Search Results (1,503)

Polysomnography monitors sleep health with non-linear physiological time-series data, consequently making interpretability a challenge. This study explores the feasibility of applying control charts, a statistical process control method, to cardio-respiratory signals derived from polysomnography studies to provide transparent and interpretable analysis of sleep-related physiological variability. Cardio-respiratory signals from a publicly available polysomnography dataset were preprocessed, transformed, and analyzed using univariate control charts. Sleep stage annotations were used as reference information to contextualize physiological variability across wake and non-REM sleep stages. Phase-level control chart rule violations were examined relative to annotated sleep-state transitions and summarized quantitatively. The results indicate that control chart rule violations occur more frequently during wakefulness and at wake–non-REM sleep transitions, while remaining relatively stable during sustained non-REM sleep. These findings indicate structural correspondence between SPC-based variability flags and annotated sleep stage dynamics. This exploratory, feasibility-focused study does not evaluate diagnostic performance or detection accuracy. Instead, it provides evidence that SPC control charts can serve as a transparent and interpretable analytical framework for exploring physiological variability in sleep data and for supporting future research on sleep-state analysis and explainable data-driven methods. Full article

Growing resistance to carbapenem antibiotics is a major public health problem as these antibiotics are considered the last line of therapy for infections caused by multidrug-resistant (MDR) Gram-negative bacteria. The rapid emergence and dissemination of carbapenem-resistant bacterial strains are mainly due to horizontal gene transfer (HGT) within or between bacterial cells via the mobilome. The aim of this article is to discuss the role of mobile genetic elements (MGEs) that capture and disseminate resistance determinants of carbapenem antibiotics, as a comprehensive review integrating the combined role of plasmids, transposons and integrons. It attempts to systematically fill the gap by investigating the role of these MGEs in the acquisition, mobilization and dissemination of genes encoding carbapenemases across clinically important bacteria. Various types of plasmids such as IncF and IncH in Klebsiella pneumoniae, IncL/M in Enterobacter cloacae, IncX3 in Escherichia coli and IncA/C₂ in Salmonella enterica carry important genes encoding carbapenemases. The rapid distribution of transposons among bacterial species is one of the main contributing factors in the dissemination of carbapenem-resistant isolates. Transposons including Tn4401 carrying bla_KPC in K. pneumoniae and Tn1721 carrying bla_KPC in E. coli; Tn2006, Tn2007, Tn2008 and Tn2009 carrying bla_OXA-23 in Acinetobacter baumannii; Tn1696 carrying bla_IMP-4 in Pseudomonas aeruginosa; Tn125 carrying bla_NDM in E. coli; and Tn6306 carrying bla_IMI in Raoultella ornithinolytica encode different types of carbapenemases. Integrons mainly belonging to class 1 capture resistance determinants for metallo-carbapenemases such as NDM-, VIM-, SIM- and IMP-type enzymes in P. aeruginosa, A. baumannii, K. pneumoniae and E. coli and can promote the transcription and expression of these determinants. These findings are useful for understanding the genetics of carbapenem resistance and additional knowledge on MGEs may provide avenues for screening of resistance to these antibiotics in clinical settings. Full article

Interstitial lung diseases (ILDs) are frequently characterized by the presence of pulmonary fibrosis (PF), which may lead to respiratory failure secondary to irreversible parenchymal distortion. Although idiopathic pulmonary fibrosis (IPF) is the clinical prototype, the emergence of the progressive pulmonary fibrosis (PPF) phenotype has shifted the therapeutic paradigm toward shared pathogenic pathways while preserving the need to recognize the biological and clinical heterogeneity of the underlying ILDs. This state-of-the-art review integrates recent experimental and clinical data to provide a comprehensive overview of the transition from inflammatory models to the current epithelial-centric framework of fibrogenesis. In particular, the shift from ineffective anti-inflammatory strategies to the success of nintedanib and pirfenidone in both IPF and non-IPF progressive diseases is discussed. Furthermore, recent advances from phase II and III clinical trials targeting specific molecular drivers of fibrosis and vascular remodeling are analyzed, with a focus on pathway-oriented therapies, including nerandomilast, admilparant, and inhaled treprostinil. Understanding this molecular crosstalk is essential for the development of new therapeutic strategy based on precision medicine and it may support a new era of combination approaches aimed at stabilizing disease and improving patient outcomes in both idiopathic and progressive pulmonary fibrosis. Full article

