Paediatric anxiety disorders are among the most common psychiatric disorders of childhood and adolescence, affecting between 15% and 30% of youth. Rates rose sharply during the COVID-19 pandemic, and untreated anxiety is associated with impaired functioning and increased risk of depression, suicidality and substance use in adulthood. Evidence-based treatments such as cognitive-behavioural therapy and selective serotonin reuptake inhibitors are highly effective yet remain underused, while non-recommended treatments, including benzodiazepines, are often prescribed. Despite the public health burden, there are currently no endorsed outcome-focused quality measures for paediatric anxiety. Developing such measures would allow health systems and providers to track outcomes, reduce disparities and drive quality improvement.

This study will develop and test two complementary outcome-focused paediatric anxiety quality measures based on the seven-item Generalised Anxiety Disorder scale: (1) remission (clinically significant reduction in anxiety symptoms to below threshold) and (2) response (clinically significant improvement, even if remission is not achieved). Using electronic health record and claims data from Kaiser Permanente Northwest and Kaiser Permanente Southern California from 2017 to 2024, we will establish measure inclusion and exclusion criteria, evaluate the application of symptom weighting, test measure reliability and validity and implement casemix adjustment models. Analyses will examine disparities by race, ethnicity and social risk factors through linkage indices capturing local social determinants of health. Qualitative interviews with providers and electronic medical record vendors will be conducted to assess feasibility and usability. Measures will be prepared and submitted for endorsement by a national quality measurement body.

This study has been reviewed and approved by the institutional review boards at RTI International and Kaiser Permanente. Findings will be disseminated through peer-reviewed publications, scientific conferences, stakeholder workshops and submissions to a national quality endorsement body.

Stigmatized women's health issues, such as polycystic ovary syndrome (PCOS) and endometriosis, are often marginalized or dismissed in traditional clinical settings. This drives individuals to seek peer support in anonymous online communities such as Reddit. While these digital platforms host critical discussions, they are often designed as static information repositories, failing to account for the complex emotional, temporal, and cultural dynamics that shape users' support needs. There is a disconnect between the lived experiences of users-particularly feelings of clinical dismissal and the need for culturally specific advice-and the design of the sociotechnical systems they rely on.

This study aimed to deconstruct support practices in online women's health forums to provide a formative basis for designing more responsive digital health systems. We analyzed the intersections of discussion topics, emotional expression, temporal shifts (specifically the impact of the COVID-19 pandemic), and culturally situated discourse to identify unmet user needs and effective peer-support patterns.

We conducted a large-scale, mixed-methods analysis of 4995 posts and 460,317 comments from 5 major women's health subreddits (r/WomensHealth, r/TwoXChromosomes, r/BirthControl, r/Endometriosis, and r/PCOS). Computational methods included Latent Dirichlet Allocation for topic modeling, Valence Aware Dictionary for Sentiment Reasoning for sentiment analysis, and the NRC Emotion Lexicon for granular emotion classification. We segmented the data into pre-, during-, and post-COVID-19 periods to analyze temporal shifts. This quantitative analysis was complemented by a 2-phase qualitative thematic analysis to identify and characterize engagement patterns within 147 validated culturally situated threads.

Our analysis revealed that the most prevalent and emotionally negative topic was "Pain & Doctor Visits," which was uniquely characterized by high levels of fear and sadness linked to systemic clinical dismissal. The COVID-19 pandemic triggered a significant topical "turn inward," with discussions shifting away from social or political issues and toward somatic concerns (eg, "PCOS" "Pain & Doctor Visits"). Paradoxically, this period saw a simultaneous rise in both negative emotions (eg, fear and sadness) and expressions of community trust. Critically, our qualitative analysis of culturally situated discourse uncovered a consistent three-stage "playbook" for effective support: (1) Affirmation to establish psychological safety and validate cultural experiences; (2) Information Scaffolding to provide actionable, culturally tailored advice; and (3) Intercultural Bridging to facilitate community-wide learning and empathy.

