Vital Signs as Predictors of Oxygen Requirements in COVID-19 Outpatients: The Development of a Streamlined Risk Score.

BACKGROUND: With COVID-19 becoming a common disease, primary care facilities such as clinics are required to efficiently triage patients at high risk of severe illness within the constraints of limited medical resources. However, existing COVID-19 severity risk scores require detailed medical history assessments, such as evaluating the severity of pneumonia via chest CT and accounting for past and comorbid conditions. Therefore, they may not be suitable for practical use in clinical settings with limited medical resources, including personnel and equipment. PURPOSE:  The goal is to identify key variables that predict the need for oxygen therapy in COVID-19 patients and develop a simplified clinical risk score based solely on vital signs to predict oxygen requirements. PATIENTS AND METHODS: A retrospective observational study of 584 outpatients with COVID-19 confirmed by polymerase chain reaction test visited Sasebo Chuo Hospital between April 28, 2022, and August 18, 2022. Analyses were conducted after adjustment for background factors of age and sex with propensity score matching. We used the Fisher test for nominal variables and the Kruskal-Wallis test for continuous variables. RESULTS: After adjusting for age and sex, several factors significantly correlated with the need for oxygen within seven days including body temperature (p < 0.001), respiratory rate (p = 0.007), SpO2 (p < 0.001), and the detection of pneumonia on CT scans (p = 0.032). The area under the receiver-operating characteristic curve for the risk score based on these vital signs and CT was 0.947 (95% confidence interval: 0.911-0.982). The risk score based solely on vital signs was 0.937 (0.900-0.974), demonstrating the ability to predict oxygen administration with no significant differences. CONCLUSIONS: Body temperature, advanced age, increased respiratory rate, decreased SpO2, and the presence of pneumonia on CT scans were significant predictors of oxygen need within seven days among the study participants. The risk score, based solely on vital signs, effectively and simply assesses the likelihood of requiring oxygen therapy within seven days with high accuracy. The risk score, which utilizes only age and vital signs and does not require a detailed patient history or CT scans, could streamline hospital referral processes for admissions.

Comparing the Efficacy of Foot Reflexology and Benson's Relaxation on Anxiety and Physiologic Parameters After Cesarean Surgery.

OBJECTIVE: To compare the efficacy of foot reflexology and Benson's relaxation on anxiety and physiologic parameters after cesarean surgery. DESIGN: Randomized controlled trial with three parallel arms. SETTING: Gynecologic ward of the Persian Gulf Martyrs Hospital in Bushehr, Iran, in 2020. PARTICIPANTS AND INTERVENTIONS: Women undergoing cesarean surgery (n = 135) were selected by convenience sampling and divided via block randomization into three groups of foot reflexology, Benson's relaxation interventions, and control group (n = 45 in each group). Interventions were performed 2 hours after cesarean surgery. MEASUREMENTS: Spielberger's State-Trait Anxiety Inventory, mercury sphygmomanometer, and pulse oximeter were used to collect the data. Anxiety was measured before and 30 minutes after the intervention. Physiologic parameters were measured before the intervention and immediately, 30 minutes, and 60 minutes after the intervention. Data were analyzed using inferential statistics. RESULTS: The mean score of situational anxiety after the intervention was significantly lower than before the intervention in the reflexology (t = 5.66, 11.14; 95% confidence interval [CI] [5.66, 11.14]) and Benson's relaxation groups (t = 7.362; 95% CI [5.91, 9.85]). However, changes in the control group were not significant (t = 1.674; 95% CI [-0.24, 2.55]). Decreases in anxiety scores were similar in the two intervention groups. After intervention, in most measurement times, respiratory rate and pulse rate decreased in the two intervention groups compared to the control group, and arterial oxygen saturation and systolic blood pressure increased. CONCLUSION: Considering the effect of both interventions on decreasing anxiety and improving most physiologic parameters, it seems that foot reflexology and Benson's relaxation can be recommended after cesarean surgery.

Comparison emergence of sedation, using dexmedetomidine and remimazolam, in spinal anaesthesia - double blinded randomized controlled trial.

