential confounding, these findings should be interpreted as hypothesis-generating. Combined biochemical and ultrasound-based assessment highlights the potential value of integrating metabolic and morphologic information when characterizing patients at risk for weaning failure. However, whether incorporation of such markers into clinical decision-making improves weaning outcomes requires prospective validation. Full article