Applied Sciences

The embodied brain is highly dynamic, changing with every thought, sensory input and motor activity. It keeps us coherent and healthy via its connections to every organ within the body, particularly the heart, which in turn supplies nutrients and oxygen to all bodily organs and the brain. Listening to music can instantly alter brain-body dynamics. Yet, the acoustic, neural, and physiologic parameters and processes that facilitate these effects are not well understood. Here, we tested the hypothesis that a custom music composition can promote healing in patients recovering from liver transplant surgery within an intensive care unit (ICU). The music presented consisted of custom,15-minute music sets curated and recorded by an experienced medical musician. We obtained cortisol samples from saliva samples [~]15 minutes before and after music presentation and captured autonomic activity by recording electrocardiography for 5 minutes before, during, and 5 minutes after music presentation in normal subjects and patients. Discriminant analysis showed a significant decrease in cortisol production (n = 17) after music presentation. Detailed analysis in a single patient showed significant changes in multiple cardiac parameters, including heart-rate variability (HRV). Multidimensional scaling of twenty-five parameters related to HRV in a patient mapped all five instances of the music presentation condition outside of the mixed cluster of baseline conditions before and after music presentation. Our results show that listening to music promotes homeostasis in ICU patients by transiently shifting physiological parameters towards a state of recovery that may stabilize over time.

Burn injuries are a significant concern in developing countries due to limited infrastructure, and treating them remains a major challenge. The manual assessment of burn severity is subjective and depends, to a large extent, on individual expertise. Artificial intelligence can automate this task with greater accuracy and improved predictions, which can assist healthcare professionals in making more informed decisions while triaging burn injuries. This study established a model pipeline for detecting burn injuries in images using multiple deep learning models, including U-Net, DenseNet, ResNet, VGG, EfficientNet, and transfer learning with the Segment Anything Model2 (SAM2). The problem statement was divided into two stages: 1) removing the background and 2) burn skin segmentation. ResNet50, used as an encoder with a U-Net decoder, performs better for the background removal task, achieving an accuracy of 0.9757 and an intersection over union (Jaccard index) of 0.9480. DenseNet169, used as an encoder with a U-Net decoder, performs well in burn skin segmentation, achieving an accuracy of 0.9662 and an intersection over Union of 0.8504. The dataset collected during the project is available for download to facilitate further research and advancements (Link to dataset: https://geninfo.iitr.ac.in/projects). TBSA was estimated from predicted burn masks using scale-based calibration

Deep vein thrombosis is a disease that occurs when a blood clot is formed in a vein and occludes the vessel lumen, blocking the blood flow, causing pain and even disability and possibly leading to complications such as postthrombotic syndrome and pulmonary embolism. Treatments for DVT include mechanical thrombectomy: introducing a device into the vasculature to remove thrombus. Currently used devices either macerate the thrombus to aid removal or pierce the thrombus to reach its distal side. This can pose risk of fragmentation or distal embolization, or in case of fibrous, cohesive thrombi can be hard to achieve due to their resistance to deformation. The following study proposes an alternative approach of bypasing the thrombus via the space between the thrombus and the vessel wall in order to avoid thrombus penetration. The design implements a strategy of simultaneously gripping the clot and expanding the vessel lumen in order to create space between the thrombus and the vessel wall while advancing along the clots length in incremental steps. The prototype has been evaluated in a custom-made experimental setup using phantom vessels and thrombi analogs. The proof-of-concept experiments have shown that the device can successfully bypass and in some cases even remove thrombi. The study shows promising results for this new kind of device and can be a foundation for future research into applying similar removal strategies in thrombectomy.

Hospital-acquired infections are a known and growing problem worldwide. Far-UVC is a novel disinfection method that inactivates bacteria with limited penetration into human skin or eyes. A clustered, unmatched, randomized control trial (RCT) will be implemented in two Bolivian hospitals. The intervention arm will receive functioning Far-UVC lamps, whereas the control arm will receive identical lamps that do not emit UV light (shams). Based on baseline data, 40 lamp fixtures will be installed above hospital sinks, 10 per arm per hospital. Environmental samples (air and surface swabs) will be collected and analyzed via culture and sequencing. Simultaneously, air chemical monitoring data will be collected.