Radon (222Rn) is a naturally occurring radioactive gas. It is colourless, odourless, and tasteless, produced through the spontaneous decay of uranium in soil and rocks. Among school-aged children, exposure to radon is a major public health concern because, during school hours, learners spend an average of 6–8 h daily inside school buildings, often on the ground floor or in basement classrooms, where radon levels tend to be highest. This study aims to contextualize radon exposure among children in educational settings, with a focus on the associated risk factors. A systematic review of the literature on radon exposure in classrooms among schoolchildren was conducted, analysing associated risk factors and methods of radon measurement. A literature search was performed across reputable databases to ensure compliance with systematic review standards. The quality of the evidence was appraised using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool. A total of 32 studies met the inclusion criteria and were analyzed. Radon levels measured in classrooms exhibit variability based on geographic location. Certain classrooms in Continental Europe and North America exceed the WHO reference limit of 100 Bq/m³, as well as regional thresholds, including the European Union limit of 300 Bq/m³ and the United States Environmental Protection Agency (EPA) limit of 148 Bq/m³. Indoor radon exposure in classrooms is a worldwide concern because children are particularly vulnerable during their formative years. Those attending daycare centers and kindergartens are at greater risk due to their nascent respiratory systems. Full article

During the coronavirus disease-2019 (COVID-19) pandemic, wastewater-based surveillance (WBS) gained renewed importance by enabling nationwide assessment of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) circulation independent of individual testing. In Germany, WBS was established by a series of initiatives, including the AMELAG project, established in 2022. As the pandemic phase waned, the extensive surveillance infrastructure—comprising around 170 wastewater treatment plants (WWTPs)—was scaled down. A subset of 53 WWTPs was selected by a hierarchical set of criteria to ensure continuation of WBS in 2025, resulting in a reduced population coverage (26% instead of 37%), preserving the monitoring of infection dynamics while improving operational efficiency. The multi-stage selection approach integrated operational experience and performance data of WWTPs collected between November 2022 and July 2024, including wastewater characteristics and laboratory quantification success, minimum population coverage across all administrative regional states of the country, and statistical quality metrics such as the frequency of outliers and implausible inflexion points or the deviation from LOESS regression trends. Additional consideration was given to sites of extended research relevance. Reducing the number of WWTPs by more than two-thirds did not result in notable deviations in the aggregated national SARS-CoV-2 viral load profile. However, the evaluation was limited to SARS-CoV-2 data, despite ongoing expansion of the WBS network to include additional pathogens. Overall, the data-driven site-selection framework, developed from scientific and operational criteria, ensures the sustainable continuation of the nationwide WBS system. Full article