Background: Continuous intravenous infusion of remimazolam may be suitable for sedation in patients undergoing regional anaesthesia. However, there have been no studies comparing remimazolam and dexmedetomidine for this purpose. This study compared emergence from sedation between dexmedetomidine and remimazolam following continuous intravenous infusion in patients undergoing spinal anaesthesia. Methods: This double-blinded, randomised controlled trial assessed the sedative effects of dexmedetomidine and remimazolam. Following spinal anaesthesia, patients were sedated using continuous intravenous infusion of either dexmedetomidine (D group) or remimazolam (R group).The D group received dexmedetomidine administered at 6 mL/kg/h (6 µg/kg/h) for 10 minutes, followed by 1 mL/kg/h (1 µg/kg/h). The R group received remimazolam administered at 6 mL/kg/h (6 mg/kg/h) for 10 minutes, followed by 1 mL/kg/h (1 mg/kg/h). Sedation levels were evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale. The time to reach MOAA/S ≤ 3 from the start of drug infusion and the time to reach MOAA/S = 5 from the end of infusion were recorded. Hemodynamic parameters and respiratory rate were also monitored. Results: The R group reached MOAA/S ≤ 3 significantly faster than the D group during induction of sedation (4 ± 1 minutes and 11 ± 3 minutes, respectively, p < 0.001). The R group also reached MOAA/S = 5 significantly faster than the D group during emergence from sedation (11 ± 3 minutes and 16 ± 5 minutes, respectively, p < 0.001). Both groups maintained stable hemodynamic parameters and respiratory rate without any significant differences, although the mean heart rate was significantly lower in the D group than in the R group after the start of infusion. Conclusion: Remimazolam demonstrated significantly faster induction of and emergence from sedation compared to dexmedetomidine, with no significant differences in haemodynamics or respiratory depression.

Agreement between Vital Signs Measured Using Mat-Type Noncontact Sensors and Those from Conventional Clinical Assessment.

Vital signs are crucial for assessing the condition of a patient and detecting early symptom deterioration. Noncontact sensor technology has been developed to take vital measurements with minimal burden. This study evaluated the accuracy of a mat-type noncontact sensor in measuring respiratory and pulse rates in patients with cardiovascular diseases compared to conventional methods. Forty-eight hospitalized patients were included; a mat-type sensor was used to measure their respiratory and pulse rates during bed rest. Differences between mat-type sensors and conventional methods were assessed using the Bland-Altman analysis. The mean difference in respiratory rate was 1.9 breaths/min (limits of agreement (LOA): -4.5 to 8.3 breaths/min), and proportional bias existed with significance (r = 0.63, p < 0.05). For pulse rate, the mean difference was -2.0 beats/min (LOA: -23.0 to 19.0 beats/min) when compared to blood pressure devices and 0.01 beats/min (LOA: -11.4 to 11.4 beats/min) when compared to 24-h Holter electrocardiography. The proportional bias was significant for both comparisons (r = 0.49, p < 0.05; r = 0.52, p < 0.05). These were considered clinically acceptable because there was no tendency to misjudge abnormal values as normal. The mat-type noncontact sensor demonstrated sufficient accuracy to serve as an alternative to conventional assessments, providing long-term monitoring of vital signs in clinical settings.

Thermal Comfort of Nelore Cattle (Bos indicus) Managed in Silvopastoral and Traditional Systems Associated with Rumination in a Humid Tropical Environment in the Eastern Amazon, Brazil.

