Vital Signs Research Articles

Physiologic validation of the compensatory reserve metric obtained from pulse oximetry: A step towards advanced medical monitoring on the battlefield.

The Compensatory Reserve Metric (CRM) provides a time sensitive indicator of hemodynamic decompensation. However, its in-field utility is limited due to the size and cost-intensive nature of standard vital sign monitors or photoplethysmographic volume-clamp (PPGVC) devices used to measure arterial waveforms. In this regard, photoplethysmographic measurements obtained from pulse oximetry (PPGPO) may serve as a useful, portable alternative. This study aimed to validate CRM values obtained using PPGPO. Forty-nine healthy adults (25 females) underwent a graded lower body negative pressure (LBNP) protocol to simulate hemorrhage. Arterial waveforms were sampled using PPGPO and PPGVC. The CRM was calculated using a one-dimensional convolutional neural network. Cardiac output and stroke volume were measured using PPGVC. A brachial artery catheter was used to measure intraarterial pressure. A 3-lead ECG was used to measure heart rate. Fixed-effect linear mixed models with repeated measures were used to examine the association between CRM values and physiologic variables. Log-rank analyses were used to examine differences in shock determination during LBNP between monitored hemodynamic parameters. The median LBNP stage reached was 70 mmHg (Range: 45-100 mmHg). Relative to baseline, at tolerance there was a 47±12% reduction in stroke volume, 64±27% increase in heart rate, and 21±7% reduction in systolic blood pressure (P<0.001 for all). CRM values obtained with both PPGPO and PPGVC were associated with changes in heart rate (P<0.001), stroke volume (P<0.001), and pulse pressure (P<0.001). Furthermore, they provided an earlier detection of hemodynamic shock relative to the traditional metrics of shock index (P<0.001 for both), systolic blood pressure (P<0.001 for both), and heart rate (P=0.001 for both). The CRM obtained from PPGPO provides a valid, time-sensitized prediction of hemodynamic decompensation, opening the door to provide military medical personnel noninvasive in-field advanced capability for early detection of hemorrhage and imminent onset of shock. Diagnostic Tests or Criteria, Level IV.

Trauma patients with type O blood exhibit unique multi-omics signature with decreased lectin pathway of complement levels.

Patients with type O blood may have an increased risk of hemorrhagic complications due to lower baseline levels of von Willebrand Factor (vWF) and factor VIII, but the transition to a mortality difference in trauma is less clear. We hypothesized that type O trauma patients will have differential proteomic and metabolomic signatures in response to trauma beyond vWF and FVIII alone. Patients meeting the highest level of trauma activation criteria were prospectively enrolled. Blood samples were collected upon arrival to the emergency department. Proteomic and metabolomic (multi-omics) analyses of these samples were performed using liquid chromatography-mass spectrometry. Demographic, clinical, and multi-omics data were compared between patients with type O blood versus all other patients. There were 288 patients with multi-omics data; 146 (51%) had type O blood. Demographics, injury patterns, and initial vital signs and laboratory measurements were not different between groups. Type O patients had increased lengths of stay (7 vs. 6 days, p = 0.041) and a trend towards decreased mortality secondary to traumatic brain injury compared to other causes (TBI, 44.4 % vs. 87.5%, p = 0.055). Type O patients had decreased levels of mannose-binding lectin (MBL) and MBL associated serine proteases 1 and 2 which are required for the initiation of the lectin pathway of complement activation. Type O patients also had metabolite differences signifying energy metabolism and mitochondrial dysfunction. Blood type O patients have a unique multi-omics signature, including decreased levels of proteins required to activate the lectin complement pathway. This may lead to overall decreased levels of complement activation and decreased systemic inflammation in the acute phase possibly leading to a survival advantage, especially in TBI. However, this may later impair healing. Future work will need to confirm these associations, and animal studies are needed to test therapeutic targets. Retrospective Comparative Study, Level IV.

Effects of Passiflora incarnata and Valeriana officinalis in the control of anxiety due to tooth extraction: a randomized controlled clinical trial.

