Tactical aircrew sometimes report physiological or cognitive impairment during flight. One hypothesis proposed to explain these events is that obstructions in the valves of the flight mask may disrupt respiration and lead to symptoms. This study investigated whether obstructions in the inhalation valve of a flight mask are a plausible contributor to physiological events in the cockpit.

This study was approved by the Naval Medical Research Unit Dayton Institutional Review Board. Sixteen qualified active-duty participants flew 2 profiles in a hypobaric chamber-1 with a normal flight mask and 1 with a modified mask. We measured outcomes related to respiratory behavior as well as subjective symptoms and cognitive performance while participants sat quietly and while reading aloud.

The modified mask caused several differences in pressures and the flow of gas through the breathing system, as well as differences in respiratory behavior, particularly when reading aloud. Symptoms were also reported more frequently when using the modified mask than the normal mask. We did not observe any differences in symptom severity or cognitive performance across the 2 masks.

Obstructions in the inhalation valve of the flight mask are a plausible contributor to reported events in flight.

Concerns over ventilator shortages during COVID-19 led to a number of potential solutions including using one ventilator for multiple patients. Large scale peer to peer military operations could create similar shortages. We developed and tested a device to allow 2 patients to be ventilated with a single, currently deployed ventilator.

Limitations of previous designs were reviewed and design requirements detailed. An accessory device capable of splitting gas flow to 2 patients was created with separate settings for peak inspiratory pressure (PIP) and positive-end expiratory pressure (PEEP). Monitoring of airway pressures and volumes delivered to each patient were also provided along with high and low alarms. Respiratory rate, inspiratory time, inspired oxygen concentration, and rise time settings were shared and identical for each simulated patient. All breaths were pressure control (PC) breaths. Bench testing on a test lung capable of separate adjustments for compliance and resistance was accomplished across the operational range. Airway pressures and volumes delivered to each lung were continuously measured using a flow and pressure monitor and recorded for analysis.

The device provided individualized setting of PIP and PEEP for each patient across the ventilator's range to account for variations in lung mechanics and ventilatory requirements. The delivered VT to patient "B" was within 10% of the target in all conditions tested. The delivered VT to patient "A" was within 10% of the target in 21 of 22 conditions tested and within 15% in all conditions. Ti was the most important shared setting with respect to delivering the target VT to either patient. Disconnection of either patient resulted in similar reductions to VT in the companion patient, while obstruction and suctioning caused markedly different effects on the VT, PIP, and PEEP delivery to the companion patient.

An accessory to a deployed ventilator allowed for independent delivery of PIP, tidal volume and PEEP across a clinically relevant range of values in the face of large differences in lung compliance and resistance between simulated patients. The complexity of the system provides monitoring and overcomes previously identified limitations. However, implementation of such a system is limited by regulatory requirements and training concerns.

Vaccine hesitancy is a persistent global health challenge. This project explored attitudes towards and utilization of COVID-19 vaccination, as well as suggestions to improve utilization within Indigenous communities in Northwest Territories, Canada. Utilizing a cross-sectional design, this project spanned two phases: 10 communities in Phase 1 (April to November 2021), and 11 in Phase 2 (August 2022-January 2023). Self-identifying Indigenous adults (≥18 years) were invited. Quantitative and qualitative data were collected via a semi-structured interviewer-administered questionnaire. In Phase 1 (n = 124; mean age = 41.6 years; 63.7% women) and Phase 2 (n = 221; mean age = 43.6 years; 66.21% women), 78.2% and 87.2% of participants had received at least one dose, respectively. In Phase 1, 67.2% reported not being concerned about the vaccine, and 61.2% believed the benefits outweighed the risks. In Phase 2, 56.2% of participants agreed all eligible individuals should be vaccinated, and 59.2% agreed the vaccine prevented serious outcomes. Bivariate analyses revealed that negative attitudes towards COVID-19 severity, vaccine safety, and effectiveness were significantly associated with lower intention to receive a COVID-19 vaccine in the future. Qualitative insights revealed factors of vaccination hesitancy, including: concerns about safety, efficacy, and necessity; a need for information; and distrust in government. Reasons for utilization included: trust in vaccine safety; perceived necessity; and employment and travel requirements. COVID-19 vaccine utilization in Indigenous communities is high, yet hesitancy persists due to safety and efficacy concerns, and distrust in government. Culturally safe strategies, improved communication, and equitable access are essential to sustaining confidence and future pandemic preparedness.