Background/Objectives: While the health effects of economic fluctuations are well-documented, the role of policy-related uncertainty remains underexplored. The objective of this study is to examine the association between economic policy uncertainty (EPU) and mortality. Furthermore, we investigate whether changes in lifestyle behaviors are associated with EPU and may help shed light on the relationship between EPU and health outcomes. Methods: We utilize a mixed data sampling (MIDAS) framework to analyze US state-level data from 2009 to 2020. The model controls for unemployment, income, demographic characteristics, as well as state and year fixed effects. This approach enables the incorporation of high-frequency uncertainty measures to capture dynamic mortality responses. Results: The results indicate a statistically significant inverse association between EPU and total mortality. The association is negative across both genders, with a stronger effect observed among males. Across age cohorts, the retirement-age group exhibits the highest sensitivity. In terms of cause-specific mortality, EPU is positively associated with mortality from respiratory diseases and suicide, while it is negatively associated with mortality from homicide, accidents, and pneumonia and influenza. In addition, EPU is significantly associated with a lower prevalence of current drinking and smoking, a higher likelihood of being in a healthy weight range, improved self-reported health, and reduced time spent traveling. Conclusions: The findings suggest heterogeneous associations between EPU and mortality outcomes across demographic groups and causes of death, highlighting the complex and multifaceted nature of the relationship between policy-related uncertainty and population health rather than a uniform response across health outcomes. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations in the United States. Prevention strategies are recommended to mitigate severe RSV outcomes. In addition to identifying potential coverage gaps, preventative administration timing is important for estimating product effectiveness. This study characterized administration timing of maternal and infant immunization against RSV across the United States during the 2024–2025 RSV season. Methods: A retrospective cross-sectional study was conducted using administrative claims of a commercially insured population from Kythera Labs. Pregnant individuals who received RSVpreF vaccine and infants who received nirsevimab were included. The seasonal cohort included infants born during the RSV season, while infants born from April to September were considered as the catch-up cohort. Baseline characteristics and calendar month and age at immunization (gestational age for RSVpreF) were evaluated. Results: Overall, 37,686 (71.9%) of maternal vaccinations were administered at 32–34 gestational weeks and 92.7% of all vaccinations occurred ≥14 days before delivery. Among infants who received nirsevimab, 34.8% of the seasonal cohort were immunized within 1 week of birth and 33.4% of the catch-up cohort were immunized in October 2024. Conclusions: Most maternal RSVpreF vaccinations occurred early in the recommended eligible gestational age window, while only approximately one-third of infants received nirsevimab during the first week of life or at the beginning of the RSV season. These findings highlight the importance of timely administration of RSV preventives. They further demonstrate that immunization timing should be incorporated into evaluation of the effectiveness and population level impact of RSV prevention programs. Full article

Objectives: Changes in public policy are eroding vaccine confidence. Previously accepted peer-reviewed evidence around vaccination and developmental outcomes for children is being questioned. Robust, methodologically sound safety data are more needed than ever to maintain consumer confidence. Establishing further safety data on infant health, development, and allergies after COVID-19 and influenza vaccination in pregnancy may improve confidence and acceptance. Methods: This is a state-wide multi-centre prospective cohort study conducted as a sub-study of the Generation Victoria birth cohort. It will examine the risk difference for infant health, developmental, and allergy outcomes between groups of mother–baby pairs who will be examined according to exposure (vaccination against a respiratory virus during pregnancy) and comparator (no vaccination against a respiratory virus). Results: Data contributing to the analysis include GenV-collected developmental, health, and allergy outcomes to 12 months of age, as well as data from state-wide linked datasets. Conclusions: This linked-data longitudinal study will provide information on health, allergy, and developmental outcomes for infants in the first year of life after influenza and COVID-19 vaccination during pregnancy. Implications for Public Health: The reporting of developmental data will be a new contribution to knowledge around outcomes after vaccination during pregnancy. Full article

Humming is a ubiquitous yet understudied form of human vocalisation that may play a role in regulating internal bodily states during early development. Unlike speech or singing with lyrics, humming consists of continuous, semantically unstructured vocal sounds produced with a closed mouth. It generates sustained sonic, vibratory and respiratory patterns that engage interoceptive and autonomic processes. This paper explores the hypothesis that humming critically contributes to homeostatic regulation in caregiver–infant interaction. Drawing on research in developmental psychology, perinatal care and vocal practice, we propose that humming provides a simple mechanism through which caregivers may scaffold the infant’s developing interoceptive awareness, paving the way to subsequent social cognition abilities. Through slow rhythmic breathing, chest and cranial vibration, and temporally structured vocal phrasing, humming may influence cardio-respiratory rhythms and support autonomic balance while also organising moments of social engagement. Evidence is gathered from studies of maternal humming during kangaroo care with preterm infants, showing that these vocalisations can stabilise physiological parameters and invite infant vocal participation. We argue that humming may function as an embodied, interoceptive form of co-regulation for both infants and caregivers, linking physiological homeostasis with early communicative exchange. Full article