This study evaluated the efficacy of Valeriana officinalis L. and Passiflora incarnata L. to control anxiety, surgical discomfort, and changes in vital signs of patients undergoing extraction of two unilateral third molars. This study is a randomized, triple-blinded clinical trial. Fifty-four patients were allocated into three groups (Valeriana officinalis L., Passiflora incarnata L., and placebo). Anxiety levels were assessed using the State-Trace Anxiety Inventory (STAI) index, surgical discomfort using the QCirDental, and through the measurement of vital signs. The surgical times evaluated were before (T0), during (T1), and after surgery (T2). There was evidence that both Valeriana officinalis L. and Passiflora incarnata L., reduced STAY-S scores between T0 and T2 (p < .05), unlike placebo (p = .129). There was no change in surgical discomfort in all groups over time, and vital signs presented variable results. Phytotherapy drugs showed a reduction in anxiety state compared to the placebo group during third molar extraction procedure. CLINICAL TRIAL REGISTRATION: klRBR-6kcxvrc, March 10, 2022.

A randomized, double-blind, placebo-controlled study on immune improvement effects of ethanolic extract of Echinacea purpurea (L.) Moench in Korean adults.

Echinacea purpurea (L.) Moench (EP), a medicinal plant native to North America, is now cultivated in various regions including Europe. With increasing popularity of Echinacea in Korea recently, a human clinical trial was conducted to evaluate immune-enhancing efficacy and safety of EP 60% ethanolic extract (EPE) in Koreans. Eighty volunteers were recruited for this randomized, double-blind, placebo-controlled clinical trial. They were randomly divided into two groups and given either a daily dose of 200 mg of EPE or a placebo. All participants underwent testing for Natural Killer (NK) cell cytotoxic activity, serum cytokine levels (IL-2, IL-6, IL-10, IL-12, IFN-γ, TNF-α), Wisconsin Upper Respiratory Symptom Survey-21 (WURSS-21), and Multidimensional Fatigue Scale (MFS) during this study to assess changes in outcomes. After 8 weeks of EPE consumption, a significant increase in NK cell cytotoxic activity compared to the placebo was observed. Additionally, serum cytokine levels of IL-2, IFN-γ, and TNF-α also significantly increased following EPE consumption. However, no significant changes were observed in WURSS-21 and MFS before and after EPE consumption. Throughout the 8-week study period, no adverse reactions were reported in relation to EPE consumption, and there were no clinically significant changes in diagnostic laboratory tests or vital signs in the EPE group. These results indicate that consumption of EPE could lead to immune improvement without any adverse effects. This clinical trial was the first to demonstrate beneficial effects of EPE consumption on immunity in Korean adults.

Syncope and Brugada-like ECG pattern in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH)

Syncope is a brief loss of consciousness caused by reduced blood flow to the brain, characterised by sudden onset, short duration and full recovery without intervention. Anamnesis, physical examination and other diagnostic tests such as laboratory analysis and electrocardiogram (ECG) can be conducted to identify the underlying cause of syncope. A Brugada pattern on an ECG in individuals with syndrome of inappropriate antidiuretic hormone secretion (SIADH) who have syncope symptoms may indicate cardiac issues. A 69-year-old man with hypertension and a history of smoking presented with syncope. His vital signs were within normal limits, with no signs of a neurological deficit. The patient met the diagnostic criteria for SIADH, as evidenced by the presence of hyponatraemia (Na 118 mmol/l), a hyperosmolar condition and euvolemia. Upon arrival, a twelve-lead ECG showed ST-segment anomalies that reflected a Brugada ECG pattern. No ventricular arrhythmias were detected during the 24-hour Holter monitoring. Coronary angiography revealed no abnormalities in the coronary arteries. The ECG demonstrated the normalisation of ST elevations and the disappearance of the Brugada ECG pattern after the correction of hyponatraemia. After three months of follow-up the patient, with a normal sodium level, had no episodes of syncope.