Coronary artery disease (CAD) and Coronavirus disease 2019 (COVID-19) are both associated with a hypercoagulable state, yet the long-term interaction between these prothrombotic conditions remains poorly characterized. This study investigated dynamic changes in coagulation function among COVID-19 survivors with CAD over a two-year follow-up period. A total of 117 CAD patients admitted to Shanghai Pudong Hospital between March and June 2022 were retrospectively enrolled: 60 with confirmed COVID-19 infection (COVID-19 group) and 57 without COVID-19 (control group). Thromboelastography (TEG) and conventional coagulation tests were performed at admission and at one and two years after discharge. Results showed that at one and two years after discharge, the COVID-19 group exhibited a comprehensive TEG profile indicative of a hypercoagulable state-including accelerated clot initiation, rapid propagation, and enhanced clot strength- compared to the control group (P < 0.05). In contrast, no significant between-group differences were observed in conventional coagulation parameters (P > 0.05). Notably, neutrophil levels in the COVID-19 group were significantly elevated at one and two years after discharge (P = 0.0353 and P = 0.0397, respectively) compared to acute-phase levels, while lymphocyte and platelet counts remained stable. Stratified analysis by antithrombotic intensity further revealed that standard antithrombotic regimens did not fully normalize the TEG-defined hypercoagulability in COVID-19 survivors at two-year follow-up. In conclusion, CAD patients with prior COVID-19 infection demonstrate sustained hypercoagulability and elevated neutrophil levels up to two years after discharge. These findings highlight the importance of TEG-based coagulation monitoring and neutrophil surveillance in CAD patients recovering from COVID-19 and support the need for individualized anticoagulation strategies. Future research should validate these findings in larger, multicenter cohorts and explore the underlying mechanisms and potential therapeutic targets.

Systemic sclerosis (SSc) is a multisystem autoimmune disease in which skin, lung, and gastrointestinal involvement often co-occur. Whether increasing organ co-involvement burden is accompanied by coherent circulating biomarker changes remains unclear.

To characterize immune, inflammatory, and nutritional biomarker patterns across skin-lung-gut burden groups in SSc.

We conducted a retrospective cross-sectional study of 314 patients with SSc fulfilling the 2013 ACR/EULAR classification criteria. Three prespecified axes were used to define organ burden: skin axis, modified Rodnan skin score (mRSS) ≥14; lung axis, interstitial lung disease (ILD); and gut axis, broad gastrointestinal involvement (bGI). Patients were classified into four mutually exclusive groups according to the number of involved axes: 0-Axis, 1-Axis, 2-Axis, and 3-Axis. Clinical characteristics and biomarker distributions were compared across groups. Multinomial logistic regression was performed using 0-Axis as the reference group, with prespecified sensitivity analyses including ordinal and treatment-adjusted models, subtype-informed analyses, and axis-specific adjusted analyses. Unsupervised clustering was used as an exploratory complementary analysis.

Among 314 patients, 37 (11.8%) were classified as 0-Axis, 136 (43.3%) as 1-Axis, 118 (37.6%) as 2-Axis, and 23 (7.3%) as 3-Axis. Anti-Scl-70 positivity increased across burden groups, from 51.4% in the 0-Axis group to 71.9% in the 1-Axis group, 83.1% in the 2-Axis group, and 91.3% in the 3-Axis group (p<0.001). hs-CRP differed across groups and was higher in the 2-Axis group than in the 1-Axis group (9.60 [3.13-19.40] vs 4.50 [1.79-12.03] mg/L, p=0.012 overall). Albumin decreased across groups and was lower in the 3-Axis group than in the 0-Axis group (31.70 [27.10-33.60] vs 34.30 [31.80-37.50] g/L, p=0.005 overall). In adjusted multinomial joint models, Anti-Scl-70 positivity was associated with 2-Axis versus 0-Axis (OR 3.86, 95% CI 1.46-10.22, p=0.007) and 3-Axis versus 0-Axis (OR 12.78, 95% CI 1.86-87.91, p=0.010). Lower albumin was associated with 2-Axis versus 0-Axis (OR 0.52, 95% CI 0.31-0.89, p=0.017) and 3-Axis versus 0-Axis (OR 0.38, 95% CI 0.18-0.79, p=0.009). Higher total cholesterol was associated with 3-Axis versus 0-Axis (OR 2.81, 95% CI 1.11-7.13, p=0.030). hs-CRP showed an inverse association for 1-Axis versus 0-Axis (OR 0.60, 95% CI 0.37-0.98, p=0.039), but was not associated with 2-Axis versus 0-Axis (OR 0.66, 95% CI 0.42-1.04, p=0.074) or 3-Axis versus 0-Axis (OR 1.04, 95% CI 0.60-1.81, p=0.890) after joint adjustment. Unsupervised clustering identified three biomarker-defined clusters with differing centroid profiles and differing axis-burden distributions. Supplementary analyses supported the robustness of the principal Anti-Scl-70 and albumin signals while clarifying the contributions of subtype structure, lung-axis predominance, treatment exposure, and GI heterogeneity.

