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Abstract Background Respiratory viral infections have significant global health impacts. We compared 30‐day intensive care unit (ICU) admission and all‐cause mortality risks in patients with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) Delta and Omicron variants versus influenza A and B (A/B). Methods Data from two retrospective inpatient cohorts in Capital Region of Denmark were analyzed. Cohorts included hospitalized influenza A/B patients (2017–2018) and SARS‐CoV‐2 Delta/Omicron patients (2021–2022), aged ≥18 years, admitted within 14 days of a positive real‐time polymerase chain reaction test result. Cumulative ICU admission and mortality rates were estimated using the Aalen–Johansen estimator. Cox regression models calculated hazard ratios (HRs) for ICU admission and mortality. Results The study encompassed 1459 inpatients (Delta: 49%; Omicron: 26%; influenza A: 6.4%; and influenza B: 18%). Cumulative incidence of ICU admission was 11%, 4.0%, 7.5%, and 4.1%, for Delta, Omicron, influenza A, and B, respectively. For ICU admission, adjusted HRs (aHRs) were 3.1 (p

Patients with nasogastric (NG) tubes require careful monitoring due to the potential impact of the tube on their ability to swallow safely. This study aimed to investigate the utility of high-resolution cervical auscultation (HRCA) signals in assessing swallowing functionality of patients using feeding tubes. HRCA, capturing swallowing vibratory and acoustic signals, has been explored as a surrogate for videofluoroscopy image analysis in previous research. In this study, we analyzed HRCA signals recorded from patients with NG tubes to identify swallowing kinematic events within this group of subjects. Machine learning architectures from prior research endeavors, originally designed for participants without NG tubes, were fine-tuned to accomplish three tasks in the target population: estimating the duration of upper esophageal sphincter opening, estimating the duration of laryngeal vestibule closure, and tracking the hyoid bone. The convolutional recurrent neural network proposed for the first task predicted the onset of upper esophageal sphincter opening and closure for 67.61% and 82.95% of patients, respectively, with an error margin of fewer than three frames. The hybrid model employed for the second task successfully predicted the onset of laryngeal vestibule closure and reopening for 79.62% and 75.80% of patients, respectively, with the same error margin. The stacked recurrent neural network identified hyoid bone position in test frames, achieving a 41.27% overlap with ground-truth outputs. By applying established algorithms to an unseen population, we demonstrated the utility of HRCA signals for swallowing assessment in individuals with NG tubes and showcased the generalizability of algorithms developed in our previous studies. Clinical impact: This study highlights the promise of HRCA signals for assessing swallowing in patients with NG tubes, potentially improving diagnosis, management, and care integration in both clinical and home healthcare settings.

In the field of contemporary epidermal bioelectronics, there is a demand for energy supplies that are safe, lightweight, flexible and robust. In this work, double-network polymer hydrogels were synthesized by polymerization of 3,4-ethylenedioxythiophene (EDOT) into a poly(vinyl alcohol)/poly(ethylene glycol diacrylate) (PVA/PEGDA) double-network hydrogel matrix. The PEDOT-PVA/PEGDA double-network hydrogel shows both excellent mechanical and electrochemical performance, having a strain up to 498%, electrical conductivity as high as 5 S m−1 and specific capacitance of 84.1 ± 3.6 mF cm⁻2. After assembling two PEDOT-PVA/PEGDA double-network hydrogel electrodes with the free-standing boron cross-linked PVA/KCl hydrogel electrolyte, the formed supercapacitor device exhibits a specific capacitance of 54.5 mF cm⁻2 at 10 mV s−1, with an energy density of 4.7 μWh cm−2. The device exhibits excellent electrochemical stability with 97.6% capacitance retention after 3000 charging–discharging cycles. In addition, the hydrogel also exhibits great sensitivity to strains and excellent antifouling properties. It was also found that the abovementioned hydrogel can achieve stable signals under both small and large deformations as a flexible sensor. The flexible and antifouling PEDOT-PVA/PEGDA double-network hydrogel-based supercapacitor is a promising power storage device with potential applications in wearable electronics.