The objective of this study was to evaluate the thermal comfort of Nelore cattle (Bos indicus) managed in silvopastoral and traditional systems associated with rumination behavior in a humid tropical environment in the Eastern Amazon, Brazil. The study was carried out on a rural property in Mojuí dos Campos, Pará, Brazil, during the transition period of the year, from June to July 2023. Over these two months, six consecutive data collection days were held. We selected 20 clinically healthy non-castrated male Nelore cattle, aged between 18 and 20 months, with an average weight of 250 kg and body condition score of 3.5 (1-5). These animals were randomly divided into two groups: traditional system (TS) and silvopastoral system (SS). The physiological variables evaluated included RR, RT and BST. The variables were analyzed using the linear mixed model. For agrometeorological variables, higher values were observed between 10:00 a.m. (33 °C) and 6:00 p.m. (30 °C), with the highest temperature observed at 4:00 p.m. (40 °C). The RR showed interactions (p = 0.0214) between systems and times; in general, higher RR were obtained in the Traditional. The animals' RT showed no significant difference (p < 0.05) between the production systems, but there was a statistically significant difference in relation to the time of collection (p < 0.0001). In the BGHI, it was possible to observe that there was mild stress in the period from 22:00 at night to 6:00 in the morning and moderate stress in the period of greatest increase in temperature, from 10:00 in the morning to 18:00 at night. BST showed no statistical difference between the regions studied or between the SP (35.6 °C) and TS (36.25 °C) systems. RT in the TS showed a positive correlation with AT (r = 0.31507; p = 0.0477). RT in the SP showed a positive correlation with THI (r = 35583; p = 0.0242). On the other hand, RT in the SP (r = 0.42873; p = 0.0058) and ST (r = 0.51015; p = 0.0008) showed a positive correlation with BGHI. RR in the TS showed a positive correlation with BGHI (r = 0.44908; p = 0.0037). The greatest amounts of rumination were carried out by animals in the SP system, generally ruminating lying down (p < 0.05). With regard to rumination behavior in the morning and afternoon, there were higher numbers of WS and LD in the TS (p > 0.05). Most of the time, the cattle were LD during the morning and afternoon shifts, and at night and dawn they were WS in the TS. Therefore, the SP offers more thermal comfort advantages compared to the TS system.

Engagement-free and Contactless Bed Occupancy and Vital Signs Monitoring.

This paper presents the design and evaluation of an engagement-free and contactless vital signs and occupancy monitoring system called BedDot. While many existing works demonstrated contactless vital signs estimation, they do not address the practical challenge of environment noises, online bed occupancy detection and data quality assessment in the realworld environment. This work presents a robust signal quality assessment algorithm consisting of three parts: bed occupancy detection, movement detection, and heartbeat detection, to identify high-quality data. It also presents a series of innovative vital signs estimation algorithms that leverage the advanced signal processing and Bayesian theorem for contactless heart rate (HR), respiration rate (RR), and inter-beat interval (IBI) estimation. The experimental results demonstrate that BedDot achieves over 99% accuracy for bed occupancy detection, and MAE of 1.38 BPM, 1.54 BPM, and 24.84 ms for HR, RR, and IBI estimation, respectively, compared with an FDA-approved device. The BedDot system has been extensively tested with data collected from 75 subjects for more than 80 hours under different conditions, demonstrating its generalizability across different people and environments.

Respiratory rate measurement by pressure variation in the high flow nasal cannula-system in healthy volunteers.

PURPOSE: This study tests if the pressure variation in the HFNC-system may allow for monitoring of respiratory rate and the pressure difference during breathing may be a marker of respiratory effort. METHODS: A HFNC system (Fisher & Paykel Optiflow Thrive 950) was modified by adding a GE Healthcare D-Lite spirometry sensor attached to a respiratory module and a pressure transducer. Participants were instructed to breathe regularly, quickly and slowly during 4 different conditions (HFNC flow 30 l/min and 70 l/min and with an open and closed mouth). Respiratory rate was counted based on pressure variation shown on the monitor graphs and compared with the count by observation of the participant. The pressure difference between inspiration and expiration was tested for correlation with the respiratory rate, as a surrogate marker for respiratory effort. RESULTS: Twenty five participants were included in this study. False detection of apnea in pressure-based measurements occurred in 10% and 11% of the measurements with open mouth position at 30 l/min and 70 l/min HFNC-flow, respectively, but not with a closed mouth. The 95% Limits of Agreement were - 1.85;1.91, -13.72;9,88, -2.25;2.47, -30.32;19.93 for the conditions of 30 l/min -closed mouth, 30 l/min - open mouth, 70 l/min - closed mouth and 70 l/min - open mouth, respectively. There was a correlation between pressure difference and respiratory effort, except for the condition of 30 l/min with open mouth. CONCLUSIONS: The pressure variation in the HFNC system allows for respiratory rate and effort monitoring, but requires further development to increase precision. TRIAL REGISTRATION: ClinicalTrials.gov (NCT05991843).