Contactless vital signs monitoring is becoming increasingly relevant in scenarios where conventional sensors are impractical or not recommended. In this manuscript, a radar-based contactless system for the joint reconstruction of phonocardiogram (PCG) waveforms and cardiac state segmentation is illustrated. The proposed method exploits a self-attention one-dimensional (1D) U-Net fed by a pre-processed radar-derived input to estimate a PCG-like waveform, its envelope, and the four main cardiac phases: S1, systole, S2, and diastole. The accuracy of our method has been assessed on a public synchronized radar–PCG dataset acquired by means of a 24 GHz Doppler radar and a digital stethoscope. On the test subset, the proposed model achieved a 13.4885 dB reduction in log-spectral distance relative to the radar input signal, indicating a marked improvement in waveform fidelity. Segmentation performance also improved, with Micro-${\mathrm{F}}_1$ increasing from 74.41% to 84.17% and Macro-${\mathrm{F}}_1$ from 68.40% to 80.43% on average. Experimental results demonstrated the viability of real-time low-power embedded hardware deployment for contactless auscultation and continuous cardiac monitoring applications. The findings confirm that respiratory interference and low-amplitude signals complicate S2 detection, especially when exacerbated by subject motion. Full article

This manuscript examines the total toxic releases from electric utilities and mining facilities in the United States in 2020, focusing on their relationships with human health outcomes. The research highlights the adverse effects of air and water pollution, linking exposure to toxic emissions to several health issues, such as low birth weight, respiratory and cardiovascular diseases, and cancers. It underscores the disproportionate impact of these pollutants on low-income and minority populations. This research project utilizes two sets of data: (1) environmental data, the EPA’s Toxic Release Inventory (TRI) data that records total emissions of all-electric and mining facilities, and (2) health data, the PLACES health data. The results of this study show that census tracts exposed to higher toxic releases are expected to have worse health outcomes. The coefficients for total toxic release indicate that higher toxic release corresponds to a higher rate of cancer, chronic obstructive pulmonary disease (COPD), diabetes, kidney diseases, arthritis, cardiac heart disorders (CHD), and stroke. Except for diabetes and kidney diseases, the associations are statistically significant. The analysis indicates the need for comprehensive public health strategies to mitigate the risks posed by toxic releases, particularly for vulnerable communities. Full article

Introduction: Chinese seniors in North America represent a growing population, and Traditional Chinese medicine (TCM) continues to play an important role in their health practices; however, TCM use has not been comprehensively synthesized from an immigrant perspective in North America. The purpose of this scoping review is to explore the use of TCM by Chinese seniors in Canada and the United States of America (USA). Methods: This scoping review is written in accordance with PRISMA guidelines. PubMed, PsycINFO, CINAHL, AgeLine, ERIC, ProQuest, Nursing and Allied Health Database, PsycARTICLES, Sociology Database, and Education Research Complete were selected for the literature search, which was conducted in August 2025. Articles were included if they investigated the use of any form of TCM among Chinese seniors aged 65 years or older living in the USA and Canada, and were published in an English-language peer-reviewed journal. Results: Twenty-four studies were included in this review, with a total sample size of 7288. The findings indicated that, in the majority of the included studies, over half of the Chinese seniors used some form of TCM. TCM therapies included over-the-counter herbal products, TCM-based physical activities, TCM practitioner consulting, and TCM food practices and therapies. Use of TCM among Chinese seniors was related to musculoskeletal symptoms, cardiovascular symptoms, mental health, severe acute respiratory syndrome prevention, cancer screening, and oral health. Chinese seniors tend to integrate TCM with Western medicine in their healthcare practices. Several factors from individual, familial, and community levels influenced Chinese seniors’ use of TCM. Conclusions: Future research should investigate the integration of TCM with Western healthcare, the training of healthcare providers to improve their understanding of TCM, and the underlying mechanisms of TCM products. Full article