BackgroundVaccine breakthrough SARS-CoV-2 infections are common and of clinical and public health concern. However, little is known about the immunological characteristics of patients hospitalized due to these infections. We aimed to investigate and compare immune cell subpopulations and induced immune responses in vaccinated and non-vaccinated patients hospitalized with severe COVID-19.MethodsA nested case-control study on adults (≥ 18 years) who received at least two doses of a mRNA-COVID-19 vaccine and were hospitalized with SARS-CoV-2 breakthrough infections and severe COVID-19 between January 7, 2021, and February 1, 2022, were eligible for inclusion. Age- and sex-matched non-vaccinated controls were identified. Immunophenotyping was performed using a custom-designed 10-color flow cytometry prefabricated freeze-dried antibody panel (DuraClone, Beckman Coulter (BC), Brea, Calif). TruCulture (Myriad RBM, Austin, USA) was used to assess induced immune response in whole blood, revealing different critical signaling pathways as a proxy for immune function. All samples were obtained within 48 hours of admission.ResultsIn total, 20 hospitalized patients with severe COVID-19 and a breakthrough SARS-CoV-2 infection were included, ten vaccinated and ten non-vaccinated patients. Vaccinated patients had lower concentrations of CD19 B cells (p = 0.035), naïve CD4 T cells (p = 0.015), a higher proportion of γδ1 T cells (p = 0.019), and higher unstimulated immune cell release of IL-10 (p = 0.015).ConclusionWe observed immunological differences between vaccinated and non-vaccinated patients hospitalized due to severe COVID-19 that indicate that vaccinated patients had lower B cell concentrations, lower concentrations of CD4 naïve T cells, a skewed gamma-delta V1/V2 ratio, and an exaggerated IL-10 response at admission. These results could indicate a suboptimal immune response involved in SARS-CoV-2 breakthrough infections that cause severe COVID-19 in vaccinated adults. However, the sample size was small, and further research is needed to confirm these results.

BackgroundAdiponectin is secreted by adipocytes and is inversely associated with obesity. Given the association between low body mass index (BMI) and higher mortality risk after community-acquired pneumonia (CAP), we hypothesized that high adiponectin levels are associated with a higher risk of adverse clinical outcomes in patients with CAP.MethodsIn a prospective cohort study of 502 patients hospitalized with CAP, adiponectin was measured in serum at admission. The associations between adiponectin and clinical outcomes were estimated with logistic regression analyses adjusted for age, sex, and measures of obesity (BMI, waist circumference or body fat percentage).ResultsAdiponectin was associated with higher 90-day mortality for each 1 μg/mL increase [OR 1.02, 95% CI (1.00, 1.04), p = 0.048] independent of age and sex. Likewise, adiponectin was associated with a higher risk of 90-day readmission for each 1 μg/mL increase [OR 1.02, 95% CI (1.01, 1.04), p = 0.007] independent of age and sex. The association between adiponectin and 90-day mortality disappeared, while the association with 90-day readmission remained after adjusting for adiposity.ConclusionAdiponectin was positively associated with mortality and readmission. The association with mortality depended on low body fat, whereas the association with readmission risk was independent of obesity.

Objective: Dysphagia management relies on the evaluation of the temporospatial kinematic events of swallowing performed in videofluoroscopy (VF) by trained clinicians. The upper esophageal sphincter (UES) opening distension represents one of the important kinematic events that contribute to healthy swallowing. Insufficient distension of UES opening can lead to an accumulation of pharyngeal residue and subsequent aspiration which in turn can lead to adverse outcomes such as pneumonia. VF is usually used for the temporal and spatial evaluation of the UES opening; however, VF is not available in all clinical settings and may be inappropriate or undesirable for some patients. High resolution cervical auscultation (HRCA) is a noninvasive technology that uses neck-attached sensors and machine learning to characterize swallowing physiology by analyzing the swallow-induced vibrations/sounds in the anterior neck region. We investigated the ability of HRCA to noninvasively estimate the maximal distension of anterior-posterior (A-P) UES opening as accurately as the measurements performed by human judges from VF images. Methods and procedures: Trained judges performed the kinematic measurement of UES opening duration and A-P UES opening maximal distension on 434 swallows collected from 133 patients. We used a hybrid convolutional recurrent neural network supported by attention mechanisms which takes HRCA raw signals as input and estimates the value of the A-P UES opening maximal distension as output. Results: The proposed network estimated the A-P UES opening maximal distension with an absolute percentage error of 30% or less for more than 64.14% of the swallows in the dataset. Conclusion: This study provides substantial evidence for the feasibility of using HRCA to estimate one of the key spatial kinematic measurements used for dysphagia characterization and management. Clinical and Translational Impact Statement: The findings in this study have a direct impact on dysphagia diagnosis and management through providing a non-invasive and cheap way to estimate one of the most important swallowing kinematics, the UES opening distension, that contributes to safe swallowing. This study, along with other studies that utilize HRCA for swallowing kinematic analysis, paves the way for developing a widely available and easy-to-use tool for dysphagia diagnosis and management.