Energy-Efficient PPG-Based Respiratory Rate Estimation Using Spiking Neural Networks.

Respiratory rate (RR) is a vital indicator for assessing the bodily functions and health status of patients. RR is a prominent parameter in the field of biomedical signal processing and is strongly associated with other vital signs such as blood pressure, heart rate, and heart rate variability. Various physiological signals, such as photoplethysmogram (PPG) signals, are used to extract respiratory information. RR is also estimated by detecting peak patterns and cycles in the signals through signal processing and deep-learning approaches. In this study, we propose an end-to-end RR estimation approach based on a third-generation artificial neural network model-spiking neural network. The proposed model employs PPG segments as inputs, and directly converts them into sequential spike events. This design aims to reduce information loss during the conversion of the input data into spike events. In addition, we use feedback-based integrate-and-fire neurons as the activation functions, which effectively transmit temporal information. The network is evaluated using the BIDMC respiratory dataset with three different window sizes (16, 32, and 64 s). The proposed model achieves mean absolute errors of 1.37 ± 0.04, 1.23 ± 0.03, and 1.15 ± 0.07 for the 16, 32, and 64 s window sizes, respectively. Furthermore, it demonstrates superior energy efficiency compared with other deep learning models. This study demonstrates the potential of the spiking neural networks for RR monitoring, offering a novel approach for RR estimation from the PPG signal.

Assessment of respiratory rate monitoring in the emergency department.

Objectives: This study aimed to compare the different respiratory rate (RR) monitoring methods used in the emergency department (ED): manual documentation, telemetry, and capnography. Methods: This is a retrospective study using recorded patient monitoring data. The study population includes patients who presented to a tertiary care ED between January 2020 and December 2022. Inclusion and exclusion criteria were patients with simultaneous recorded RR data from all three methods and less than 10 min of recording, respectively. Linear regression and Bland-Altman analysis were performed between different methods. Results: A total of 351 patient encounters met study criteria. Linear regression yielded an R-value of 0.06 (95% confidence interval [CI] 0.00-0.12) between manual documentation and telemetry, 0.07 (95% CI 0.01-0.13) between manual documentation and capnography, and 0.82 (95% CI 0.79-0.85) between telemetry and capnography. The Bland-Altman analysis yielded a bias of -0.8 (95% limits of agreement [LOA] -12.2 to 10.6) between manual documentation and telemetry, bias of -0.6 (95% LOA -13.5 to 12.3) between manual documentation and capnography, and bias of 0.2 (95% LOA -6.2 to 6.6) between telemetry and capnography. Conclusion: There is a poor correlation between manual documentation and both automated methods, while there is relatively good agreement between the automated methods. This finding highlights the need to further investigate the methodology used by the ED staff in monitoring and documenting RR and ways to improve its reliability given that many important clinical decisions are made based on these assessments.

The utility of the respiratory rate-oxygenation index as a predictor of treatment response in dogs receiving high-flow nasal cannula oxygen therapy.

Objective: This study aims to evaluate the respiratory rate-oxygenation index (ROX) and the ratio of pulse oximetry saturation (SpO2) to the fraction of inspired oxygen (FiO2) (SpO2/FiO2, [SF]) to determine whether these indices are predictive of outcome in dogs receiving high-flow nasal cannula oxygen therapy (HFNOT). Design: This is a prospective observational study. Setting: This study was carried out at two university teaching hospitals. Animals: In total, 88 dogs treated with HFNOT for hypoxemic respiratory failure due to various pulmonary diseases were selected. Measurements and main results: The ROX index was defined as the SF divided by the respiratory rate (RR). ROX and SF were calculated at baseline and for each hour of HFNOT. The overall success rate of HFNOT was 38% (N = 33/88). Variables predicting HFNOT success were determined using logistic regression, and the predictive power of each variable was assessed using the area under the receiver operating curve (AUC). ROX and SF were adequately predictive of HFNOT success when averaged over 0-16 h of treatment, with similar AUCs of 0.72 (95% confidence interval [CI] 0.60-0.83) and 0.77 (95% CI 0.66-0.87), respectively (p < 0.05). SF showed acceptable discriminatory power in predicting HFNOT outcome at 7 h, with an AUC of 0.77 (95% CI 0.61-0.93, p = 0.013), and the optimal cutoff for predicting HFNC failure at 7 h was SF ≤ 191 (sensitivity 83% and specificity 76%). Conclusion: These indices were easily obtained in dogs undergoing HFNOT. The results suggest that ROX and SF may have clinical utility in predicting the outcomes of dogs on HFNOT. Future studies are warranted to confirm these findings in a larger number of dogs in specific disease populations.

