Breathing Pattern Research Articles

Coupling of anticipation and breathing in expert flute performance: the influence of musical structure and practice

IntroductionIn this study, we examined the cognitive processes and physiological responses involved in learning a flute piece by the composer Charles Koechlin among musicians of different expertise levels. Participants performed the piece four times consecutively, with a 2-min practice interval between the first and the second trial.MethodsUsing data obtained from an eye tracker, respiratory sensors, and an audio recorder we assessed short-term improvement and the effect of musical structure and practice on key variables identified through a multivariate approach: eye-hand span (EHS), time index of EHS, thoracic and abdominal amplitude (breathing patterns) and pupil dilation.ResultsThe analysis revealed two main dimensions: one associated with EHS; and the other with embodied responses to music, closely linked to breathing patterns and pupil dilation. We found an effect of musical structure on all the variables studied, while the EHS improved with practice. Expert musicians demonstrated enhanced EHS and adapted their breathing patterns more effectively to the music's structure.DiscussionThese insights support the hypothesis of a coupling between anticipation and breathing, emphasizing the role of perceptual and embodied components in music reading and learning.

A study protocol for a randomized controlled trial on the effect of Surya Nadi Pranayama practice on cognitive abilities in school children

Abstract Background Surya Nadi Pranayama is a yogic breathing technique that involves controlled breathing through the right nostril. The study aims to evaluate the effects of the 20-min practice of Surya Nadi pranayama (4 weeks) on cognition among schoolchildren, comparing it to observing a normal breathing pattern. Methods A randomized control study design will be adopted for this study with 100 school children with 12–16 years of age, will be recruited. Subjects will be randomly divided into the study and control groups. The study group will be advised to practice Surya Nadi Pranayama (n = 50), whereas the control group (n = 50) will be asked to relax in a sitting posture between 9 am and 10 am, Monday to Friday, for 20 min daily over 30 days. Results A baseline and post-intervention assessment will be performed for all the subjects a day before and after the intervention. The primary outcome measures are visual reaction time and auditory reaction time. The secondary outcome is critical flicker fusion frequency. Conclusion The potential benefits of this yogic breathing technique and the findings of this research may contribute to the development of interventions aimed at improving cognitive functioning in school-aged children. The study is prospectively registered in the Clinical Trial Registry of India (CTRI/2024/05/067441).

Effects of Sports Bras and Breast Volume on Pulmonary System and Respiratory Symptom Responses to Exercise in Healthy Females.

This study assessed the individual and combined effects of sports bras and breast volume on pulmonary system and respiratory symptom responses to exercise in recreationally-active females. Twenty-three healthy females (18-27 y; bra sizes 32B-36DDD) were divided into small and large breast volume groups (SBV and LBV, respectively) around median volume (324 ml; mean ± SD SBV: 284 ± 38 ml vs. LBV: 560 ± 97 ml; p < 0.001, g = 3.84). Participants completed three 5-minute bouts of constant-load cycle exercise at 30, 60, and 90% of their peak power output while wearing a high-support sports bra, low-support sports bralette, or their own (self-selected) sports bra in randomized order. Measurements included ventilation, breathing pattern, respiratory pressures, diaphragm electromyogram (EMGdi), and ratings of perceived exertion (RPE), breathlessness (intensity and unpleasantness) and chest tightness due to bra. Compared to low-support and personal sports bras, the high-support sports bra evoked stronger sensations of restricted breathing and chest tightness ('slight' to 'moderate' restriction in n = 7 [30%] vs. n = 1 [4%] in low-support and personal bras; p = 0.014). There was, however, no evidence of greater concomitant inspiratory constraints, EMGdi, or inspiratory muscle pressure generation in either bra (all p > 0.05). Notably, LBV compared to SBV participants reported greater RPE (p = 0.037, ηp2 = 0.20), breathlessness intensity (p = 0.039, ηp2 = 0.20) and unpleasantness (p = 0.041; ηp2 = 0.19), which, in the setting of comparable pulmonary system responses to exercise, was likely driven by stronger perceived chest tightness and/or bra awareness in LBV participants. Despite evoking mild-to-moderately severe chest tightness due to bra during exercise - correctly fitted sports bras, whether low- or high-support, do not impose a physiological burden to the respiratory system and its response to mild-to-heavy intensity exercise in otherwise healthy females.