Online health forums operate as essential, resilient sociotechnical infrastructures that actively compensate for failures and gaps in formal health care. The "Affirmation-Scaffolding-Bridging" model identified in our research provides a clear, formative framework for designing future digital health interventions. These findings can guide the development of new platforms that are emotionally aware, culturally responsive, and adaptive to user needs and external crises.

U.S. home healthcare agencies provide essential care to homebound patients, primarily older adults at high risk for infection. The COVID-19 pandemic intensified existing infection prevention and control challenges, particularly among marginalized communities. This qualitative study explored unique infection prevention and control challenges faced by agencies and differences in responses among those serving vulnerable populations. Ten agencies representing diverse geographic regions, ownership models, and patient characteristics participated; 25 staff across varied roles completed semi-structured interviews examining infection prevention and control policies, care coordination, and patient/caregiver communication during COVID-19. Thematic analysis identified four major themes: Into the Fray; Changing Relationships to Patients; Solutions Aimed at Care Provision Continuity; and Alleviating Fear and Providing Information. Staff experienced fear and stress from uncertainty and essential worker pressures, with urban infection prevention, quality, and education personnel particularly affected. Urban staff faced parking challenges and exposure risks in multi-generational homes; many rural staff contended with long drives and regional/county protocols that complicated patient access. Wearing full PPE in inclement weather further strained staff. Patient/caregiver hesitancy made trust building essential. Telehealth, education, remote work, and local partnerships supported care continuity, with corporately resourced agencies adapting more rapidly. Findings highlight the need for centralized guidance, telehealth investment, and stronger staff well-being supports in future public health crises.

Mucosal antibody response in lower respiratory tract to COVID-19 vaccines is less studied. This cross-sectional study evaluated the respiratory mucosal antibody response in subjects vaccinated with Aikewei or CoronaVac inactivated COVID-19 vaccines. A total of 39 participants were enrolled June 7 to September 15, 2021, including 16 patients who underwent pneumonectomy and 23 patients who underwent bronchoscopy. IgG to nucleocapsid (N) and spike (S) protein of SARS-CoV-2 (anti-N/S IgG), receptor-binding domain (RBD) of S (anti-RBD IgG), and IgA to N (anti-N IgA) were measured with chemo-luminescence immunoassays. Three patients without vaccination and 10 patients vaccinated with one dose showed negative for these antibodies in peripheral or alveolar blood samples or bronchoalveolar lavage fluid (BALF). Of the 12 patients with pneumonectomy vaccinated with two doses, 11 (91.7%), and 10 (83.3%), and 1 (8.3%) were positive for anti-N/S IgG, anti-RBD IgG, and anti-N IgA in peripheral blood, respectively, whereas the positive rates in alveolar blood samples were 66.7% (8), 66.7% (8), and 0%, respectively, and the median level of anti-N/S and anti-RBD in alveolar blood samples was each significantly lower than that in peripheral blood (10.16 vs. 22.18 AU/ml; 10.24 vs. 15.47 AU/ml, both p = .001). Among patients with bronchoscopy, 92.9% (13) of 14 subjects vaccinated with two or three doses showed positive for both anti-N/S IgG and anti-RBD IgG and 7.1% (1) was anti-N IgA positive in peripheral blood; however, all these 14 subjects showed negative in BALF. Together, the results indicate that inactivated COVID-19 vaccines rarely induce mucosal antibody response in the lower respiratory tract.

Working-From-Home (WFH) practices expanded rapidly during the COVID-19 pandemic and continue to be a point of discussion today with debates increasingly focused on productivity rather than the underlying reasons for WFH or flexibility. This study investigates why individuals value WFH and hybrid work arrangements in the United States. The specific period of study was during the COVID-19 pandemic. Understanding these motivations can inform constructive negotiations and effective policies that enhance productivity while supporting employees' work-life balance and caregiving responsibilities. Despite extensive discussion of whether employers should permit WFH, the diverse reasons employees seek flexibility remain understudied. Using data from a nationally representative online survey conducted in late 2021, we employ a best-worst scaling experiment to rank motivations for remote work. Results show the most valued reason for WFH is balancing work with caregiving, followed by reducing commuting time and costs, limiting exposure to illness, and preferring the home environment. A latent class model identifies four heterogeneous preference segments: (1) caregiving and commuting, (2) productivity and comfort, (3) multitasking and health safety, and (4) diffuse preferences without a dominant motivation. Additionally, seemingly unrelated regression analysis links WFH preferences with behavioral changes in grooming, attire, and personal care routines. These findings highlight the heterogeneity in workers' motivations for flexibility and suggest that one-size-fits-all approaches may be inefficient. By revealing the underlying drivers of WFH preferences, this study offers nuanced insights for organizations seeking to design flexible work policies that balance productivity objectives with employee well-being.