Smart Health Monitoring with Power-Aware IoT Using a Wireless Body Area Network

Smart health monitoring systems have become increasingly popular in recent years due to the growth of the Internet of Things (IoT) technology and its applications in healthcare. This project proposes an IoT-based smart health monitoring system that utilises an ESP32 Microcontroller, MAX30100 Pulse Oximeter Heart Rate Sensor Module, MLX90614 ESF Non-Contact Human Body Infrared Temperature Measurement Module, LCD 16*2, 3.7v 2000mAh Lithium Battery, TP4056 1A Li-Ion Lithium Battery charging Module, and some buttons. The system is designed to monitor the user's heart rate, blood oxygen level, and body temperature in real-time and display the readings on an LCD screen as well as an IoT web page. The project aims to provide an affordable, portable, and user-friendly smart health monitoring solution that can be used at home, in hospitals, or other healthcare settings. The project methodology involved a combination of hardware and software components, including circuit design and programming using the Arduino IDE. The system was tested and evaluated for its performance, accuracy, and usability using a sample population. The results showed that the system was effective in monitoring the user's vital signs and displaying the readings in real-time. The system was found to be accurate and reliable, with a high level of user satisfaction and ease of use. Overall, the IoT-based smart health monitoring system proposed in this project has significant implications for healthcare, particularly in terms of remote monitoring, telemedicine, and personalised healthcare. The system has the potential to improve patient outcomes, reduce healthcare costs, and increase access to healthcare services. The project also highlights the potential of IoT technology in healthcare and the need for further research and development in this area

Predictive Factors for Major Complications and Urological Cancer Diagnosis in Older Adults (≥80 Years) Admitted to the Emergency Department for Hematuria

Background: Gross Hematuria is a relevant cause of admission to the emergency department in the general population and particularly in older adults (≥80 years). This specific urological symptom is often underestimated and usually associated with benign conditions such as urinary infections or poor hydration. Nevertheless, hematuria could lead to severe acute complications or be the first symptom of urological cancers. Methods: We retrospectively analyzed clinical data from 1169 patients aged ≥80 years consecutively admitted to the emergency department for hematuria. The primary endpoint of the study was to identify risk factors for major complications, and the secondary endpoint was to analyze risk factors for urological cancer diagnosis. The median age was 85 years (IQR 82–88 years), and 908 (77%) were males. Among them, 449 (38.4%) had a past medical history of urological neoplasm (kidney, ureter, bladder, prostate, or urethral cancer). Results: Overall, 87 patients (7.4%) had major complications (patient death, septic shock, and admission to the intensive care unit). Worse vital signs at admission, fever, and confusion (p &lt; 0.001, OR 18.0 IC 95% [5.5–58.7]; p = 0.015, OR 2.0 IC 95% [1.1–3.5]; p = &lt;0.001, OR 4.2 IC 95% [1.9–3.5], respectively), as well as lower hemoglobin values and higher Charlson comorbidity index (p &lt; 0.001, OR 0.8 IC 95% [0.7–0.9]), p = 0.002, OR = 1.2 [1.1–1.3]) were independent predictive factors for major complications. The multivariate analysis identified as risk factors for diagnosis of urological cancer older age, male sex and higher comorbidity (OR 1.05 IC95% [1–1.09]; OR 2.19 IC95% [1.42–3.39] and OR 1.11 IC95% [1.2–1.2], respectively); interestingly the presence of indwelling vesical catheter (IVC) (OR 0.44 IC95% [0.24–0.82]) resulted as an independent factor for absence of urological cancers. Conclusions: Hematuria is a frequent symptom in older adults admitted to the emergency department. While this is often associated with benign conditions, there are some risk factors for major complications and for urological cancer that must be taken into account to identify the patients who need further evaluation or prompt hospital admission.

Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study

Mortality rates among adult critical care patients with unusual or extreme values of vital signs and other physiological parameters: a retrospective study

Clinical Profile and In-hospital Outcome of Acute Household Substances Poisoning in a Tertiary Care Hospital

