This study introduces a multi-band metasurface absorber, optimized for high-sensitivity detection of hepatic (liver) cancer. The unit cell comprises a top ITO sheet with several "+" - shaped slots, in which a graphene layer is incorporated into the central slot. This layer is attached to a quartz glass substrate to provide optical clarity, while a continuous ITO ground layer is used to mitigate electromagnetic (EM) transmission. Simulation results indicate that the structure attains exceptional absorption of 95%, 99%, 96%, and 94% at 0.594 (f₁), 0.988 (f₂), 1.196 (f₃), and 1.518 (f₄) THz, respectively. Electric field distribution and an equivalent electric circuit (EEC) analysis are used to theoretically analyze and confirm the resonance properties and physical operating mechanism. Furthermore, the proposed multi-band metasurface absorber demonstrates a sensitivity of 36 GHz/RIU, a Figure of Merit (FOM) of 2045 RIU^-1, and a quality factor (Q-factor) of 70, thereby enabling reliable and precise detection of minor refractive index fluctuations associated with hepatic cancer biomarkers. To improve diagnostic accuracy, a deep learning (DL) analysis framework is used to distinguish cancerous hepatic tissues. The model demonstrates 99.9% accuracy on the training data, with a validation accuracy of 98.7%. Owing to its multi-band adaptability and DL-driven enhanced detection accuracy, the proposed work provides a revolutionary foundation for next-generation visually accessible oncological diagnostics and advanced biomedical imaging.

Introduction. While rhinovirus was thought to cause mild infections such as the common cold, severe infections such as community-acquired pneumonia and asthma exacerbations can also occur. Children with chronic medical conditions have been shown to have increased risks of severe infections.Hypothesis/Gap statement. There is a difference in the risks of serious in-hospital outcomes among adults hospitalized for rhinovirus or influenza virus infection. Multiple morbidities in adult patients are associated with severe infections among patients hospitalized for rhinovirus infections.Aim. To compare the risks of serious in-hospital outcomes among adults hospitalized for rhinovirus or influenza virus infection and assess the association between multiple morbidities as represented by Charlson comorbidity index (CCI) in predicting risks of severe infections among patients hospitalized for rhinovirus infections.Methodology. We conducted a territory-wide retrospective study on adults hospitalized for rhinovirus or influenza virus infection between 1 January 2016 and 30 June 2023 in Hong Kong. The in-patient mortality, severe respiratory failure (SRF), secondary bacterial pneumonia and acute kidney injury (AKI) were compared. The association between multi-morbidities as reflected by CCI and severe in-hospital outcomes among adult patients hospitalized for rhinovirus infections was also assessed.Results. A total of 41,206 and 2,222 patients were hospitalized for influenza and rhinovirus infections, respectively. Patients with rhinovirus infection showed a significantly higher risk of SRF, secondary bacterial pneumonia and AKI compared to those with seasonal influenza (P<0.001 for all). Higher CCI (as both continuous variables, by grading as well as cut-off identified by receiver operating characteristic curve analysis) was associated with increased risks of severe in-hospital outcomes.Conclusion. Adults hospitalized for rhinovirus infection were associated with a significantly increased risk of adverse respiratory and kidney outcomes compared with those with seasonal influenza. More medical comorbidities, as reflected by CCI, were shown to be associated with an increased risk of severe in-hospital outcomes.

Current pulmonary embolism (PE) guidelines support outpatient management for selected low-risk patients, typically identified using the simplified Pulmonary Embolism Severity Index (sPESI). The prognostic value of individual sPESI scores in the direct oral anticoagulant (DOAC) era, particularly when combined with cardiac biomarker assessment, remains uncertain.

To evaluate 7-day and 30-day all-cause mortality among patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers treated with a DOAC.

Retrospective cohort study of US adults diagnosed with acute PE in a VA emergency department and prescribed a DOAC within 24 h of diagnosis at any U.S. Veterans Affairs (VA) Health System from 2015 to 2024.

Seven-day and 30-day all-cause mortality.

Of 6427 eligible patients, 1365 had an sPESI score of 2 and 455 had an sPESI score of 3 with negative cardiac biomarkers. In the sPESI 2 cohort, 7-day and 30-day mortality were 0.44% and 1.39%, respectively. In the sPESI 3 cohort, rates were 0.22% and 2.20%. Approximately 71% of sPESI 2 patients and 75% of sPESI 3 patients were hospitalized. Hospitalization was not associated with lower 7-day or 30-day mortality in either cohort.