Pulmonary rehabilitation (PR) is a core component of chronic obstructive pulmonary disease (COPD) management; however, its implementation during acute exacerbations remains variable, particularly with respect to individualized approaches. This study aimed to evaluate the association between inpatient personalized PR and recovery-related clinical outcomes in hospitalized patients with acute exacerbations of COPD (AECOPD). A single-center retrospective cohort study was conducted at a tertiary care hospital between January 2021 and June 2024. Hospitalized patients aged ≥40 years with spirometry-confirmed COPD who experienced AECOPD and completed an inpatient personalized PR program were included. The rehabilitation program was initiated within 48-72 h of clinical stabilization and tailored based on baseline symptom burden, functional capacity, dyspnea severity, oxygen saturation, and exercise tolerance. Primary outcomes included changes in the COPD assessment test (CAT), modified medical research council (mMRC) dyspnea scale, and 6-minute walk test (6MWT) distance from baseline to program completion. Secondary outcomes included length of hospital stay and 30-day readmission rates. A total of 200 patients were included in the analysis. Mean CAT scores decreased from 25.4 ± 4.6 at baseline to 17.2 ± 3.8 following rehabilitation (p < 0.001). Mean mMRC dyspnea scores improved from 3.1 ± 0.8 to 2.0 ± 0.7 (p < 0.001). Functional exercise capacity increased, with the mean 6MWT distance improving from 210 ± 68 m to 310 ± 75 m (p < 0.001). The average length of hospital stay was reduced from 10.5 ± 3.2 days to 6.3 ± 2.1 days (p < 0.001), and 30-day readmission rates decreased from 25% to 10% (p < 0.001). In this retrospective cohort, inpatient personalized PR implemented during AECOPD was associated with improvements in symptom burden, dyspnea severity, functional exercise capacity, and selected healthcare utilization outcomes.

Symptoms in chronic obstructive pulmonary disease (COPD) commonly co-occur as 'symptom clusters', yet little is known about how patients interpret and make sense of these experiences. This study aimed to explore the meanings patients with COPD attribute to symptom clusters, their impact on health-related quality of life, and the strategies used to manage them.

A qualitative study using semi-structured interviews was conducted with a purposive sample of 30 patients with COPD recruited from a university teaching hospital in China. Data were analysed using the Framework approach, informed by the Theory of Unpleasant Symptoms and the concept of biographical disruption.

Three interrelated themes were identified. First, participants understood symptom clusters as dynamic, interacting experiences, often organised around "trigger symptoms" (e.g., cough precipitating breathlessness and fatigue), rather than as isolated symptoms. Second, these clusters disrupted multiple dimensions of everyday life, including physical functioning, social participation, and sense of self. Third, participants actively negotiated symptom burden through a range of adaptive strategies, prioritising symptoms based on their perceived meaning and impact rather than clinical severity. These findings highlight how symptom experiences are shaped by both physiological interconnections and personal interpretations.

This study provides novel insight into how people with COPD experience symptom clusters as interconnected, meaning-laden phenomena. Recognising the role of "trigger symptoms" and patients' subjective prioritisation of symptoms has important implications for person-centred assessment and supports the development of targeted, mechanism-informed approaches to symptom management in COPD. I can't walk long distances. I can't go out and spend time with my friends. This is a big problem in my life. (69-year-old male, GOLD stage III) Other people can run around. They visit relatives or friends during the holidays. I can't. I cough all day long and can only stay at home. (63-year-old female, GOLD stage IV).