Parasternal Intercostal Muscle Thickness Fraction (PICTF%): Ultrasound a New Tool for Weaning Prediction?

How to cite this article: Bhattacharya D, Esquinas AM, Mandal M. Parasternal Intercostal Muscle Thickness Fraction (PICTF%): Ultrasound a New Tool for Weaning Prediction? Indian J Crit Care Med 2024;28(4):404.

A Wearable Sandwich Heterostructure Multimode Fiber Optic Microbend Sensor for Vital Signal Monitoring.

This work proposes a highly sensitive sandwich heterostructure multimode optical fiber microbend sensor for heart rate (HR), respiratory rate (RR), and ballistocardiography (BCG) monitoring, which is fabricated by combining a sandwich heterostructure multimode fiber Mach-Zehnder interferometer (SHMF-MZI) with a microbend deformer. The parameters of the SHMF-MZI sensor and the microbend deformer were analyzed and optimized in detail, and then the new encapsulated method of the wearable device was put forward. The proposed wearable sensor could greatly enhance the response to the HR signal. The performances for HR, RR, and BCG monitoring were as good as those of the medically approved commercial monitors. The sensor has the advantages of high sensitivity, easy fabrication, and good stability, providing the potential for application in the field of daily supervision and health monitoring.

Unobtrusive Sensors for Synchronous Monitoring of Different Breathing Parameters in Care Environments.

Respiratory problems are common amongst older people. The rapid increase in the ageing population has led to a need for developing technologies that can monitor such conditions unobtrusively. This paper presents a novel study that investigates Wi-Fi and ultra-wideband (UWB) antenna sensors to simultaneously monitor two different breathing parameters: respiratory rate, and exhaled breath. Experiments were carried out with two subjects undergoing three breathing cases in breaths per minute (BPM): (1) slow breathing (12 BPM), (2) moderate breathing (20 BPM), and (3) fast breathing (28 BPM). Respiratory rates were captured by Wi-Fi sensors, and the data were processed to extract the respiration rates and compared with a metronome that controlled the subjects' breathing. On the other hand, exhaled breath data were captured by a UWB antenna using a vector network analyser (VNA). Corresponding reflection coefficient data (S11) were obtained from the subjects at the time of exhalation and compared with S11 in free space. The exhaled breath data from the UWB antenna were compared with relative humidity, which was measured with a digital psychrometer during the breathing exercises to determine whether a correlation existed between the exhaled breath's water vapour content and recorded S11 data. Finally, captured respiratory rate and exhaled breath data from the antenna sensors were compared to determine whether a correlation existed between the two parameters. The results showed that the antenna sensors were capable of capturing both parameters simultaneously. However, it was found that the two parameters were uncorrelated and independent of one another.

The Influence of Noise Level on the Stress Response of Hospitalized Cats.