The effect of temperature and breathing pattern on the surface activity of ground squirrel pulmonary surfactant.

This study investigates how hibernation affects the surface activity of pulmonary surfactant with respect to temperature and breathing pattern. Surfactant was isolated from a hibernating species, the 13-lined ground squirrel, and a homeotherm, the rabbit, and analysed for biophysical properties on a constrained sessile drop surfactometer. The results showed that surfactant from ground squirrels reduced surface tension better at low temperatures, including when mimicking episodic breathing, as compared with rabbit surfactant. In addition, low temperature adaptation was also observed using only the hydrophobic components of surfactant from ground squirrels. Overall, the data support the conclusion that ground squirrel surfactant has adapted to maintain surface activity during low temperature episodic breathing patterns, and that temperature adaptation is maintained with the hydrophobic components of the surfactant.

Nanostructured NiS2-based flexible smart sensors for human respiration monitoring.

The growing demand for wearable healthcare devices has led to an urgent need for cost-effective, wireless and portable breath monitoring systems. However, it is essential to explore novel nanomaterials that combine state-of-the-art flexible sensors with high performance and sensing capabilities along with scalability and industrially acceptable processing. In this study, we demonstrate a highly efficient NiS2-based flexible capacitive sensor fabricated via a solution-processible route using a novel single-source precursor [Ni{S2P(OPr)2}2]. The developed sensor could precisely detect the human respiration rate and exhibit rapid responsiveness, exceptional sensitivity and selectivity at ambient temperatures, with an ultra-fast response and recovery. The device effectively differentiates the exhaled breath patterns including slow, fast, oral and nasal breath, as well as post-exercise breath rates. Moreover, the sensor shows outstanding bending stability, repeatability, reliable and robust sensing performance and is capable of contactless sensing. The sensor was further employed with a user-friendly wireless interface to facilitate smartphone-enabled real-time breath monitoring systems. This work opens up numerous avenues for cost-effective, sustainable and versatile sensors with potential applications for Internet of Things-based flexible and wearable electronics.This article is part of the theme issue 'Celebrating the 15th anniversary of the Royal Society Newton International Fellowship'.

Quantification of physiological effect of respiration on automated measurement of blood pressure among normotensive adult individuals.

Accurate blood pressure measurement necessitates meticulous methodology, as even minor variations like speaking or sitting can impact the readings. Additionally, respiration plays a role in blood pressure, exhibiting a dip during inhalation and a subsequent increase during exhalation. However, the influence of breathing patterns, duration, and rate on blood pressure remains largely unexplored. In this study, we have attempted to quantify the changes in blood pressure and heart rate (HR) of normotensive individuals while performing predefined respiratory patterns - slow, medium, and fast (respiratory rates of 5, 10, and 20/m, respectively). For each respiratory pattern, age-matched and gender-matched (18-40 years) volunteered normotensive individuals were selected as volunteers. Baseline readings were recorded and each volunteer was randomly allotted a respiratory pattern. The volunteers performed the assigned respiratory pattern while the BP and HR were recorded. A fall in both SBP and DBP was observed in all three patterns of respiration. There was no inter-pattern difference in the blood pressure change. A novel finding in our study was a trend of respiratory rate and HR - the change in HR linearly increased with a rise in respiratory rate difference. We also proposed a linear regression equation for this increase in HR with the increase in respiratory rate which was statistically significant. The findings suggest the decline in blood pressure is independent of the respiratory pattern employed. The study also demonstrates that the HR is a linear function of respiratory rate.