Background: Poisoning is an acute medical emergency. Among the thousands of harmless products available for household, very few are hazardous. Still, self-poisoning with these substances is one of the commonest mode of poisoning. This study was carried out to get information related to clinical profile and inhospital outcome of household substances poisoning in a particular area of Bangladesh. Methods: This cross-sectional type of descriptive study was carried out in the department of Medicine, Sylhet M.A.G. Osmani Medical College Hospital, Sylhet, Bangladesh during the period of June 2022 to November 2022.Purposive convenient sampling was applied to recruit sample from study population. Calculated sample size was 64. Detailed history including nature of poisoning (unintentional/ intentional), route of poisoning, type of poison, symptoms and signs with relevant laboratory findings were documented in a structured data collection sheet through interview from the patient or their guardians after obtaining informed written consent. In-hospital outcome in terms of survival (discharged, discharge without advice/absconded) and mortality were recorded.Results:Among 64 participants majority 65.63% (n=42) were female and most 56.25% (n=36) were of 18-20 years age group.Regarding educational status 96.87 %(n=62) participants were educated. All of the poisoning were intentional and by oral route. Harpic was the most common agents 59.38% (n=38) used by the victims.Vomiting was the most common 81.25% (n=52) symptomand oral ulcer was the commonest 40.63% (n=26) sign. No significant abnormality of vital signs and laboratory investigations were found. Majority of the respondents 43.75 % (n=28) stayed 2 days in hospital for treatment purpose. Total 85.94% (n=55) respondents were discharged with advice and 14.06% (n=9) respondents left hospital without medical advice. No death was documented in this study. Conclusion: Young teenaged female patients were the majority of victims in our study reflecting the degree of powerlessness and hopelessness of young, educated people with unemployment and difficulties in coping with life stressors. Bangladesh J Medicine 2024; 35: 70-75

The influence of biological rhythms on the initial onset of status epilepticus in critically ill inpatients and the study of its predictive Model

ABSTRACT This study aims to explore the relationship between the circadian rhythms of critically ill patients and the incidence of Status Epilepticus (SE), and to develop a predictive model based on circadian rhythm indicators and clinical factors. We conducted a diurnal rhythm analysis of vital sign data from 4413 patients, discovering significant differences in the circadian rhythms of body temperature, blood oxygen saturation, and heart rate between the SE and non-SE groups, which were correlated with the incidence of SE. We also employed various machine learning algorithms to identify the ten most significant variables and developed a predictive model with strong performance and clinical applicability. Our research provides a new perspective and methodology for the study of biological rhythms in critically ill patients, offering new evidence and tools for the prevention and treatment of SE. Our findings are consistent or similar to some in the literature, while differing from or supplementing others. We observed significant differences in the vital signs of epileptic patients at different times of the day across various diagnostic time groups, reflecting the regulatory effects of circadian rhythms. We suggest heightened monitoring and intervention of vital signs in critically ill patients, especially during late night to early morning hours, to reduce the risk of SE and provide more personalized treatment plans.

Factors for predicting 28‐day mortality in older patients with suspected of having sepsis in the emergency department

AbstractBackgroundOlder patients face increased sepsis risk, requiring precise prognostic tools in the emergency department (ED). This study aimed to explore factors predicting 28‐day mortality among older (≥60 years) patients with suspicion of sepsis in the ED.MethodsWe performed a retrospective cohort study. Data for all older patients with clinical suspected sepsis presenting to the ED from 1 October 2018 to 31 December 2018, were collected. Prognostic factors, characteristics, comorbidities, vital signs at triage, the emergency severity score, initial laboratory results, and sepsis bundle treatment were analyzed using univariable and multivariable Cox regression. Hazard ratios (HR) were calculated using these analytical methodologies to prognosticate 28‐day mortality.ResultsA total of 329 older patients with suspected sepsis were included. The overall 28‐day mortality was 10.33%. Independent prognostic factors that were significantly associated with 28‐day mortality were malignancy (adjusted hazard ratio [aHR]: 3.67; 95% confidence interval [CI]: 1.90, 7.09; p &lt; 0.01), oxygen saturation ≤93% (aHR: 3.37; 95% CI: 1.79, 3.43; p &lt; 0.01), and dependent status (hazard ratio [HR]: 2.27; 95% CI: 1.14, 4.53; p = 0.02).ConclusionsThis study suggests that “MOD”; M‐Malignancy, O‐Oxygen saturation ≤93%, and D‐Dependent status are significant prognostic indicators for 28‐day mortality among older patients with suspected sepsis in the ED.Trial registrationThe trial was retrospectively registered in the Thai Clinical Trial Registry on 06/05/2022, identification number TCTR20220506006.

[Consensus on the procedure of balloon pulmonary angioplasty for chronic thromboembolic pulmonary hypertension].