Abstract Background Viral shedding and neutralizing antibody (NAb) dynamics among patients hospitalized with severe coronavirus disease 2019 (COVID-19) and immune correlates of protection have been key questions throughout the pandemic. We investigated the duration of reverse transcriptase-polymerase chain reaction (RT-PCR) positivity, infectious viral shedding and NAb titers as well as the association between NAb titers and disease severity in hospitalized COVID-19 patients in Denmark 2020–2021. Materials and methods Prospective single-center observational cohort study of 47 hospitalized COVID-19 patients. Oropharyngeal swabs were collected at eight time points during the initial 30 days of inclusion. Serum samples were collected after a median time of 7 (IQR 5 – 10), 37 (IQR 35 – 38), 97 (IQR 95 – 100), and 187 (IQR 185 – 190) days after symptom onset. NAb titers were determined by an in-house live virus microneutralization assay. Viral culturing was performed in Vero E6 cells. Results Patients with high disease severity had higher mean log2 NAb titers at day 37 (1.58, 95% CI [0.34 –2.81]), 97 (2.07, 95% CI [0.53–3.62]) and 187 (2.49, 95% CI [0.20– 4.78]) after symptom onset, compared to patients with low disease severity. Peak viral load (0.072, 95% CI [− 0.627 – 0.728]), expressed as log10 SARS-CoV-2 copies/ml, was not associated with disease severity. Virus cultivation attempts were unsuccessful in almost all (60/61) oropharyngeal samples collected shortly after hospital admission. Conclusions We document an association between high disease severity and high mean NAb titers at days 37, 97 and 187 after symptom onset. However, peak viral load during admission was not associated with disease severity. Trial registration. The study is registered at https://clinicaltrials.gov/ (NCT05274373).

Purpose: The prevalence of dysphagia in patients with neurodegenerative diseases (ND) is alarmingly high and frequently results in morbidity and accelerated mortality due to subsequent adverse events (e.g., aspiration pneumonia). Swallowing in patients with ND should be continuously monitored due to the progressive disease nature. Access to instrumental swallow evaluations can be challenging, and limited studies have quantified changes in temporal/spatial swallow kinematic measures in patients with ND. High-resolution cervical auscultation (HRCA), a dysphagia screening method, has accurately differentiated between safe and unsafe swallows, identified swallow kinematic events (e.g., laryngeal vestibule closure [LVC]), and classified swallows between healthy adults and patients with ND. This study aimed to: (1) compare temporal/spatial swallow kinematic measures between patients with ND and healthy adults; and (2) investigate HRCA's ability to annotate swallow kinematic events in patients with ND. We hypothesized there would be significant differences in temporal/spatial swallow measurements between groups and that HRCA would accurately annotate swallow kinematic events in patients with ND. Method: Participants underwent videofluoroscopic swallowing studies with concurrent HRCA. We used linear mixed models to compare temporal/spatial swallow measurements (n = 170 ND patient swallows, n = 171 healthy adult swallows) and deep learning machine-learning algorithms to annotate specific temporal and spatial kinematic events in swallows from patients with ND. Results: Differences (p < 0.05) were found between groups for several temporal and spatial swallow kinematic measures. HRCA signal features were used as input to machine-learning algorithms and annotated upper esophageal sphincter (UES) opening, UES closure, LVC, laryngeal vestibule reopening, and hyoid bone displacement with 66.25%, 85%, 68.18%, 70.45%, and 44.6% accuracy, respectively, compared to human judges' measurements. Conclusion: This study demonstrates HRCA's potential in characterizing swallow function in patients with ND and other patient populations.