Patients with acute PE, sPESI scores of 2 or 3, and negative cardiac biomarkers had low short-term mortality in this large, contemporary DOAC-treated cohort. These findings support prospective studies evaluating outpatient management in carefully selected patients.

Occupation-Based Practice (OBP) is fundamental to occupational therapy, enhancing consumer engagement and outcomes, yet implementation is challenging due to local environments and dominance of impairment-based interventions.

To investigate implementation of a service-wide OBP strategy in a large metropolitan tertiary health service over 6 years; understand its influence on occupational therapists; identify barriers and facilitators; and observe changes in clinician perceptions supporting sustainability.

Qualitative case study at two time points. Participants were occupational therapists and allied health assistants (n = 95 in 2017; n = 39 in 2023). Data was collected through focus groups (n = 8 in 2017; n = 3 in 2023) and multiple documents. Descriptive thematic analysis identified themes and sub-themes.

Strategic leadership cultivated an OBP culture. Barriers included resource limitations and systemic pressures; facilitators included interdisciplinary support and professional development. Over time, perceptions shifted from conceptual understanding to practical application as OBP became integrated into service culture.

A service-wide OBP strategy was effectively used in practice. Implementation depended on consistent application, a supportive service culture, and responsive systems. Although COVID-19 negatively impacted OBP, commitment to the strategy supported re-establishment, demonstrating sustainability.

A service-wide OBP strategy increases OBP and can be sustained in a tertiary healthcare setting.

The aim of this study is to investigate the effect of CPAP treatment on depression scores in OSA, which is associated with impaired quality of life and functional decline in the geriatric population.

The study was an ambispective cohort involving geriatric patients aged 65-80 with moderate-to-severe OSA confirmed by polysomnography. Initial depressive symptoms were assessed using the Geriatric Depression Scale (GDS). Participants were categorized based on their adherence to CPAP. Objective CPAP usage data, including mean nightly usage time and the percentage of nights used, were obtained from device downloads. Baseline predictors of depression were examined using multiple linear regression. The effect of CPAP adherence on post-treatment GDS scores was analyzed with analysis of covariance (ANCOVA), adjusting for initial depression scores. The model was also run with body mass index, lowest oxygen saturation and follow-up duration as additional covariates, and effect sizes were calculated.

Of the 53 patients, 31 (58.5%) adhered to CPAP. Demographic and clinical characteristics were similar between adherent and non-adherent groups. Regression analysis showed that lower nocturnal oxygen saturation (p = 0.012) and higher body mass index (BMI) (p = 0.011) were independently associated with higher initial GDS scores, while the apnea-hypopnea index was not significantly related to depressive symptoms. After adjusting for initial GDS scores, the adherent group had significantly lower post-treatment depression scores compared to non-adherents (adjusted mean GDS: 7.15 ± 0.18 vs. 10.10 ± 0.21, p < 0.001). The adjusted mean difference was 2.95 points (95% CI 2.40-3.50; partial η² = 0.70). Mean nightly use was 6.44 ± 0.97 h in the adherent group and 2.41 ± 0.95 h in the non-adherent group, on 88.4 ± 15.0% and 36.0 ± 25.0% of nights respectively (p < 0.001).

CPAP adherence was associated with a significant reduction in depressive symptoms in older adults with OSA. Nocturnal hypoxemia and obesity were key predictors of depression severity. These findings suggest that effective OSA treatment may improve mental health outcomes in the elderly.