Chronic thromboembolic pulmonary hypertension (CTEPH) is classified as group IV pulmonary hypertension, characterized by thrombotic occlusion of the pulmonary arteries leading to vascular stenosis or obstruction, progressive increase in pulmonary vascular resistance and pulmonary arterial pressure, and eventual right heart failure. Unlike other types of pulmonary hypertension, the prognosis of CTEPH can be significantly improved by surgery, vascular intervention, and/or targeted drug therapy. Pulmonary endarterectomy (PEA) is the preferred treatment of choice for CTEPH. However, PEA is an invasive procedure with high operative risks, and is currently only performed in a few centers in China. Balloon pulmonary angioplasty (BPA) is an emerging interventional technique for CTEPH, serving as an alternative for patients who are ineligible for PEA or with residual pulmonary hypertension after PEA. BPA is gaining traction in China, but its widespread adoption is limited due to its complexity, operator skills, and equipment requirements, a lack of standard operating procedures and technical guidance, which limit the further improvement and development of BPA in China. To address this, a multidisciplinary panel of experts was convened to develop the Consensus on the Procedure of Balloon Pulmonary Angioplasty for the Chronic Thromboembolic Pulmonary Hypertension, which fomulates guidelines on BPA procedural qualification, perioperative management, procedural planning, technical approach, and complication prevention, with the aim of providing recommendations and clinical guidance for BPA treatment in CTEPH and standardizing its clinical application in this setting. Summary of recommendations: Recommendation 1: It is recommended that physicians who specialize in pulmonary vascular diseases take the lead in formulating the diagnostic and treatment plans for CTEPH, using a multidisciplinary approach.Recommendation 2: Training in BPA technique is critical; novice operators should undergo standardized operative training with at least 50 procedures under the guidance of experienced physicians before embarking on independent BPA procedures.Recommendation 3: BPA requires catheterization labs, angiography systems, standard vascular interventional devices and consumables, drugs, and emergency equipment.Recommendation 4: Patient selection for BPA should consider cardiac and pulmonary function, coagulation status, and comorbid conditions to determine indications and contraindications, thereby optimizing the timing of the procedure and improving safety.Recommendation 5: In experienced centers, patients deemed likely to benefit from early BPA, based on clinical and imaging features of CTEPH and without elevated D-dimer levels, could bypass standard 3-month anticoagulation therapy.Recommendation 6: BPA is a complex interventional treatment that requires thorough pre-operative assessment and preparation.Recommendation 7: The use of perioperative anticoagulants in BPA requires a comprehensive risk assessment of intraoperative bleeding by the operator for individualized decision making.Recommendation 8: A variety of venous access routes are available for BPA; unless contraindicated, the right femoral vein is usually preferred because of its procedural convenience and reduced radiation exposure.Recommendation 9: For the different types of vascular lesion in CTEPH, treatment of ring-like stenoses, web-like lesions, and subtotal occlusions should be prioritized before addressing complete occlusions and tortuous lesions, in order to reduce complications and improve procedural safety.Recommendation 10: A targeted, incremental balloon dilatation strategy based on vascular lesions is recommended for BPA.Recommendation 11: Intravascular pulmonary artery imaging technologies, such as OCT and IVUS can assist in accurate vessel sizing and confirmation of wire placement in the true vascular lumen. Pressure wires can be used to objectively assess the efficacy of dilatation during BPA.Recommendation 12: Endpoints for BPA treatment should be individually assessed, taking into account improvements in clinical symptoms, hemodynamics, exercise tolerance, and quality of life.Recommendation 13: Post-BPA routine monitoring of vital signs is essential; anticoagulation therapy should be initiated promptly post-procedure in the absence of complications. In cases of intraoperative hemoptysis, postoperative anticoagulation regimen adjustments should be adjusted according to the bleeding severity.Recommendation 14: If reperfusion pulmonary edema occurs during or after BPA, ensure adequate oxygenation, diuresis, and consider non-invasive positive-pressure ventilation if necessary, while severe cases may require early mechanical ventilation assistance or ECMO.Recommendation 15: In cases of intraoperative hemoptysis, temporary balloon occlusion to stop bleeding is recommended, along with protamine to neutralize heparin. Persistent bleeding may warrant the use of gelatin sponges, coil embolization, or covered stent implantation.Recommendation 16: For contrast imaging during BPA, non-ionic, low or iso-osmolar contrast agents are recommended, with hydration status determined by the patient's clinical condition, cardiac and renal function, and intraoperative contrast volume used.