599. ASSESSMENT OF BREATHING MECHANICS IN OESOPHAGEAL CANCER SURVIVORS USING A 3D-MOTION CAPTURE SYSTEM

Abstract Background Traditional open surgery is characterised by an intercostal incision. The associated ribcage injury may precipitate the development of post-thoracotomy-related pain, with impaired respiratory muscle contraction, leading to compromised coughing and decreased lung volumes. These changes in breathing mechanics may precipitate pulmonary complications, occurring in up to 40% of the patients. There is however no data available on the long-term breathing function and its implications on the health-related quality of life following oesophagectomy. This proof-of-concept study aimed to objectively measure breathing movements using a 3D-motion capture system and to understand the impact of surgery on breathing patterns in oesophageal cancer survivors. Methods Oesophageal cancer survivors who were disease-free for at least 1 year postoperatively and healthy controls were included. Participants completed quality-of-life (QoL) questionnaires, including EORTC QLQ-C30, -OG25 and LASORS. Eighty-nine retroreflective markers were affixed to the participants' trunks to measure respiratory movements via the Vicon motion capture system during handheld spirometry performance. The highest spirometry value was recorded for the slow inspiratory (SIVC) and forced expiratory vital capacity (FEVC). Concurrent movement data was obtained from adjacent surface markers connected to the midpoint, allowing evaluation of the total volumetric movement of the trunk, and thoracic and abdominal contributions. Results Eighteen patients (median age 68) and 22 controls (median age 29) were included. Patients exhibited a significantly reduced SIVC alongside decreased chest movement contribution (median 2.4519 litres IQR 0.9270) compared to controls (median 3.1492 litres, IQR 1.8381) (p=0.013). Meanwhile, patients also had significantly lower FEVC with lower abdominal movement (median 1.5134 litres, IQR 0.7852) compared to controls (median 2.1263 litres, IQR 0.8740) (p=0.039). The QoL amongst patients was significantly worse for half of the EORTC domains, including physical functioning, fatigue, dyspnoea, pain and discomfort, and coughing (p&amp;lt;0.05). Additionally, the QoL of patients was consistently lower across all LASOR domains (p&amp;lt;0.05). Conclusion Current data showed lower spirometry parameters and breathing movements amongst oesophageal cancer survivors, suggestive of impaired breathing mechanics. Specifically, chest expansion was compromised during slow inhalation, while abdominal contraction was reduced during forced exhalation. These findings suggest restrictive changes in breathing mechanics

P01-13 Inhibition of lung surfactant function in vitro and breathing pattern changes in mice after exposure to plant protection products

P01-13 Inhibition of lung surfactant function in vitro and breathing pattern changes in mice after exposure to plant protection products

3M: Measuring Vital Signs With Markov-Gauss Model.

Measuring vital signs (VS) contained in the echoes is crucial to the analyses of breathing and heartbeat signals using medical radar. Although many advanced signal processing algorithms have been developed for radar-based VS measurement and make some improved progress, existing schemes cannot achieve a good estimation of echo phases modulated by the respiratory and cardiac activities with high accuracy or low computation, and thus resulting in serious performance degradation on the subsequent separation of breathing and heartbeat patterns as well as the assessment of breathing rate (BR), heart rate (HR), and heart rate variability (HRV). In this paper, we propose a simple yet effective method to measure VS for medical radar, named 3M method. Specifically, our method firstly introduces the Markov-Gauss model to obtain the recursive expression of the echo phases carrying VS, and secondly derive a simple observation equation (SOE) to reflect the relationship between the observed signal and VS of radar measurement. Thirdly, the aforementioned Markov-Gauss model and SOE are fused by Kalman filter to measure VS with accurate estimation. The 3M method demonstrates an elegant structure, low complexity and excellent features introduced by Kalman filter. Simulation results show the superiority of 3M over other methods. Then, we conduct extensive experiments with insightful visualizations to validate the effectiveness of the 3M method. Comparative results on different scenarios illustrate that the 3M method not only achieves state-of-the-art VS measurement performance but also expresses robust properties to HRV analysis.