Smartphone ownership among children and adolescents has risen sharply over the past decade, coinciding with a parallel rise in pediatric metabolic disorders, including obesity, hypertension, insulin resistance, and early markers of metabolic syndrome. Whether these two trends are mechanistically related has become a question of growing clinical and public health relevance. This study synthesizes evidence on the association between problematic smartphone use in children and adolescents and metabolic health outcomes, with attention to the behavioral, neurobiological, and psychiatric pathways that may connect the two. Peer-reviewed studies published between 2019 and 2026 were identified through structured searches of PubMed, Scopus, Web of Science, Google Scholar, and IEEE Xplore, using combinations of terms related to smartphone addiction, problematic smartphone use, screen time, and pediatric metabolic outcomes. Fourteen studies meeting predefined eligibility criteria (original research; participants aged 5-18 years; a quantitatively examined association between smartphone use and a metabolic or closely related outcome) constituted the primary evidence base. This base was supplemented with additional targeted literature on diagnostic classification, neurobiology, psychiatric comorbidity, and intervention, cited separately, to address conceptual and clinical gaps identified during peer review. Across the included studies, the prevalence of problematic smartphone use ranged from approximately 22% to 53%, varying by instrument, cutoff score, and cultural context. Problematic use was consistently associated with obesity, hypertension, unfavorable dietary patterns, sleep disruption, and reduced physical activity; evidence for a direct association with insulin resistance was more limited and inconsistent. The COVID-19 pandemic was associated with a marked, temporary increase in both screen time and addiction prevalence. Proposed mechanisms include displacement of physical activity, altered dietary behavior, circadian disruption via melatonin suppression, and dysregulation of reward and stress-response circuitry, occurring within an apparently bidirectional relationship with psychiatric symptoms such as anxiety, depression, and attention-deficit/hyperactivity disorder.

 Problematic smartphone use appears to be a plausible, modifiable contributor to pediatric metabolic risk, operating through overlapping behavioral, neurobiological, and psychosocial pathways. Because most available evidence is cross-sectional and drawn from a limited number of heterogeneous studies, causal inference is not currently possible, and the associations reported here should be interpreted as correlational rather than confirmed pathogenic relationships. Longitudinal and mechanistic research, alongside coordinated clinical screening and family-centered intervention, is needed to clarify and act on this relationship.

• Previous studies have investigated the role of how excessive use of smartphones has progressively become common among children and adolescents worldwide. • The researches also demonstrated how excessive smartphone use may negatively affect overall well-being in pediatric populations.

• In this review, all the recent studies on smartphone addiction and metabolic health risk in pediatrics are highlighted. • Unlike previous studies that have focused on individual outcomes, this review combines evidence on sleep disturbances, sedentary behavior, psychological factors, dietary pattern, obesity, hypertension, diabetes, and other health consequences within a single framework. • The review highlights the diverse impact of smartphone addiction and identifies important gaps for future research.

In patients with COPD, exacerbations mark disease progression, with significant reduction in quality of life and impact on mortality. Early detection is crucial to mitigate their consequences. The aim of this study was to investigate whether monitoring symptoms and exercise endurance at each pulmonary rehabilitation maintenance session could predict severe exacerbations of COPD.

Prospective multicentre study including 128 stable COPD patients in maintenance pulmonary rehabilitation programmes, in 21 French rehabilitation centres (NCT05492149). At each session, symptoms with COPD Assessment Test (CAT), perceived dyspnoea (mBorg scale) and endurance exercise performance (in MET.minutes) were recorded. We evaluated whether these parameters could predict severe exacerbations using baseline and lagged logistic regression models, and explored temporal relationships with cross-lagged correlation analyses.

Over one year and 4,200 recorded sessions (33 ± 25 per patient), 19 out of 128 participants experienced a severe exacerbation (a prevalence of 14.8%). Prediction models using isolated clinical markers such as CAT, mBorg or performance showed limited predictive accuracy (AUCs 0.45-0.58; all p > 0.1). Cross-lagged analyses revealed weak, short-term associations between symptoms (CAT score), perceived dyspnoea (mBorg scale) and exercise performance.

This study showed that nearly 15% of patients with COPD included in a maintenance rehabilitation programme experienced severe exacerbations during long-term follow-up. In this real-world maintenance pulmonary rehabilitation setting, routine clinical and isolated exercise data were insufficient to reliably predict severe COPD exacerbations. These findings highlight the complexity of severe exacerbations in COPD and emphasise the importance of developing more integrated research and digital monitoring strategies, using multimodal approaches that combine physiological, biological, behavioural, and environmental data.