A mixed-methods study to investigate feasibility and acceptability of an early warning score for preterm infants in neonatal units in Kenya: results of the NEWS-K study

Preterm birth (< 37 weeks gestation) complications are the leading cause of neonatal mortality. Early-warning scores (EWS) are charts where vital signs (e.g., temperature, heart rate, respiratory rate) are recorded, triggering action. To evaluate whether a neonatal EWS improves clinical outcomes in low-middle income countries, a randomised trial is needed. Determining whether the use of a neonatal EWS is feasible and acceptable in newborn units, is a prerequisite to conducting a trial. We implemented a neonatal EWS in three newborn units in Kenya. Staff were asked to record infants’ vital signs on the EWS during the study, triggering additional interventions as per existing local guidelines. No other aspects of care were altered. Feasibility criteria were pre-specified. We also interviewed health professionals (n = 28) and parents/family members (n = 42) to hear their opinions of the EWS. Data were collected on 465 preterm and/or low birthweight (< 2.5 kg) infants. In addition to qualitative study participants, 45 health professionals in participating hospitals also completed an online survey to share their views on the EWS. 94% of infants had the EWS completed at least once during their newborn unit admission. EWS completion was highest on the day of admission (93%). Completion rates were similar across shifts. 15% of vital signs triggered escalation to a more senior member of staff. Health professionals reported liking the EWS, though recognised the biggest barrier to implementation was poor staffing. Newborn unit infant to staff ratios varied between 10 and 53 staff per 1 infant, depending upon time of shift and staff type. A randomised trial of neonatal EWS in Kenya is possible and acceptable, though adaptations are required to the form before implementation.

Biomedical Applications of Cold Atmospheric Plasma: Cancer Therapy and Virus Inactivation

Cold atmospheric plasma (CAP), known for its ability to generate Reactive Oxygen Species (ROS) and Reactive Nitrogen Species (RNS), has emerged as a promising tool in many biomedical applications, including cancer therapeutics and virus inactivation. In cancer therapy, ROS and RNS induced by plasma have been shown to selectively target cancer cells, triggering apoptosis and inhibiting tumor growth while sparing healthy cells. This selective cytotoxicity makes plasma an attractive option for localized cancer treatment with minimal side effects. Additionally, the antimicrobial properties of ROS and RNS make plasma an effective agent for virus inactivation. By connecting the dots between cancer therapy and virus disinfection, this review paper sheds light on the potential of plasma-generated ROS and RNS as versatile tools in medical applications, offering a dual benefit of targeted cancer treatment and effective virus control. Specifically, this review explores the effects of CAP treatment on B16 melanoma cells, assessing changes in cell viability, proliferation, apoptosis and oxidative stress response. Dichloroacetate (DCA), a mitochondrial modulator, has shown promise in inducing apoptosis in melanoma cells. However, its clinical use is limited by side effects related to its neurotoxicity and suspected carcinogenicity. The potential of CAP in enhancing the therapeutic efficacy of DCA on B16-F10 melanoma apoptosis is also explored. CAP therapeutics for other types of cancers are also explored in this review. Alongside its implications in oncology, CAP has gathered substantial attention for its extraordinary potential in neutralizing viruses. CAP’s exceptional precision in targeting viral envelopes, genetic material and structural components disrupts their integrity and vital functions. This orchestrated mechanism offers a swift and efficacious route to render viruses inactive, encompassing both enveloped and nonenveloped viral types. In parallel pursuit, this review examines CAP-generated reactive species’ proficiency in deactivating SARS-CoV-2 across various surfaces. The inquiry entails subjecting surfaces to CAP treatment, succeeded by quantifying viral load and scrutinizing viral integrity. The outcomes gleaned from these investigations provide pivotal insights into CAP’s potential as a robust surface disinfection strategy, poised to combat the propagation of viral transmission.