To characterize sleeping posture, behaviour, and environment in healthy pregnant participants and their bed partners across multiple nights in the home setting during late pregnancy, we completed a manual review of overnight video recordings from a four-night, in-home, level 3 sleep apnea study. Sleeping postures were scored according to a thirteen-posture classification system to determine the cumulative time per night spent in each sleeping posture. Additional aspects of sleeping posture, behaviour, and environment were also assessed. Forty-one pregnant participants and 36 bed partners completed the study, contributing 168 nights of video. Significant differences were found between the pregnant participants and bed partners in cumulative time spent in each posture as well as frequency and duration of episodes spent in each posture. Pregnancy status, side of the bed, and presence of a pregnancy pillow, bed partner, shared bed sheets, and pets in the sleeping space had various effects on the time spent in each posture. Pregnant participants spent more time in transition postures (going-to-sleep, waking-to-void, returning-to-bed, and waking-in-the-morning) than bed partners. There was a moderately positive correlation in posture changes between pregnant participants and their bed partners. Pets significantly increased the number of posture changes per night for both groups. Pregnant participants had more absences and time absent from bed. Sleep in late pregnancy is characterized by an increased frequency and duration of episodes spent in a restricted number of sleeping postures and is impacted by the sleep environment. Modifying the sleeping environment may improve comfort, minimize disturbances, and benefit sleep. Statement of SignificanceSubjectively-recalled supine going-to-sleep posture in late pregnancy is associated with stillbirth and fetal growth restriction. Sleeping posture, however, is dynamic, and few studies provide comprehensive analyses of sleeping posture in pregnancy using objective measurements. This novel study used a gold-standard objective measure of sleeping posture, was conducted across multiple nights in the participants own homes, and accounts for usual sleeping behaviours and environment by including the participants bed partner. A critical remaining knowledge gap is whether an individuals nightly sleeping posture varies significantly across the third trimester. Future work should use nightly, continuous, and objective methods to measure sleeping posture across the entire third trimester to bridge this gap and investigate the relationship between sleeping posture and pregnancy outcomes.

BackgroundPlacenta accreta spectrum (PAS) is characterized by abnormal trophoblastic invasion into the uterine myometrium and is a cause of postpartum hemorrhage and maternal death. Protease-activated receptor-1 (PAR-1) promotes various cellular actions, including invasion. Here, we analyzed the expression of PAR-1, platelet antigen, and fibrin in PAS. MethodsWe analyzed 49 PAS cases (placenta accreta vera [accreta vera], 31 cases; placenta increta [increta], 8 cases; placenta percreta [percreta], 10 cases, classified by the degree of placental villous invasion) and 33 control cases. We immunohistochemically examined the expression of PAR-1, platelet glycoprotein (GP) IIb/IIIa, and fibrin. ResultsThe frequency of previous cesarean section was higher in the increta and percreta groups than in the control and accreta vera groups. PAR-1 expression in placental villi was weak and limited in extent in control cases, whereas immunoreactivity and staining density increased in increta and percreta. Immunofluorescence revealed PAR-1 expression in cytotrophoblasts of placental villi and in aggregated platelets. PAR-1 expression scores in cytotrophoblasts increased significantly with the degree of villous invasion (accreta vera, increta, percreta) compared with controls. The immunopositive areas for GPIIb/IIIa and fibrin were significantly larger in PAS groups than in controls. Furthermore, the immunopositive areas for platelets and fibrin were positively correlated with the PAR-1 expression score. ConclusionThese results indicate that PAR-1 may play a role in placental villous invasion and that a thrombogenic placental environment may influence PAR-1 activation.

BackgroundNeonatal jaundice management increasingly relies on transcutaneous bilirubinometry (TcB), yet discrepancies with serum bilirubin (TSB) have limited its clinical reliability. This study introduces Skin Residual Bilirubin Volume (SRBV) as a physiologically grounded framework to enhance TcB interpretation. ObjectiveTo evaluate SRBV as an explanation for TcB-TSB discordance and assess whether incorporating SRBV improves the interpretability and reliability of TcB measurements during diagnosis, phototherapy, and recovery. MethodsTcB readings (MBj20) were calibrated against laboratory TSB in non-jaundiced neonates (TSB <3 mg/dL). Neonates undergoing phototherapy were monitored using paired TcB measurements before and after treatment breaks (TBL-out and TBL-return). TSB was measured before treatment, at mid-treatment, and prior to discharge. Patterns of TcB-TSB disparity and an observed reproducible Recovery Value Flip (RVP) phenomenon were analysed. ResultsAcross 102 neonates, TBL consistently equalled or exceeded TSB, supporting the additive SRBV model. Early in phototherapy, TBL-return > TBL-out, indicating persistent cutaneous bilirubin. A reproducible RVP occurred mid-treatment, after which TBL-return < TBL-out coincided with sustained bilirubin decline. Fractional SRBV contribution increased with baseline bilirubin and persisted into recovery, demonstrating dynamic, patient-specific cutaneous bilirubin retention. ConclusionSRBV provides a biologically plausible explanation for TcB-TSB discordance and dynamic TcB behaviour. Incorporating SRBV into TcB interpretation enables physiologically informed monitoring, improving safety and reliability in laboratory-limited neonatal settings. Significance StatementTranscutaneous bilirubinometry is widely used but limited by disagreement with serum bilirubin. This study introduces SRBV as a physiological explanation for TcB variability and proposes an SRBV-adjusted framework that transforms TcB measurements into actionable, non-invasive clinical guidance.