This cross-sectional study aimed to characterize the pathogen profile among hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) in the Heyuan region and examine the distribution of infection types across severity grades defined by the Global Initiative for Chronic Obstructive Lung Disease (GOLD). The study included 203 hospitalized patients with AECOPD from the largest comprehensive tertiary Grade A hospital in Heyuan. Pathogen screening was performed using serological antibody testing and sputum culture. The overall pathogen detection rate was 50.25%, while non-infectious factors accounted for 49.75%. Atypical pathogens were frequently detected, with Mycoplasma pneumoniae accounting for 35.96% and influenza virus for 11.82%. Mixed infections comprised 17.24%, and pure atypical pathogen infections represented 22.17%. Among the 109 AECOPD patients stratified by disease severity, simple viral and mixed pathogen infections had the highest combined proportions of severe and very severe cases (100.0% and 92.9%, respectively). These findings characterize pathogen detection patterns among hospitalized patients with AECOPD in Heyuan and demonstrate variation in infection types across GOLD severity grades. The findings should be interpreted cautiously because serological detection, particularly M. pneumoniae immunoglobulin G (IgG), cannot independently distinguish previous exposure from active infection. C-reactive protein (CRP) and procalcitonin (PCT) measurements may provide additional information when evaluating infection patterns; however, the observational study design does not establish treatment efficacy or support GOLD-stage-specific therapeutic recommendations.

Data on health utilities in Alpha-1 antitrypsin deficiency (AATD) are scarce. This study aimed to evaluate health-related quality of life (HRQoL) using the EQ-5D in a cohort of AATD Pi*ZZ individuals from the European AATD Research Collaboration (EARCO) registry and to identify factors associated with impaired health utilities.

Observational, cross-sectional, multicenter study including AATD patients with Pi*ZZ genotype enrolled up to April 2025. HRQoL was assessed using the EQ-5D questionnaire (index and visual analogue scale (VAS)). Sociodemographic data, smoking history, respiratory symptoms, comorbidities, lung function and exacerbations were collected. Multivariable generalised linear models were used to identify factors independently associated with EQ-5D index scores in the overall population and in patients with AATD-COPD.

A total of 1710 Pi*ZZ individuals were analysed with a mean age 55.2 ± 13.8 years, 51% were male and 49.6% had COPD. Mean EQ-5D index and VAS were 0.82 ± 0.22 and 62.9 ± 25.9, respectively. Patients with COPD had significantly worse EQ-5D index (0.75 ± 0.24 vs 0.90 ± 0.16) and VAS scores (56.3 ± 24.4 vs 70.4 ± 26.8; both p < 0.001). In multivariable analyses, higher symptom burden (CAT, mMRC), long-term oxygen therapy, being unemployed, exacerbations, COPD, bronchiectasis and lower educational level were independently associated with worse EQ-5D scores in Pi*ZZ subjects.

HRQoL was substantially impaired in Pi*ZZ individuals, particularly in those with COPD. Symptom burden and exacerbations were stronger determinants of EQ-5D than lung function alone in all Pi*ZZ patients. Patients with AATD-associated COPD exhibited an HRQoL impairment comparable to that observed in usual COPD populations, but at a younger age.

In 2020 the Irish Health Service Executive (HSE) shifted chronic disease management (CDM), including COPD and asthma, into primary care via a funded CDM programme. An Enhanced Community Care (ECC) initiative established local clinical specialist teams (CSTs) providing spirometry, nurse-led clinics and pulmonary rehabilitation to support primary care practitioners (PCPs). We explored early PCP experience, diagnostic access, and confidence, to identify improvement priorities.

We sought to evaluate PCPs experiences with the implementation of Ireland's CDM and ECC programmes for COPD and asthma, focusing on diagnostic access, clinical confidence and priorities for service improvement and professional development.

A semi-structured survey was distributed nationally through PCP faculty meetings, mailing lists and messaging groups. Single- and multi-choice items, Likert scales (1-10) reported as median and interquartile range (IQR), and ranked options quantified satisfaction, access and educational needs; free-text responses underwent thematic analysis.

One-hundred-12 PCPs responded (62% urban; 65% >10 years in practice). Most practices (97%) had adopted CDM and 87% perceived better patient outcomes arising from this, yet only 33% reported a major change in their own practice. Integrated-care hubs were rated good-excellent by 87% and superior to hospital outpatient care by 84%, but limited diagnostics (52%), delayed two-way communication (45%) and inadequate specialist support (50%) persisted. Self-reported confidence in guideline knowledge was modest (asthma 7 (IQR 6-7); COPD 7 (IQR 6-7)) and very low for interpreting pulmonary-function tests and prescribing pulmonary rehabilitation (3 (IQR 2-5) and 5 (IQR 4-6) respectively). Priority topics for continuing-professional-development were: differentiating asthma from COPD, inhaler device choice and PFT interpretation.Irish PCPs value the CDM/ECC model but highlight implementation gaps. Targeted CPD, faster digital feedback and decision-support tools are needed, alongside longitudinal evaluation against health-service benchmarks and sustainability frameworks.