Svanberg et al. longitudinally assess the immune response in patients with COVID-19. The authors report specific immune parameters associated with the development of severe disease.

In the field of contemporary epidermal bioelectronics, there is a demand for energy supplies that are safe, lightweight, flexible and robust. In this work, double-network polymer hydrogels were synthesized by polymerization of 3,4-ethylenedioxythiophene (EDOT) into a poly(vinyl alcohol)/poly(ethylene glycol diacrylate) (PVA/PEGDA) double-network hydrogel matrix. The PEDOT-PVA/PEGDA double-network hydrogel shows both excellent mechanical and electrochemical performance, having a strain up to 498%, electrical conductivity as high as 5 S m−1 and specific capacitance of 84.1 ± 3.6 mF cm⁻2. After assembling two PEDOT-PVA/PEGDA double-network hydrogel electrodes with the free-standing boron cross-linked PVA/KCl hydrogel electrolyte, the formed supercapacitor device exhibits a specific capacitance of 54.5 mF cm⁻2 at 10 mV s−1, with an energy density of 4.7 μWh cm−2. The device exhibits excellent electrochemical stability with 97.6% capacitance retention after 3000 charging–discharging cycles. In addition, the hydrogel also exhibits great sensitivity to strains and excellent antifouling properties. It was also found that the abovementioned hydrogel can achieve stable signals under both small and large deformations as a flexible sensor. The flexible and antifouling PEDOT-PVA/PEGDA double-network hydrogel-based supercapacitor is a promising power storage device with potential applications in wearable electronics. [ABSTRACT FROM AUTHOR]

Background Respiratory syncytial virus (RSV) and influenza cause significant health challenges, particularly for individuals with comorbid conditions and older adults. However, information on the clinical manifestations and outcomes of adults hospitalized with RSV in Europe remains limited. Methods This multicenter observational cohort study of adults hospitalized with RSV or influenza A or B from March 2016 to April 2020 investigated the clinical manifestations, mortality risk factors, and association with 90-day mortality rates by logistic regression analysis after adjustment for covariates. Results Of 988 patients hospitalized with either virus, 353 had RSV, 347 had influenza A, and 288 had influenza B infection. Patients with RSV, compared with those with influenza A or B, were more likely to have comorbid conditions (83% for RSV vs 72% for influenza A [ P =.03] and 74% for influenza B [ P =.001]) or pneumonia (41% vs 29% [ P =.03] and 24% [ P <.001], respectively). After adjustment for covariates, RSV infection was associated with an increased all-cause mortality rate within 90 days compared with influenza B (odds ratio, 2.16 [95% confidence interval, 1.20–3.87]; P =.01) but not influenza A (1.38 [.84–2.29]; P =.21). Increasing age and present pneumonia were identified as independent mortality risk factors in patients with RSV. Conclusions Older adults hospitalized with RSV infections are at a higher risk of dying within 90 days of hospitalization than patients admitted with influenza B but at a similar risk as those admitted with influenza A, emphasizing the detrimental effects and severity of older patients being infected with RSV. Our findings underscore the need for strategic testing and vaccination approaches to mitigate the impact of RSV among older adults. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic caused by the virus SARS-CoV-2 was the greatest global threat to human health in the last three years. The most widely used methodologies for the diagnosis of COVID-19 are quantitative reverse transcription polymerase chain reaction (RT-qPCR) and rapid antigen tests (RATs). PCR is time-consuming and requires specialized instrumentation operated by skilled personnel. In contrast, RATs can be used in-home or at point-of-care but are less sensitive, leading to a higher rate of false negative results. In this work, we describe the development of a disposable, electrochemical, and laser-scribed graphene-based biosensor strips for COVID-19 detection that exploits a split-ester bond ligase system (termed ‘EsterLigase’) for immobilization of a virus-specific nanobody to maintain the out-of-plane orientation of the probe to ensure the efficacy of the probe-target recognition process. An anti-spike VHH E nanobody, genetically fused with the EsterLigase domain, was used as the specific probe for the spike receptor-binding domain (SP-RBD) protein as the target. The recognition between the two was measured by the change in the charge transfer resistance determined by fitting the electrochemical impedance spectroscopy (EIS) spectra. The developed LSG-based biosensor achieved a linear detection range for the SP-RBD from 150 pM to 15 nM with a sensitivity of 0.0866 [log(M)]−1 and a limit of detection (LOD) of 7.68 pM.