Increasing skin-lung-gut co-involvement burden in SSc was associated with structured circulating biomarker patterning. The most consistent adjusted signals were Anti-Scl-70 positivity and lower albumin in higher burden groups. These findings support a clinically anchored, biomarker-informed perspective on multisystem involvement in SSc, while remaining complementary to conventional subtype-based classification and requiring cautious interpretation.

To evaluate the efficacy and short-term safety of omadacycline as second-line therapy for macrolide-unresponsive Mycoplasma pneumoniae pneumonia (MUMPP) in children aged 8-16 years.

A total of 64 hospitalized children with MUMPP admitted between September 2023 and December 2024 were enrolled. Children with persistent fever (>38.0 °C) after 72 hours of azithromycin monotherapy were assigned to receive intravenous omadacycline (n=18) or continued azithromycin (n=46). Omadacycline was dosed according to body surface area (BSA)-based scaling from the approved adult regimen (loading dose on day 1; maintenance dose once daily for 7 days). Primary outcome: time to defervescence (TTD). Secondary outcomes: 72-hour defervescence rate, radiological improvement, corticosteroid use, and adverse events. Three-month follow-up included dental examinations.

Omadacycline achieved shorter TTD than continued macrolides (50.78 ± 20.71 vs. 72.46 ± 25.61 hours; P = 0.002) and higher 72-hour defervescence rate (55.6% vs. 26.1%; P = 0.026). On multivariate linear regression, continued macrolide therapy (B = 13.43 h, 95% CI: 2.02-24.84, P = 0.022), positive 23S rRNA mutation status (B = 20.85 h, 95% CI: 10.94-30.77, P<0.001), and systemic corticosteroid use (B = 21.21 h, 95% CI: 10.79-31.62, P<0.001) were independently associated with prolonged TTD. No significant difference was observed in radiological improvement (P = 0.668). Corticosteroid requirement was significantly lower in the omadacycline group than in the macrolide group (27.8% vs. 67.4%; P = 0.004). Adverse events were comparable (5.6% vs. 8.7%; P = 0.645). At 3-month follow-up, no clinically significant changes were observed in hematological indices, hepatic or renal function, or cardiac enzyme profiles, and dental examination revealed no discoloration or enamel hypoplasia in any patient.

In this retrospective cohort, omadacycline as second-line therapy was associated with significantly faster fever resolution than continued macrolide treatment, with acceptable short-term safety profiles over a 3-month follow-up. Prospective randomized trials are needed to confirm these findings.

In many low- and middle-income countries, surveillance of severe acute respiratory infections (SARI) relies on administrative hospital data without virological confirmation, and its ability to capture epidemic dynamics and age-specific burden remains uncertain.

We analyzed 11,232,698 hospital discharges recorded by Ecuador's National Institute of Statistics and Censuses between 2014 and 2023, identified SARI episodes using International Classification of Diseases, 10th Revision (ICD-10) codes under broad and length-of-stay-restricted case definitions, and incorporated a neonatal component that included perinatal respiratory codes for infants younger than 1 year. Serfling harmonic regression was used to estimate seasonal baselines and excess SARI admissions at national, provincial, and age-stratified levels.

Administrative data identified 538,272 SARI discharges and revealed marked heterogeneity in incidence and case fatality across provinces and age groups. A previously unrecognized shift in ICD-10 coding from respiratory to perinatal chapters produced an apparent 99% decline in infant SARI after 2014; reclassifying perinatal respiratory codes restored stable high SARI rates in infants and increased their estimated burden by nearly ten-fold. Nationally, we identified 50 epidemic weeks with 77,352 excess SARI discharges (95% CI 70,030-85,982), while the COVID-19 pandemic disrupted typical seasonality, reducing admissions but increasing mortality among older adults.

Routinely collected hospital discharge data can reconstruct SARI epidemic dynamics and geographic disparities in the absence of virological surveillance, but are highly sensitive to coding practices. Incorporating neonatal perinatal respiratory codes into SARI definitions is essential to avoid underestimating infant burden and misinforming public health priorities.

Pneumoconiosis is a chronic pulmonary disease characterized by diminished physical function, impaired mental health, and deteriorated socioeconomic status. The study aims to evaluate the status of psychosocial distress and identify its associated factors in patients with pneumoconiosis.

This cross-sectional study enrolled 369 patients with pneumoconiosis admitted to the Hunan Prevention and Treatment Institute for Occupational Diseases between July 2022 and March 2023. Psychosocial distress was assessed using the Distress Thermometer (DT) scale and the accompanying Problem List. An exploratory multivariable linear regression analysis was performed to identify factors associated with psychosocial distress, and sensitivity analyses were conducted to examine the robustness of the results.