Sound absorption performance and mechanism of aluminum foam with double-layer structures of conventional and porous cell walls

Open-cell aluminum foam exhibits sound absorption valleys in the 2500-4000 Hz range, reducing its sound absorption performance in the 800–6300 Hz range. This paper prepared a novel aluminum foam with a double-layer structure using the infiltration casting method, and its pore structure, sound absorption performance, acoustic model, and sound absorption mechanism are investigated. The double-layer structure consists of a conventional pore (CP) layer with a single pore size of 250 μm or 600 μm and a porous cell wall (PCW) layer with double pore diameters of 250 μm and 600 μm. As the thickness ratio between the CP and PCW layers decreases, the acoustic absorption valley value of the double-layer structure increases when combined with a small-pore CP layer. In contrast, it decreases slightly when combined with a large-pores CP layer. The double-layer structure reaches a sound absorption valley value and average sound absorption coefficient of 0.912 and 0.902, respectively. The double-layer structure's sound absorption valley value is better than that of a homogeneous structure, improving sound absorption performance. A Lu modified model is established to characterize the sound absorption of the double-layer structure, which closely matches the experimental results. The modified model further analyzed the vital geometrical parameters affecting the absorption valleys. Acoustic impedance analysis shows the enhanced sound absorption valleys are due to: 1) Gradient acoustic impedance reduces sound reflections at the air-structure interfaces and increases secondary reflection at the interfaces in the structure; 2) The series–parallel configuration increased the resonance peak bandwidth, while the dual-sized resonance cavities regulated the resonance peak frequency.

Wireless Patient Health Monitoring System

Wireless Patient Health Monitoring Systems (WPHMS) have emerged as transformative solutions in modern healthcare, facilitating continuous and remote monitoring of patients' vital signs in real-time. This paper presents a comprehensive exploration of a Wireless Patient Health Monitoring System leveraging the Blynk app, a versatile IoT platform. The system is designed to enable seamless data collection, transmission, and visualization of critical health parameters such as pulse rate, temperature, and blood pressure. By integrating cutting-edge hardware components with intuitive software interfaces, the proposed system offers unprecedented flexibility and accessibility in patient monitoring, transcending the limitations of traditional wired monitoring systems. The research begins with a thorough review of existing literature on wireless healthcare technologies, highlighting the evolution of patient monitoring systems and the role of IoT platforms in revolutionizing healthcare delivery. Building upon this foundation, the paper proceeds to outline the hardware architecture of the WPHMS, detailing the selection and integration of microcontroller boards, sensor modules.

Music from noise-canceling headphones is beneficial against anxiety in male bladder cancer patients undergoing follow-up cystoscopy: A prospective randomized trial.

Bladder cancer, with a greater incidence in males than in females, requires frequent cystoscopies. We aim to evaluate the effect of music played through noise-canceling headphones on male bladder cancer patients during follow-up cystoscopy. A total of 160 male bladder cancer patients undergoing follow-up flexible cystoscopy were randomly divided into the noise-canceling headphones without music group and the noise-canceling headphones with music group (groups 1 and 2, respectively; n = 80 per group). The patients' clinical characteristics were examined and objective and subjective measurements were compared before and after cystoscopy. The primary outcomes that were evaluated included the visual analog scale (VAS, 0-10) and the state-trait anxiety inventory (STAI, 20-80). Other outcomes, including vital signs and scores for assessing satisfaction and the willingness to repeat the procedure, were also examined. The characteristics of the patients in groups 1 and 2, and their pre-cystoscopy status, did not differ significantly. Although post-cystoscopy vital signs for the objective parameters and VAS pain scores were similar between the groups, subjective parameters were not. When compared with group 1, post-cystoscopy STAI-state scores were significantly lower in group 2, whereas patients' satisfaction scores and the willingness to repeat the procedure were significantly higher in group 2 (p = 0.002, 0.001, and 0.001, respectively). Additionally, in group 2, STAI-state scores changed significantly after the procedure when compared with before the procedure (p = 0.002). In male bladder cancer patients, music from noise-canceling headphones might have reduced anxiety and improved satisfaction and the willingness to repeat cystoscopy.

Nurse by numbers: The impact of early warning systems on nurses' higher-order thinking, a quantitative study.