Investigation of exertional dyspnoea by cardiopulmonary exercise testing with continuous laryngoscopy

ObjectivesAbnormal breathlessness at maximal exercise may be caused by a range of conditions, including exercise-induced bronchospasm, breathing pattern disorder, or exercise-induced laryngeal obstruction. These three disorders may not be detected on standard cardiopulmonary exercise testing. The aim of this study was to describe diagnostic outcomes of an expanded protocol during cardiopulmonary exercise testing. DesignRetrospective cohort study. MethodsPatients presenting with abnormal breathlessness on maximal exercise underwent continuous laryngoscopy with cardiopulmonary exercise testing on a stationary cycle ergometer. Breathing pattern disorder was evaluated by video and ventilatory data. Pre- and post-exercise spirometry was performed. Results24 adult patients were evaluated; 10 were professional athletes. Mean age was 40 years (range 18–73). Nine of 24 (38 %) were diagnosed with exercise-induced laryngeal obstruction and referred for speech pathology. Six of these had supraglottic exercise-induced laryngeal obstruction; all were aged <30 years; 5/6 were professional athletes. One patient had breathing pattern disorder and was referred for physiotherapy; one had exercise-induced bronchospasm, requiring escalation of asthma medication; one had muscle tension dysphonia resulting in referral to an otolaryngologist who administered a laryngeal injection of botulinum toxin. A further four patients had unexplained lower maximal oxygen consumption with cardiac limitation and were referred for further cardiac investigation. ConclusionsIn patients reporting abnormal breathlessness at maximal exercise, this expanded exercise protocol provided diagnostic information in 66.7 % cases which contributed to further personalised management.

Changes in Craniofacial Morphology Induced by Unilateral Nasal Obstruction in Mice of Different Ages.

Nasal obstruction in humans leads to mouth breathing and subsequent hypoxia in the entire body. Furthermore, nasal obstruction in growing children affects craniofacial growth and development. To investigate the effects of unilateral nasal obstruction (UNO) on craniofacial growth in mice of different ages, particularly on the morphology of the nasomaxillary complex and mandible. Mice aged 3, 6 and 12 weeks were selected as representatives of juvenile, adolescent and adult stages, respectively. A total of 30 male C57BL/6J mice (10 mice each at the ages of 3, 6 and 12 weeks) were used in this study for a 3-week experiment. The mice in each age stage were randomly and evenly assigned to either the control group (C3+3, C6+3 and C12+3) or the experimental group (E3+3, E6+3 and E12+3). The UNO model in experimental group was constructed by plugging the mouse's left nostril, thereby disrupting its normal nasal breathing pattern and inducing hypoxia. The control group underwent the sham procedure. After 3 weeks, the length, width and height of the cranium, nasomaxillary complex and mandible of each group were measured on two-dimensional images constructed by micro-computed tomography. Furthermore, the impact of UNO on mouse growth was evaluated through the measurement of femoral length. In juvenile mice, UNO inhibited the growth of cranial width, cranial height and mandibular length. In adolescent mice, UNO impeded the growth of the femoral length, cranial length, nasomaxillary length and mandibular length. In adult mice, no significant negative effects of UNO on craniofacial growth were found. Referring to the experimental results, in addition to actively treating nasal obstruction in patients, it is important to monitor the growth of the mandible in juveniles, as well as the nasomaxillary and mandibular growth in adolescents during orthodontic clinical practice.

High-speed bioimpedance-based gating system for radiotherapy: Prototype and proof of principle.