BackgroundAuditory steady-state responses (ASSRs) provide an objective method for estimating hearing thresholds in individuals unable to provide behavioural responses. Bone conduction (BC) testing is required to differentiate conductive from sensorineural hearing loss. Accurate BC ASSR threshold estimation relies on "correction" factors, which are not yet well established. This meta-analysis evaluated the reliability of BC ASSR thresholds to estimate hearing thresholds at 500, 1000, 2000 and 4000 Hz. MethodsA systematic search of PubMed, the Cochrane Library, and Embase was conducted to identify studies involving normal-hearing (NH) and hearing-impaired (HI) participants of all ages. Outcomes were (1) the difference between ASSR behavioural and ASSR thresholds, and (2) ASSR thresholds. The risk of bias was evaluated using the Newcastle-Ottawa Scale. The mean and 95% confidence intervals (CI) were calculated for the thresholds at the four frequencies. The certainty of the evidence was assessed using GRADE approach. ResultsOf records identified, 11 records met the inclusion criteria, yielding a total of 27 studies. Sample sizes ranged from 60 to 249 participants across frequencies and age groups. The quality of records ranged from low to high. Data were synthesised using random-effects models due to heterogeneity. In NH adults, the mean differences ({+/-}95% CI) between BC ASSR thresholds and behavioural thresholds were 17.0 ({+/-}4.8), 15.5 ({+/-}6.0), 13.4 ({+/-}3.3), and 12.1 ({+/-}4.1) dB at 500, 1000, 2000, and 4000 Hz, respectively. In NH infants, mean ({+/-}95% CI) BC ASSR thresholds were 17.2 ({+/-}2.2), 10.5 ({+/-}3.6), 26.4 ({+/-}2.7), and 19.9 ({+/-}4.0) dB HL at the same frequencies. The certainty of the evidence was very low. ConclusionsBC ASSR can be a reliable method for estimating BC thresholds. However, age and frequency significantly impact BC ASSR thresholds, highlighting the need to develop of "correction" factors to accurately predict BC behavioural thresholds. RegistrationPROSPERO CRD42023422150.

Cervical intraepithelial neoplasia grade 2 (CIN2) lesions show variable outcomes, and accurate prediction of regression remains a major clinical challenge. We developed an interpretable machine learning pipeline that integrates quantitative histological, clinical, and human papillomavirus (HPV) -genotyping data to predict lesion regression within one and two years. Using panoptic segmentation of routine hematoxylin and eosin (H&E) -stained biopsies, we extracted human-interpretable morphological and immune cell infiltration related features that capture the key histopathological characteristics of CIN2 and identified features that predicted lesion regression. Further, integrating these features to predictive clinical features achieved higher predictive accuracy than clinical variables alone. These findings demonstrate that quantitative, interpretable analysis of H&E histology of routine diagnostic biopsies contains relevant information that predicts the natural history of CIN2 lesions. Graphical Abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=121 SRC="FIGDIR/small/26344510v1_ufig1.gif" ALT="Figure 1"> View larger version (38K): org.highwire.dtl.DTLVardef@11735f5org.highwire.dtl.DTLVardef@d76e89org.highwire.dtl.DTLVardef@19a1d39org.highwire.dtl.DTLVardef@f48a01_HPS_FORMAT_FIGEXP M_FIG Created in BioRender. Lehtonen, O. (2026) https://BioRender.com/rlnkbkp C_FIG

