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.

This study assessed the risk of active pulmonary tuberculosis (ATB) in elderly patients with weakened immunity by jointly detecting serum interferon-γ (IFN-γ) and neutrophil CD64, and analyzed the impact of this diagnostic protocol on the course of ATB. A total of 50 patients with ATB and 50 age- and sex-matched healthy controls were recruited. Subsequently, the patient's neutrophil CD64 (quantified as the percentage of CD64-positive neutrophils [CD64%]), IFN-γ (by enzyme-linked immunosorbent assay [ELISA]), C-reactive protein (CRP; by immunoturbidimetry), and erythrocyte sedimentation rate (ESR; by Westergren method). Sputum samples from patients were cultured on Löwenstein-Jensen (L-J) medium and in the MGIT 960 automated system. The diagnostic efficacy of individual and combined biomarkers was assessed with receiver operating characteristic (ROC) curve analysis, and a logistic regression model was developed for combined detection. Significantly elevated levels of both IFN-γ and CD64 were observed in ATB patients versus healthy controls (P<0.05). A diagnostic model incorporating both biomarkers had an area under the curve (AUC) of 0.838, with a sensitivity of 84.00% and a specificity of 76.00%. Both markers decreased following therapeutic intervention (P<0.05), showing the lowest values in culture-negative patients (P<0.05). Furthermore, the combined model showed predictive utility for culture conversion, attaining an AUC of 0.756 (65.71% sensitivity, 80.00% specificity; P<0.001). The combined detection of IFN-γ and CD64 can effectively diagnose the occurrence of ATB in immunocompromised elderly people, providing a reference for clinical practice.

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity in Saudi Arabia. Early identification and management of risk are critical to addressing this burden. Community pharmacies (CPs) offer an accessible setting for proactive screening; however, pharmacy-based CVD initiatives remain underexplored locally despite demonstrated success internationally. Understanding public perspectives is therefore essential to inform service development.

To assess the perceptual factors shaping public acceptance of CP-based CVD risk screening services in Saudi Arabia.

A convergent parallel mixed-methods design was employed, combining an online questionnaire and semi-structured interviews. Quantitative data were analysed descriptively, while qualitative data were examined using framework analysis guided by the Health Belief Model (HBM), a framework used to explain how beliefs influence health behaviours.

A total of 523 survey responses and 9 interviews were analysed. Most participants were young, educated Saudi nationals, and reported visiting CPs more frequently than general practitioners. Over half expressed confidence in pharmacists' competence to conduct CVD risk screening, and 60% felt comfortable discussing CVD-related concerns. HBM constructs highlighted perceived susceptibility, severity, and self-efficacy as key motivators, with accessibility and convenience serving as important cues to action. However, concerns related to privacy, cost, and staffing limitations remained significant deterrents.

Public perception of CP-based CVD screening were generally positive, with accessibility, trust in pharmacists, and perceived benefits supporting engagement. However, views regarding suitability were mixed, and concerns related to privacy, cost, and staffing remain important barriers. The Health Belief Model (HBM) provided a useful framework for understanding these motivations and barriers. Addressing these issues is essential for successful implementation.

In-hospital cardiac arrest (IHCA) requires coordinated interdisciplinary action. Nurses are often first responders and essential members of resuscitation teams, yet the attributes that define their effectiveness remain unclear. Although team performance has been widely studied, few works have systematically examined nursing competencies in this context. This is the first Delphi-based study in Greece defining key nursing attributes within in-hospital resuscitation teams.

To achieve expert consensus on the key attributes characterizing effective nursing participation in IHCA teams.

A two-round Delphi study was conducted with experts in resuscitation and critical care. Round one involved thematic analysis of semi-structured interviews. In round two, experts rated attributes on a 10-point Likert scale. Consensus was defined as mean (M) > 8 and coefficient of variation (CV) < 20%. Descriptive statistics and Kendall's W assessed agreement across domains.

Thirty-nine attributes were identified and grouped into seven domains: education, experience, physical condition, psychological resilience, technical skills and non-technical skills. Thirty-five attributes met the consensus criteria. Highest agreement was observed for ALS certification, stress resilience, closed-loop communication, adaptability and teamwork. Strongest consensus emerged in non-technical (M = 9.75, CV = 3.79%) and technical (M = 9.61, CV = 5.62%) domains.

This study provides an evidence-informed framework of competencies and personal qualities underpinning nurses' effectiveness in resuscitation teams, emphasizing both technical expertise and non-technical skills-especially closed-loop communication, composure and collaboration.

The framework supports clearer role delineation, structured competency development and enhanced team effectiveness in IHCA management.

ObjectiveThis study aimed to describe the clinical and neuroimaging characteristics and 120-day outcomes in neuropsychiatric systemic lupus erythematosus patients.MethodsThis prospective study involved 32 patients with systemic lupus erythematosus who presented with neuropsychiatric symptoms. The Systemic Lupus Erythematosus Disease Activity Index 2000 was used to evaluate disease activity. Standard treatments were administered, and patients were followed up for 120 days. Outcomes were assessed in terms of remission, partial remission, and mortality.ResultsThe most prevalent neuroimaging characteristics were microhemorrhage in eight patients (25%), hemorrhagic infarct in four patients (12%), and ischemic infarct in four patients (12%). Additionally, magnetic resonance angiography of the cerebral artery revealed a beaded appearance in the middle cerebral artery or its branches in nine patients (28%). Magnetic resonance venography showed a filling defect, narrowing, and irregularity of the superior sagittal and transverse sinus in five patients (16%). Upon admission, the mean Systemic Lupus Erythematosus Disease Activity Index 2000 score was 24 (SD = 9). After receiving standard treatment, complete remission occurred in 24 patients (75%) and partial remission in 7 patients (22%), with a median Systemic Lupus Erythematosus Disease Activity Index 2000 score of 2 (interquartile range = 1-4.5) at 120 days, p = 0.02.ConclusionMagnetic resonance angiography of cerebral vessels helps confirm vasculitis. Patients generally experience satisfactory outcome with standard treatment at 4 months.