To investigate a novel bioimpedance-based respiratory gating system (BRGS) designed for external beam radiotherapy and to evaluate its technical characteristics in comparison with existing similar systems. The BRGS was tested on three healthy volunteers in free breathing and breath-hold patterns under laboratory conditions. Its parameters, including the time delay (TD) between the actual impedance change and the gating signal, temperature drift, root mean square (RMS) noise, and signal-to-noise ratio (SNR), were measured and analyzed. The gate-on TD and the gate-off TD were found to be 9.0±2.0ms [mean±standard deviation (M±SD)] and 7.2±1.3ms, respectively. The temperature drift of the BRGS output signal was 0.02 Ω after 30 min of operation. RMS noise averaged 0.14±0.05 Ω (M±SD) for all subjects and varied from 0.08 to 0.20 Ω with repeated measurements. A significant difference in SNR (p<0.001) was observed between subjects, ranging from 4 to 15. The evaluated bioimpedance-based gating system showed a high performance in real-time respiratory monitoring and may potentially be used as an external surrogate guidance for respiratory-gated external beam radiotherapy. Direct comparison with commercially available systems, 4D correlation studies, and expansion of the patient sample are goals for future preclinical studies.

CARETestLung: A mechanical test lung with Configurable airway Resistance, lung Elastance, and breathing efforts

A mechanical test lung is a crucial tool in accurately simulating patient-specific physiological responses of patients undergoing mechanical ventilation (MV), which, in turn, offer clinicians insight into lung mechanics during MV. In particular, it can be used to facilitate better methods to identify optimal ventilator settings, modes for individual patients by providing a platform to experiment with different MV settings. This addresses the challenge of optimising MV settings caused by variability in pathological conditions and the progression of respiratory disease over time within patients. However, the accessibility and cost of versatile test lungs limit widespread adoption in clinical settings, underscoring the need for affordable alternatives. This paper presents detailed instructions for the design and construction of a replicable, cost-effective mechanical test lung. The design features 3 subsystems: 1) the lung compartment; 2) the airway; and 3) a spontaneous breathing system. A detailed tests series shows its ability to replicate clinically realistic lung elastance values ranging from 25 to 85 cmH2O/L and airway resistance values from 10 to 45 cmH2O·s/L. It can also simulate a range of clinically realistic spontaneous breathing patterns. These capabilities yield pressure and flow ventilation data comparable to certified clinical test lungs across diverse scenarios, as well as matching clinically observed behaviours and dynamics. This accessible and versatile test lung offers valuable opportunities for optimising MV settings and advancing patient care, as well as its use in developing a range of physiological models for model-based decision support.

Joubert syndrome: a rare cause of hypotonia with developmental delay

Joubert syndrome is a rare autosomal recessive disorder. It is characterized by congenital ataxia, hypotonia, developmental delay, and at least one of the following features: neonatal respiratory disturbances and abnormal eye movements; including nystagmus and oculomotor apraxia. Molar tooth appearance is an essential finding for the diagnosis of Joubert syndrome. Here we presented a case of an 18-month-old male who presented with developmental delay and marked hypotonia. The main purposes of the case report were to highlight the benefit of a multidisciplinary rehabilitation team approach and describe the clinical features associated with Joubert syndrome. Brain magnetic resonance imaging showed a thick, elongated, and abnormally oriented superior cerebellar peduncle showing a molar tooth appearance with elongated bat-wing-shaped 4th ventricle and hypoplasia of the vermis suggestive of JS. Hypotonia during infancy and developmental delay with or without learning disability, associated with abnormal breathing patterns and abnormal eye movements (nystagmus) along with the radiological presence of a molar tooth sign on the brain MRI is an essential component to confirm the diagnosis.

Illness perceptions, symptom severity and psychosocial outcomes in adults with dysfunctional breathing

Background People with dysfunctional breathing (DB) experience symptoms such as air hunger and breathing pattern irregularities. The condition is often comorbid with other respiratory conditions, as well as anxiety and depression. Illness perceptions, the beliefs an individual has of an illness may explain health and wellbeing outcomes. Methods In this cross-sectional study we examined the illness perceptions of those diagnosed with DB, symptom severity, and psychosocial outcomes of depression, anxiety, and impact on daily living. Data were analyzed using tests of comparison and regression analysis. Results 82 people diagnosed with DB completed the brief illness perception questionnaire, the Nijmegen symptoms questionnaire, and questionnaires measuring mood and impact on daily living. The illness perceptions of those with DB were overall negative. There was a positive correlation between illness perceptions and mood, indicating that the stronger the beliefs that individuals had that DB is a serious condition, the more negative their mood. Illness perceptions significantly predicted psychosocial outcomes, even when controlling for demographic factors and symptom severity (depression: adj. R2=.352, F(10,51)=4.32, p<.001; anxiety: adj. R2=.40, F(11,47)=4.55, p<.001; impact on daily living: adj. R2= .33, F(8,53)=4.79, p<.001). Conclusions This is the first study to examine illness perceptions held by those diagnosed with DB. Our study found significant relationships between illness perceptions and psychosocial outcomes. It is possible that psychological interventions that target illness perceptions may also improve outcomes.