All participants were men, with a mean age of 58.60 ± 7.43 years. Most of patients had low education levels, long exposure duration and one or more complications or comorbidities. The mean DT score was 5.42 ± 2.45, and 75.88% of patients reported clinically relevant psychosocial distress (DT score≥4). Breathing, insurance/financial, loss of memory/concentration were the main problems for psychosocial distress. Factors associated with psychosocial distress included advanced disease stage, comorbid diabetes, and medium education level.

Psychosocial distress was common among the patients with pneumoconiosis included in our study. Breathing problems, financial concerns, and advanced disease progression were associated with higher levels of psychosocial distress. Future multi-center studies with probability sampling and inclusion of female patients are needed to confirm and extend these results.

Evidence on the association between ambient pollution and occupational hazards in Ecuador remains limited. This cross-sectional study evaluated the association between working conditions, satellite-derived ambient pollutants, geographic factors, and respiratory symptoms.

We analyzed 1,807 workers across four sectors. Respiratory symptoms (ECRHS) were cross-referenced with Sentinel-5P telemetry, utilizing z-score standardized environmental variables and selecting optimal spatial/temporal concentration percentiles (p25, p50, p75, and p95) via the Akaike Information Criterion (AIC) for each outcome. Multivariable penalized logistic regression (Firth's method) identified factors associated with respiratory symptoms.

Informal employment showed the strongest association with respiratory symptoms, including asthma (aOR 12.56; 95% CI: 5.09-32.87), wheezing (aOR 6.78; 95% CI: 1.83-27.89), chronic cough (aOR 4.14; 95% CI: 2.26-7.74), and chronic phlegm (aOR 2.53; 95% CI: 1.39-4.67). Direct workplace chemical inhalation, compounded by a complete lack of risk awareness, was associated with significantly higher odds for asthma, wheezing, and chronic cough. Geospatially, after controlling for canton-level altitude-which acted as an independent protective factor against asthma (aOR 0.78; 95% CI: 0.66-0.93)-nitrogen dioxide (NO2) and sulfur dioxide (SO2) emerged as the primary independent environmental predictors for chronic phlegm and cough, while ozone lost statistical significance.

Informal employment and unprotected chemical inhalation are strongly associated with respiratory symptoms, frequently exceeding the risks observed in traditional high-exposure sectors. Furthermore, regional atmospheric pollution showed a significant statistical association with chronic respiratory outcomes at the cantonal level. Integrating high-resolution aerospace monitoring into occupational health surveillance represents a potential strategy to address these overlapping structural vulnerabilities; however, causal inference remains limited by the cross-sectional design.

To characterise the associations of heat and bushfire smoke with health services utilisation and medication use at a national scale to support Australia's first National Climate Risk Assessment.

Cross-sectional, population study, covering health conditions with the highest burden of disease.

People in Australia accessing public health services between 2014 and 2020 for care related to cardiovascular, respiratory and mental health conditions.

Relative risks of heat and bushfire smoke (particulate matter ≤ 2.5 μm in diameter [PM_2.5]) on health system utilisation and medication use, measured as emergency department (ED) presentations, hospital inpatient admissions, Medicare Benefits Schedule service claims in primary care and Pharmaceutical Benefits Scheme prescriptions dispensed. Relative risks (RRs) and 95% confidence intervals were estimated for short-term lags between exposure periods and health system usage.

Heat was most strongly associated with ED presentations, with a RR of 1.033 (95% CI, 1.023-1.043; p < 0.001) per degree temperature change for respiratory conditions and 1.023 (95% CI, 1.016-1.031; p < 0.001) for mental health conditions. PM_2.5 at a 1-day lag had the highest association with hospital admissions, with a RR of 1.014 per 1 μg/m³ change in particulate density for both cardiovascular (p = 0.001) and respiratory (p = 0.002) conditions. Primary care visits for mental health conditions were strongly associated with levels of PM_2.5 (RR, 1.049 [95% CI, 1.040-1.058]; p < 0.001) and with temperature (RR, 1.027 [95% CI, 1.014-1.039]; p < 0.001), while medication use increased across respiratory, cardiovascular and mental health categories in response to both exposures, with particulate matter showing stronger effects for cardiovascular, respiratory and mental health prescriptions. Mental health outcomes consistently showed vulnerability across all domains.

Heat was strongly associated with acute ED presentations, while particulate matter was strongly associated with hospital admissions and medication use. Mental health services are broadly sensitive to both exposures. These findings emphasise the need for integrated air quality management and heat-health polices to reduce system-wide health burdens.