The study aimed to investigate the impact of noise levels in the hospital environment on the stress experienced by hospitalized cats undergoing elective ovariohysterectomy surgery. A total of 33 domestic female cats were included in the study, divided into four groups: a control group (CG) and three experimental groups based on ward noise levels: G1 (Quiet, <60 dB), G2 (Medium, between 60 and 85 dB), and G3 (Noisy, >85 dB). Behavioral assessments, respiratory rate (RR), and plasma cortisol levels ([Cort]p) were measured as indicators of stress. A composite measure of stress, termed the final stress value (FSV), was calculated by summing scores across various behavioral categories. Data collection occurred at three time points: immediately following surgery (T1), and at 2 h (T2) and 3 h (T3) post-surgery. FSV and RR were assessed at all three time points (T1, T2, and T3), while [Cort]p levels were measured at T1 and T3. The study observed that the median values of FSV, RR, and [Cort]p tended to increase with both higher noise levels and longer exposure durations to noise. Significant differences in RR were found between group pairs G1G2 at T1 (|D| = 0.63 < cut-off = 0.98), and G2G3 at T2 (|D| = 0.69 < cut-off = 0.97). Regarding [Cort]p, significant differences were noted between the CGG1 group pair at T0 (p < 0.01), and T3 (p = 0.03). Furthermore, an excellent Spearman correlation coefficient (rho = 0.91) was found between FSV and RR, indicating that RR can serve as an effective tool for assessing stress levels in cats. The findings of this study provide valuable insights into the welfare of cats in a hospital environment and support the scientific validity of existing recommendations aimed at improving their well-being. Specifically, the study underscores the importance of minimizing noise levels in hospitals as a means to reduce stress in cats. This conclusion aligns with existing guidelines and recommendations for enhancing the welfare of hospitalized cats.

Respiratory Responses to Single Oral Administration of Taurine in Sprague-Dawley Rats.

Taurine is a nonessential amino acid that has been increasingly consumed due to its various beneficial biological effects. Excessive taurine intake has been linked to the positive regulation of inflammatory responses and endoplasmic reticulum stress through the modulation of intracellular calcium levels. However, research on the potential adverse effects of taurine consumption on the respiratory system is limited. To address this, we investigated the respiratory responses of 6-week-old male Sprague-Dawley rats to taurine administered orally at 0, 100, 200, and 400 mg/kg. Respiratory rate, tidal volume, and minute volume were monitored in accordance with the International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Harmonized Tripartite Guideline S7A for Safety Pharmacology Studies for Human Pharmaceuticals. We found that taurine administration did not significantly alter respiratory rate or tidal volume; however, a significant increase in minute volume was observed 6 h after administration of 200 mg/kg taurine.

Association between early manifestations of infection or sepsis and prognosis in a high complexity hospital in the city of Medellín.

OBJECTIVE: To identify the first symptoms and signs of patients with suspected infection or sepsis and their association with the composite outcome of admission to the Intensive Care Unit (ICU) or mortality. DESIGN: Prospective cohort study between June 2019 and March 2020. SETTING: Hospital Universitario San Vicente Fundación, Colombia. PATIENTS: Over 18 years of age with suspicion or confirmation of sepsis, which required hospitalization. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Symptoms and signs associated with infection, with their time of evolution, specified in the study. RESULTS: From 1005 eligible patients, 261 were included. After multivariable adjustment with a logistic regression model, the main factors for ICU admission or mortality were heart rate (OR 1.04 with 95% CI 1.04-3.7), respiratory rate (OR 1.19 with 95% CI 1.0-1.4) and capillary refill time (OR 3.4 with 95% CI 1.9-6.1). CONCLUSIONS: Heart rate, respiratory rate, and capillary refill may behave as early predictors of ICU admission and mortality in cases of sepsis.

Respiratory rate monitoring in ICU patients and healthy volunteers using electrical impedance tomography: a validation study.