To address the challenges of complex acoustic patterns and limited interpretability in pertussis cough sound recognition, this study proposes an interpretable deep learning framework based on adaptive time-frequency fusion and medically guided attention mechanisms. The framework first employs an Adaptive Time-Frequency Fusion Transformer to extract multi-scale temporal and spectral features of cough sounds, followed by a Medically-Guided Interpretable Attention Mapping module that aligns attention distributions with medically relevant acoustic features, achieving explicit interpretability in the diagnostic process. Experiments were conducted on three publicly available pertussis cough sound datasets from Kaggle, containing 68, 66, and 44 recordings, respectively. Under an 8:2 training-testing split with strict data leakage prevention, the proposed method achieved AUC scores of 0.994, 0.984, and 0.996 on the three datasets, outperforming the best existing baselines by an average of approximately 2%. Ablation studies demonstrated that the ATF module significantly enhances time-frequency dependency modeling, while the MGIAM module improves attention consistency in medically relevant regions. In noise robustness experiments, performance degradation remained below 3%, confirming the model's reliability and generalization ability in clinical applications. Overall, the proposed framework achieves unified high accuracy and strong interpretability for pertussis sound recognition, providing a reusable modeling paradigm for medical acoustic analysis.

Managing patients with respiratory failure increasingly involves non-invasive respiratory support (NIRS) strategies to support respiration, often preventing the need for invasive mechanical ventilation. However, despite the rapidly expanding use of NIRS, there remains a significant challenge to its optimal use across all medical circumstances. It lacks a unified ontological structure, complicating guidance on NIRS modalities across healthcare systems. In this study, we introduced NIRS ontology to support knowledge representation in acute care settings by providing a unified framework that enhances data clarity and interoperability, laying the groundwork for future clinical decision-making research. We developed NIRS ontology using the Web Ontology Language (OWL) and Protégé to organize clinical concepts and relationships. To enable rule-based clinical reasoning beyond hierarchical structures, we added Semantic Web Rule Language (SWRL) rules. We evaluated logical reasoning using a sample of 6 patient scenarios and used SPARQL queries to retrieve and test targeted inferences. The ontology has 145 classes, 11 object properties, and 18 data properties across 949 axioms that establish concept relationships. To standardize clinical concepts, we added 392 annotations, including descriptive definitions based on controlled vocabularies. SPARQL queries successfully validated all test cases (rules) by retrieving appropriate patients' outcomes: for instance, a patient treated with HFNC (high-flow nasal cannula) for 2 hours due to acute respiratory failure may avoid endotracheal intubation. This NIRS ontology formally represents domain-specific concepts, including ventilation modalities, patient characteristics, therapy parameters, and outcomes. SPARQL query evaluations across clinical scenarios confirmed the ontology's ability to support rule‑based reasoning and therapy recommendations, providing a foundation for consistent documentation practices, integration into clinical data models, and advanced analysis of NIRS outcomes. In conclusion, this proof-of-concept NIRS ontology demonstrates how clinical concepts can be formally represented and queried, offering a foundation for future validation, EHR integration, and evidence-based refinement of NIRS practices.

Unilateral vocal fold paralysis secondary to peripheral nerve injury presents limited treatment options and inconsistent outcomes. This protocol describes an electroacupuncture-based cerebral electric field therapy designed to target neuroanatomically relevant pathways through combined scalp, posterior cervical, and anterior neck electroacupuncture. The procedure includes standardized point selection, stimulation parameters, and treatment sequencing, followed by objective functional assessment using laryngoscopy and videofluoroscopic swallowing study. In a representative case, the application of this protocol was associated with observable improvements in voice quality and swallowing function. Patients with unilateral vocal fold paralysis frequently experience hoarseness, dysphagia, aspiration, and reduced laryngeal sensation, leading to substantial functional limitations and decreased quality of life. This protocol demonstrates the feasibility of electroacupuncture-based cerebral electric field therapy as a structured intervention for unilateral vocal fold paralysis and provides a reproducible framework for future clinical exploration. Additional investigation may help clarify its potential role as a supportive therapeutic option. Future controlled studies may further evaluate its clinical effectiveness and applicability.