Effect of Different Breathing Patterns on Heart Rate and Blood Pressure Response to Resisted Exercises in Females Within the Age Group of 25 to 35 Years

Introduction: Blood pressure and heart rate increases in individuals while performing heavy resisted exercises but acquiring different breathing patterns during exercise shows its effect on blood pressure and heart rate, it may or may not exaggerate. Inhalation or exhalation when coupled with concentric phase of resisted exercise may or may not show similar blood pressure response as compare to inhalation or exhalation when coupled with eccentric phase of resisted exercise whereas Valsalva maneuver can exaggerate the blood pressure response. Objective: To study the inhalation, exhalation and Valsalva maneuver on systolic, diastolic blood pressure and heart rate. Research Design: Quasi experimental. Methodology: 30 female subjects were taken which were asked to do a set of bicep curls with 3 different patterns of breathing with each pattern performed on a separate day. Then the recordings were taken and calculated to see in which pattern of breathing blood pressure and heart rate rises. Result: ANOVA was used and the result showed that diastolic blood pressure increases while exhalation coupled with the concentric phase and inhalation coupled with the eccentric Phase but there is a marked increase in diastolic blood pressure during Valsalva maneuver as compared to the inhalation coupled with the concentric phase and exhalation coupled with the eccentric phase. The result showed that the change in the blood pressure due to the different breathing patterns were significant p&gt;0.05 Conclusion: It is concluded that Valsalva maneuver exaggerates the blood pressure response. Keywords: resisted exercises, Valsalva maneuver, exhalation. breathing patterns.

Quantified Ataxic Breathing Can Detect Opioid-Induced Respiratory Depression Earlier in Normal Volunteers Infused with Remifentanil.

Ataxic breathing (AB) is a well-known manifestation of opioid effects in animals and humans, but is not routinely included in monitoring for opioid-induced respiratory depression (OIRD). We quantified AB in normal volunteers receiving increasing doses of remifentanil. We used a support vector machine (SVM) learning approach with features derived from a modified Poincaré plot. We tested the hypothesis that AB may be found when bradypnea and reduced mental status are not present. Twenty-six healthy volunteers (13 female) received escalating target effect-site concentrations of remifentanil with a low baseline dose of propofol to simulate typical breathing patterns in drowsy patients who had received parenteral opioids. We derived respiratory rate (RR) from respiratory inductance plethysmography, mental alertness from the Modified Observer's Assessment of Alertness/Sedation Scale (MOAA/S), and AB severity on a 0 to 4 scale (categories ranging from none to severe) from the SVM. The primary outcome measure was sensitivity and specificity for AB to detect OIRD. All respiratory measurements were obtained from unperturbed subjects during steady state in 121 assessments with complete data. The sensitivity of AB for detecting OIRD by the conventional method was 92% and specificity was 28%. As expected, 69 (72%) of the instances not diagnosed as OIRD using conventional measures were observed to have at least moderate AB. AB was frequently present in the absence of traditionally detected OIRD as defined by reduced mental alertness (MOAA/S score of <4) and bradypnea (RR <8 breaths/min). These results justify the need for future trials to explore replicability with other opioids and clinical utility of AB as an add-on measure in recognizing OIRD.