Objective. The respiratory rate (RR) is considered one of the most informative vital signals. A well-validated standard for RR measurement in mechanically ventilated patient is capnography; a noninvasive technique for expiratory CO2measurements. Reliable RR measurements in spontaneously breathing patients remains a challenge as continuous mainstream capnography measurements are not available. This study aimed to assess the accuracy of RR measurement using electrical impedance tomography (EIT) in healthy volunteers and intensive care unit (ICU) patients on mechanical ventilation and spontaneously breathing post-extubation. Comparator methods included RR derived from both capnography and bioimpedance electrocardiogram (ECG) measurements.Approach. Twenty healthy volunteers wore an EIT belt and ECG electrodes while breathing through a capnometer within a 10-40 breaths per minute (BPM) range. Nineteen ICU patients underwent similar measurements during pressure support ventilation and spontaneously breathing after extubation from mechanical ventilation. Stable periods with regular breathing and no artefacts were selected, and agreement between measurement methods was assessed using Bland-Altman analysis for repeated measurements.Main result. Bland-Altman analysis revealed a bias less than 0.2 BPM, with tight limits of agreement (LOA) ±1.5 BPM in healthy volunteers and ventilated ICU patients when comparing EIT to capnography. Spontaneously breathing ICU patients had wider LOA (±2.5 BPM) when comparing EIT to ECG bioimpedance, but gold standard comparison was unavailable. RR measurements were stable for 91% of the time for capnography, 68% for EIT, and 64% of the ECG bioimpedance signals. After extubation, the percentage of stable periods decreased to 48% for EIT signals and to 55% for ECG bioimpedance.Significance. In periods of stable breathing, EIT demonstrated excellent RR measurement accuracy in healthy volunteers and ICU patients. However, stability of both EIT and ECG bioimpedance RR measurements declined in spontaneously breathing patients to approximately 50% of the time.

Mitochondrial coding genes mediate insecticide tolerance in the oriental fruit fly, Bactrocera dorsalis (Hendel).

The oriental fruit fly, Bactrocera dorsalis (Hendel), an invasive insect pest infesting fruits and vegetables, possesses a remarkable capacity for environmental adaptation. The investigation of behind mechanisms of the stress adaptability in B. dorsalis holds significantly practical relevance. Previous studies on the molecular mechanism underlying stress resistance in B. dorsalis have predominantly focused on nuclear-coding genes, with limited exploration on organelle-coding genes. In this study, we assessed alterations in the mitochondrial physiological parameters of B. dorsalis under exposure to malathion, avermectin, and beta-cypermethrin at LD50 dosages. The results showed that all three insecticides were capable of reducing mitochondrial complex IV activity and ATP content. Expression patterns of mitochondrial coding genes across different developmental stages, tissues and insecticide exposures were analyzed by RT-qPCR. The results revealed that these mitochondrial coding genes were expressed in various tissues and at different developmental stages. Particularly noteworthy, atp6, cox2, and cytb exhibited substantial up-regulation in response to malathion and avermectin treatment. Furthermore, RNAi-mediated knockdown of atp6 and cox2 resulted in the increased toxicity of malathion and avermectin against B. dorsalis, and cox2 silencing was also associated with the decreased complex IV activity. These findings suggest that atp6 and cox2 most likely play pivotal roles in mediating tolerance or resistance to malathion and avermectin in B. dorsalis. Our results provide novel insights into the role of mitochondrial coding genes in conferring tolerance to insecticides in B. dorsalis, with practical implications for controlling this pest in the field.

Advocating for Action: Exploring the Potential of Virtual Reality in Breathing Exercise - A Review of The Clinical Applications.

The emergence of virtual reality (VR) technologies is currently shaping the healthcare system and is now being employed in various healthcare interventions. Pulmonary rehabilitation remains one such area in which VR is currently thriving to ensure overall health and well-being. While the importance of these novel technologies is being primarily researched in pulmonary rehabilitation, especially over passive conventional breathing exercise training, there seems to be a limited number of studies that have comprehensively put together these findings. This study utilizes a scoping review methodology to review VR exercises in clinical settings related to pulmonary rehabilitation. To achieve this objective, three electronic databases (Web of Science, PubMed, and Cochrane Library) were searched using a formulated search string related to the research objective. Following the database search, a total of 236 references were retrieved and managed using the reference manager. The screening of references was conducted according to the PRISMA 2020 screening process, and their quality was assessed using the JBI checklist. Ultimately, a total of eight publications of high quality were selected for inclusion in the scoping review. The results of the synthesis validate the importance of utilizing VR in the context of breathing exercise in rehabilitation. The effectiveness and rapid development of VR breathing exercises are primarily attributed to the engaging and immersive experience they provide. The use of biofeedback and self-regulation techniques into VR exercise systems was also seen to have a notable impact on the effectiveness of the breathing exercise system.