Dysphagia, commonly referred to as abnormal swallowing, affects millions of people annually. If not diagnosed expeditiously, dysphagia can lead to more severe complications, such as pneumonia, nutritional deficiency, and dehydration. Bedside screening is the first step of dysphagia characterization and is usually based on pass/fail tests in which a nurse observes the patient performing water swallows to look for dysphagia overt signs such as coughing. Though quick and convenient, bedside screening only provides low-level judgment of impairment, lacks standardization, and suffers from subjectivity. Recently, high resolution cervical auscultation (HRCA) has been investigated as a less expensive and non-invasive method to diagnose dysphagia. It has shown strong preliminary evidence of its effectiveness in penetration-aspiration detection as well as multiple swallow kinematics. HRCA signals have traditionally been collected and investigated in conjunction with videofluoroscopy exams which are performed using barium boluses including thin liquid. An HRCA-based bedside screening is highly desirable to expedite the initial dysphagia diagnosis and overcome all the drawbacks of the current pass/fail screening tests. However, all research conducted for using HRCA in dysphagia is based on thin liquid barium boluses and thus not guaranteed to provide valid results for water boluses used in bedside screening. If HRCA signals show no significant differences between water and thin liquid barium boluses, then the same algorithms developed on thin liquid barium boluses used in diagnostic imaging studies, it can be then directly used with water boluses. This study investigates the similarities and differences between HRCA signals from thin liquid barium swallows compared to those signals from water swallows. Multiple features from the time, frequency, time-frequency, and information-theoretic domain were extracted from each type of swallow and a group of linear mixed models was tested to determine the significance of differences. Machine learning classifiers were fit to the data as well to determine if the swallowed material (thin liquid barium or water) can be correctly predicted from an unlabeled set of HRCA signals. The results demonstrated that there is no systematic difference between the HRCA signals of thin liquid barium swallows and water swallows. While no systematic difference was discovered, the evidence of complete conformity between HRCA signals of both materials was inconclusive. These results must be validated further to confirm conformity between the HRCA signals of thin liquid barium swallows and water swallows.

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Abstract Background Community-acquired pneumonia (CAP) is a leading cause of hospitalization worldwide. Bed rest with low levels of physical activity is common during periods of hospitalization and leads to functional decline as well as increased risk of complications. The aim of this study is to assess the effect of supervised physical training during hospitalization with CAP compared with standard usual care for CAP on length of hospital stay, risk of readmission, mortality risk, physical capacity, muscle and fat mass, muscle strength, metabolic function, systemic inflammation, health-related quality of life, and physical activity level. Methods This study is a randomized controlled trial with three parallel experimental arms. Based on a sample size calculation, a total of 210 patients admitted with CAP at Nordsjællands Hospital, Hillerød, Denmark, will be recruited. Patients will be randomly allocated (1:1:1) to either (1) standard usual care, (2) standard usual care combined with in-bed cycling, or (3) standard usual care combined with exercises from a booklet. The primary outcome is differences in length of hospital stay between groups, with secondary outcomes being differences between groups in time to (1) 90-day readmission and (2) 180-day mortality. Further secondary outcomes are differences in changes from baseline between groups in (3) lean mass, (4) fat mass, (5) fat-free mass, (6) physical capacity, (7) health-related quality of life, (8) systemic inflammation, and (9) physical activity level after discharge. Data on length of hospital stay, readmission, and mortality will be collected from patient files, while total lean, fat, and fat-free mass will be quantitated by dual-energy x-ray absorptiometry and bioelectrical impedance analysis. Physical function will be assessed using grip strength, 30-s chair stand tests, and Barthel Index-100. Health-related quality of life will be assessed with the EQ-5D-5L questionnaire. Systemic inflammation will be assessed in blood samples, while accelerometers are used for measuring physical activity. Discussion If a simple physical training program appears to diminish the impact of critical illness and hospitalization on clinical outcome, mobility, and health-related quality of life, it may lead to novel therapeutic approaches in the treatment of patients hospitalized with CAP. Trial registration ClinicalTrials.gov NCT04094636 . Registered on 1 April 2019