DeepBreath: Breathing Exercise Assessment with a Depth Camera

Practicing breathing exercises is crucial for patients with chronic obstructive pulmonary disease (COPD) to enhance lung function. Breathing mode (chest or belly breathing) and lung volume are two important metrics for supervising breathing exercises. Previous works propose that these metrics can be sensed separately in a contactless way, but they are impractical with unrealistic assumptions such as distinguishable chest and belly breathing patterns, the requirement of calibration, and the absence of body motions. In response, this research proposes DeepBreath, a novel depth camera-based breathing exercise assessment system, to overcome the limitations of the existing methods. DeepBreath, for the first time, considers breathing mode and lung volume as two correlated measurements and estimates them cooperatively with a multitask learning framework. This design boosts the performance of breathing mode classification. To achieve calibration-free lung volume measurement, DeepBreath uses a data-driven approach with a novel UNet-based deep-learning model to achieve one-model-fit-all lung volume estimation, and it is designed with a lightweight silhouette segmentation model with knowledge transferred from a state-of-the-art large segmentation model that enhances the estimation performance. In addition, DeepBreath is designed to be resilient to involuntary motion artifacts with a temporal-aware body motion compensation algorithm. We collaborate with a clinical center and conduct experiments with 22 healthy subjects and 14 COPD patients to evaluate DeepBreath. The experimental result shows that DeepBreath can achieve high breathing metrics estimation accuracy but with a much more realistic setup compared with previous works.

Elastomeric Ionic Hydrogel-Based Flexible Moisture-Electric Generator for Next-Generation Wearable Electronics.

Rapid consumption of traditional energy resources creates utmost research interest in developing self-sufficient electrical devices to progress next-generation electronics to a level up. To address the global energy crisis, moisture-electric generators (MEGs) are proving to be an emerging technology in this field, capable of powering wearable electronics by harvesting energy from abundantly available ambient moisture without any requirement for external/additional energy. Recent advances in MEGs generally utilize an inorganic, metal, or petroleum-based polymeric material as an active material, which may produce sufficient current but lacks the flexibility and stretchability required for wearable electronics. Herein, we prepared an elastomer-based ionic hydrogel as an active material, and an MEG was fabricated by placing the ionic hydrogel on a PET sheet with two copper tapes on both sides of the hydrogel. The preparation of the hydrogel was thoroughly optimized and characterized in terms of spectroscopic analysis, swelling, water retention, and mechanical and rheological studies. The highly stretchable (350%) fabricated MEG is capable of producing a short-circuit current (JSC) of 16.1 μA/cm2, an open-circuit voltage (VOC) of 0.24 V, and a power density of 3.86 μW/cm2. The synergistic effect of the ion concentration gradient and the redox reaction on electrodes can be considered MEG's working principle. Apart from the current generation, this device is also used as a self-powered electronic sensor to monitor different physical activities by measuring breathing patterns. This prepared device is also capable of sensing the proximity of a hand. Therefore, our low-cost, easily fabricable, sustainable MEG device can be a potential aspirant for next-generation self-powered wearable electronics in healthcare applications.

How to undertake respiratory auscultation with infants and children.

Respiratory auscultation involves listening to and interpreting sounds from within the chest. Undertaking respiratory auscultation effectively requires appropriate equipment, knowledge of physiology and pathophysiology and experience in listening to and interpreting breath sounds. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. This article provides a step-by-step guide that explains how to undertake respiratory auscultation with infants and children aged 0-16 years. • Respiratory auscultation is an essential procedure for informing differential diagnoses and assessing the trajectory of a child's illness and response to treatment. • In children with structurally normal, healthy lungs and a regular breathing pattern, the respiratory sound should be relatively quiet, with regular movement of air along the trachea and bronchioles, in and out of the lungs. • Any breath sounds heard in unexpected areas requires further investigation, while a complete absence of breath sounds must be treated as a clinical emergency and assistance from the medical team must be sought immediately. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking respiratory auscultation with infants and children. • How you could use this information to educate nursing students or your colleagues on the procedure for undertaking respiratory auscultation with infants and children.