To evaluate registered nurses' perceptions of whether the mandated use of the early warning system vital signs tool impacts the development of nurses' higher-order thinking skills. A concurrent mixed methods study design. Using an online survey, registered nurses' perceptions were elucidated on whether early warning system algorithmic tools affected the development of their higher-order thinking. Likert-type matrix questions with additional qualitative fields were used to obtain information on nurse's perceptions of the tool's usefulness, clinical confidence in using the tool, compliance with escalation protocols, work environment and perceived compliance barriers. Most of the 305 (91%) participants included in the analysis had more than 5 years of nursing experience. Most nurses supported the early warning tool and were happy to comply with escalation protocols if the early warning score concurred with their assessment of the patient (63.6%). When the score and the nurse's higher-order thinking did not align, some had the confidence to override the escalation protocol (40.0%), while others omitted (69.4%) or inaccurately documented vital signs (63.3%) to achieve the desired score. Very few nurses (3.6%) believe using early warning tools did not impede the development of higher-order thinking. Although experienced nurses appreciate the support of early warning tools, most value patient safety above the tools and rely on their higher-order thinking. The sustained development and use of nurses' higher-order thinking should be encouraged, possibly by adding a critical thinking criterion to existing algorithmic tools. The study has implications for all nurses who utilize algorithmic tools, such as early warning systems, in their practice. Relying heavily on algorithmic tools risks impeding the development of higher-order thinking. Most experienced nurses prioritize their higher-order thinking in decision-making but believe early warning tools can impede higher-order thinking. Registered nurses participated as survey respondents.

Detection and classification of human respiration under building debris model using VHF/UHF waves

AbstractDetecting live humans in buildings that have collapsed due to disasters and identifying their condition of health is of great importance for search and rescue operations. Although various methods have been used for this purpose, there are still critical challenges to ensure accurate and rapid life-saving operations. Immediate detection of the presence of living humans under debris combined with the assessment of their vital signs is a crucial factor. This research endeavors to introduce a previously unexplored method: the use of artificial neural network-based techniques to detect human respiration under building debris by generating novel simulation-derived electromagnetic data. To achieve this, a realistic three-dimensional debris model was integrated into an electromagnetic simulation program and complemented by a phantom simulating anterior–posterior body movements indicative of respiration. Measurements of magnitude and phase between 150 and 650 MHz were performed under different conditions. Using surrogate models based on artificial neural networks, noise with different signal-to-noise ratios within the selected frequencies was introduced. These models were used to perform two different steps. Firstly, the presence of respiration of living humans trapped under debris was successfully detected with a success rate of 99.97%. Secondly, the difficult task of classifying the respiration patterns of the human was accomplished with an impressive accuracy of 99.69%, providing a solid basis for proof of concept.

Price theory, loanable fund theory, and indifference curves: theorizing authority through misuse of mathematics, logic and improbable assumptions

Economist Adam Smith‘s study ( 1776 ) initially was ‘Political Economy ‘, then knowledge used for eradicating poverty, want, and unemployment and then to study inflation, stagnation, recession, etc. Thus it became the science of economics. Economist J.M. Keynes viewed ‘ Political Economy and added three definitions a) Wealth b) Welfare and c) Scarcity in the study. But Richardo shifted from production and distribution of wealth to “ The produce of earth - all that is derived from its surface by the united application of labor, machinery, and capital. Economist T.R. Malthus ( 1820 ) joined to add one more dimension of wealth “ material(productive ) wealth and immaterial ( unproductive ) wealth “. L. Robbins and others criticized the neglect of immaterial wealth and stressed the importance of services. Modern economists are of the view that immaterial wealth - services are essential to increase production, productivity, and good health. Economist Alfred Marshall stated, “ Political Economy or Economics is the study of mankind in the ordinary business of life; it examines that part of individual and social action which is most closely connected with the attainment and the use of the material requisites of well-being “. Robins ( 1931 ), defined economics based on i) Unlimited wants ii) Scarce means, and iii) Alternative uses of means. This is the historical background of definitions in Economics in general. With utopian and illogical assumptions, passing no mathematical rigor, ignoring very vital parameters, and free use of mathematical figures as ornaments the topics of a) price theory b) loanable fund theory, and c) indifference curves have no theories, no precision but are only verbose and literary...The author feels that these topics do not deserve a place in 21st-century Economics.