Piezo-driven active vibrating mesh devices are increasingly being used across a variety of applications. These include respiratory drug delivery and inhaled vaccine delivery, as well as multiple industrial processes such as coating, improving the efficiency of chemical reactions through mixing and 3D printing in low gravity. The adoption of this technology shall continue to rise as its reliability, the scalability of manufacturing, and the functionalisation of active vibrating mesh assemblies advance. Early-stage design and development of these complex electromechanical devices can be a costly and time-consuming process. Finite element analysis (FEA) allows us to simulate these devices and analyse their input parameter interactions and design optimisation without the expense of costly prototyping, while also reducing time to market. A review of the state of the art in FEA techniques has identified piezoelectric coupling, modal analysis, harmonic response, fluid–structure interaction, acoustic–structural coupling, and thermal analysis as the recommended simulation tools for dry (no liquid present) and wet (with liquid present) state simulations. Theoretical and empirical validation techniques have given us confidence in these tools for vibrating mesh device design iterations and optimisation. This review summarises the current state of the art for the application of these techniques in the development of active vibrating mesh devices intended for use in respiratory drug delivery. Full article

The prevalence of bla_KPC-carrying Klebsiella pneumoniae poses a significant clinical challenge, yet its systematic metabolic adaptations remain poorly understood. We employed an engineered K. pneumoniae (pACYC184/KPC-2) model and UHPLC-QE-Orbitrap-MS-based untargeted metabolomics to characterize metabolic shifts under steady-state and antibiotic-stressed conditions. OPLS-DA revealed profound metabolic divergence induced by KPC-2. At steady state, the 96 differential metabolites (30 up-regulated, 66 down-regulated) indicated enhanced cell membrane and nucleotide metabolism but suppressed carbohydrate and amino acid pathways. Under antibiotic challenge, the 90 differential metabolites (49 up-regulated, 41 down-regulated) indicated activated porphyrin, purine, and aromatic amino acid metabolism, alongside inhibited respiratory chain and lipid oxidative processes. NADH, FAD, and UDP were identified as core regulatory nodes. Our findings suggest that KPC-2 is associated with systematic metabolic rewiring that may facilitate bacterial survival and adaptation. These metabolic signatures provide novel insights into the putative physiological cost of resistance and potential therapeutic targets. Full article

Coronavirus Disease 2019 (COVID-19) and other lower respiratory tract diseases (LRTDs), including bacterial pneumonia and acute respiratory distress syndrome, share overlapping clinical features but arise from distinct pathophysiological mechanisms. The molecular signatures that distinguish these diseases remain insufficiently characterized in African populations, where genetic background, endemic infections, and environmental exposures may substantially shape immune responses. We integrated spatially resolved single-cell transcriptomic profiles from lung autopsy specimens of 30 Malawian patients, including 10 with COVID-19, 12 with other LRTDs, and 8 non-LRTD controls. In total, 61,391 cells representing 15 cell types and 36,602 gene expression features were analyzed. Using an integrated machine learning framework that combined nine feature-ranking algorithms with incremental feature selection, we identified potential molecular signatures that could discriminate among disease states within this cohort. The optimal classification models achieved weighted F1 scores greater than 0.94, demonstrating a robust capacity to differentiate COVID-19 from other LRTDs in our dataset. Notably, the macrophage-associated state in COVID-19 was dominated by an IFN-γ response with upregulation of CD163 and HLA-DQA2, contrasting sharply with the type I/III interferon signature reported in European cohorts. In addition, we observed cell-type-specific COVID-19 signatures, including downregulation of CAV1 in AT1 cells, consistent with epithelial damage; dysregulation of SFTPC in AT2 cells, suggesting surfactant dysfunction; and upregulation of NFKBIA in neutrophils, indicating altered inflammatory regulation. Gene Ontology enrichment further revealed universal disruption of protein synthesis machinery, along with cell-type-specific alterations in immune activation, epithelial repair, and inflammatory signaling pathways. Full article