Patients with SLE have increased risk of both clinical cardiovascular disease (CVD) and subclinical atherosclerosis. Reports have shown that controlling CVD risk factors reduces subclinical plaque progression in patients with SLE. We investigated whether this finding was confirmed in our ethnically diverse cohort of patients, measuring total plaque area (TPA) as well as the number of plaques.

69 patients with SLE underwent ultrasound scans of the carotid and common femoral arterial bifurcations on two occasions (mean 63 months apart). Clinical, demographic, CVD risk and treatment factors were recorded for each patient. Change in plaque number and increase in TPA between scans were the outcome measures.

31 patients had plaque at the second scan. 13 had unchanged number of plaques while 18 had increased plaque numbers including six who were initially free of plaque. All 31 patients had increased TPA with median increase 4.59 mm²/year (IQR 2.4-7.33) and these patients were subdivided into two groups with change in TPA above or below the median. Factors associated with both increased plaque number and above-median TPA increase at the second scan compared with the first were age at baseline, positive lupus anticoagulant, negative anti-La and failure to attain at least three CVD risk targets within the follow-up period between scans. We found no associations with disease activity or medication.

In this ethnically diverse (40% non-Caucasian) population, we confirmed earlier findings that better control of CVD risk targets reduces progression of atherosclerotic plaque. Anti-La positivity was associated with less plaque progression, which was unexpected.

Both Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) are conditions characterised by the acute onset of left ventricular (LV) dysfunction. While LV thrombus is a known complication of LV dysfunction, its epidemiology in these two patient groups remains poorly understood.

We used data from the Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study, which prospectively enrolled patients with TS and STEMI at Sahlgrenska University Hospital. Serial echocardiography was performed on admission and on days 1, 2, 3, 7, 14 and 30. Predictors of LV thrombus were identified using Cox regression analyses.

314 patients were included; 68 with TS, 148 with anterior STEMI and 98 with non-anterior STEMI. Mean LV ejection fraction (LVEF) at admission was 39% (95% CI 35.8 to 42.2) in TS, 46.7% (95% CI 43.3 to 50.1) in anterior STEMI and 52.8% (95% CI 48.9 to 56.7) in non-anterior STEMI. LV thrombus occurred in 20 of 246 (8.1%) STEMI patients but in none of the TS patients. All but one LV thrombus was found in anterior STEMI. All LV thrombi in anterior STEMI were detected within 7 days, while the single non-anterior LV thrombus was found on day 30. All patients with LV thrombi received anticoagulation. Predictors of LV thrombus included lower LVEF and higher troponin levels.

Despite more severe LV dysfunction in TS compared with STEMI, LV thrombus was exclusively found in STEMI patients. Almost all LV thrombi were found in anterior STEMI within the first week and showed a high-resolution rate at 30 days. Our findings highlight pathophysiological differences between these two conditions, warranting further investigation and implications for differing surveillance needs after TS and STEMI.

The Heavy, Hypertensive, Atrial fibrillation, Pulmonary hypertension, Elder, Filling pressure (H₂FPEF) score is a widely used diagnostic tool for heart failure with preserved ejection fraction (HFpEF). Angina symptoms are common in patients with HFpEF but are not included in the score. We aimed to determine whether incorporating angina into the H₂FPEF score improves its diagnostic performance sex-specifically, given the well-known sex differences in both HFpEF and angina presentation.

We included 515 individuals from the UHFO-DM cohort with suspected HFpEF. Participants underwent standardised symptom collection, including angina using WHO questionnaires, and expert-panel adjudication of HFpEF. Following evaluation of H₂FPEF, we assessed the association of angina with HFpEF independent of H₂FPEF using logistic regression. By adding angina to H₂FPEF, we developed a modified algorithm and evaluated it by the area under the receiver operating characteristic curve (AUC), calibration, reclassification and decision curve analysis. All analyses were stratified by sex. We also included another 751 individuals with suspected HFpEF from a Combination cohort of UHFO-COPD (n=136), STRETCH (n=331) and TREE (n=284) for regression analysis.

In the UHFO-DM cohort, HFpEF prevalence was 24%. Overall H₂FPEF discrimination (AUC) was 0.72, with 0.69 in women and 0.74 in men. Angina was independently associated with HFpEF in women (OR 3.96, 95% CI 1.72 to 9.11, p=0.001) but not in men (1.90, 0.88 to 4.10, 0.102). Adding one point for angina in a modified H₂FPEF score in women improved AUC from 0.69 to 0.71 (DeLong p=0.030), increased sensitivity (0.53 to 0.60) and negative predictive value (0.80 to 0.82) and yielded a continuous net reclassification improvement of 0.449, with preserved calibration and higher net clinical benefit on decision curves. No performance gain was observed with the same modification in men. In the Combination cohort, angina was also independently associated with HFpEF only in women (women, 2.13, 1.14 to 3.97, 0.018; men, 0.85, 0.44 to 1.66, 0.638).

In women with suspected HFpEF, the presence of angina provides diagnostic information independent of H₂FPEF to uncover HFpEF. A simple sex-specific modification of H₂FPEF, adding one point for angina in women, may slightly improve discrimination and rule-out performance in women.