In this research, we create a new fractional-order SEIHRD framework to examine how the Nipah virus moves from one species to another (zoonotic spillover) and how it later spreads throughout a community (via contact with one another) or in a hospital or isolation situation (via entering into a hospital or being placed under quarantine). We used the fractional-derivative formulation of the SEIHRD model to demonstrate memory-based effects related to the progression of an infection and also reflect time-distributed effects associated with surveillance and control measures placed on an infected patient. We first demonstrated that the basic epidemiologic properties of the model were consistent by showing that the solutions of the SEIHRD differential equations will always yield positive and bounded solutions within biologically relevant parameter ranges. We then established the well-posedness of this model by transforming the SEIHRD differential equations into an equivalent integral operator and applying various fixed-point arguments to demonstrate that there will always be unique solution(s) to the SEIHRD differential equations. To evaluate the threshold parameter for the transmission of Nipah virus within a given population we calculated the threshold level through the next generation method to determine the expected number of secondary infections from a new or chronically infected host. One of the main contributions of this work is to include an analysis of the robustness of a given solution to all potential perturbations (i.e., Ulam-Hyers and generalized Ulam-Hyers stability). In addition, we provide analytic results guaranteeing that small perturbations due to approximate modeling, numerical approximation (discretization), or the lack of data fidelity will produce controlled deviations in the solutions. To finish this project, we perform a global sensitivity analysis on uncertain coefficients to evaluate their contribution to the uncertainty of each coefficient and to find out the coefficients that most strongly influence major outcome metrics. This will allow us to develop a priority order for prioritizing spillover control (reduction of human contact and/or isolation), contact reduction, and expenditure of resources towards isolation-related interventions. The resulting framework converts fractional epidemic modeling from a descriptive simulation to a replicable method with robustly defined behavior and equal response prediction.

BackgroundSepsis-induced mortality is frequently driven by the systemic dissemination of pore-forming toxins (PFTs), such as Staphylococcus aureus alpha-hemolysin. Biomimetic "nanosponges" which are nanoparticles coated in red blood cell (RBC) membranes have emerged as a promising detoxification strategy. However, current methods rely largely on empirical iteration, often failing to optimize the competitive binding kinetics required to outcompete native RBCs in a high-flow hemodynamic environment. MethodsWe developed a deterministic ordinary differential equation (ODE) kinetic model based on the law of mass action to simulate the competitive inhibition of alpha-toxin by decoy nanoparticles. Unlike prior geometric models, this study explicitly tracked molar receptor concentrations to enforce saturation kinetics and mass conservation. We performed a multi-parametric sweep of nanoparticle radius (r_{NP}: 50-200 nm) and receptor surface density (d_{rec: 200-10,000 sites {micro}m{square}2) to identify the design window that maximizes toxin sequestration efficiency within a clinically relevant timeframe (60 minutes). ResultsBaseline simulations established a native RBC receptor concentration of 3.34 x 10^{-7} M. The optimization landscape revealed a non-linear dependence on receptor density rather than particle size. The optimal design window was identified at a receptor density of >8,000 sites {micro}m{square}2 on an 80 nm vector, achieving a theoretical toxin neutralization efficiency of 91.79%. Notably, complete (100%) neutralization was not observed even under optimized conditions, suggesting a theoretical upper bound imposed by physiological competition. In contrast, standard biomimetic formulations (low-density, 100 nm) achieved suboptimal capture, failing to prevent significant toxin-RBC interaction. ConclusionWe demonstrate that "decoy" efficacy is governed primarily by receptor surface density rather than geometric surface area. Our model suggests that current manufacturing protocols, which prioritize particle stability over receptor enrichment, may be kinetically insufficient for human application. These findings provide a rational design framework for next-generation nanotoxoid therapeutics.

BackgroundML models in critical care often perform well retrospectively but deliver limited bedside value once deployed under European governance constraints. ObjectiveEvaluate feasibility and early sociotechnical lessons from an offline Clinical Decission Support System (CDSS) predicting ICU LoS on a surgical ICU in practice MethodsWe conducted a prospective implementer study. Residents used AI and recorded estimates (n=136), consultants provided blinded estimates (n=162), AI outputs were logged (n=221). Version 1 showed LoS prediction, Version 2 updated the model and added a compact feature importance panel by using TreeSHAP. Human factors were assessed with Psychological Assessment of AI-based Decision Support (PAAI) and an embedded ethicist informed design and onboarding. Ethics Projekt.Nr 24-0336-KB, registry: DRKS00037851. ResultsOffline deployment was feasible but caused coordination burden. Version 2 reduced MAE for AI (5.80[-&gt;]4.92) and resident+AI estimates (6.18[-&gt;]3.84; both p<0.05). PAAI identified user groups. ConclusionsEarly embedding exposed governance-driven costs and highlighted iterative upgrading to address the translation gap.

BackgroundIndustrial and peri-urban settings present complex health challenges driven by occupational exposures, environmental risks, and socioeconomic vulnerability. Despite ongoing health education and preventive efforts, many populations living and working in such settings continue to experience significant unmet health needs that limit wellbeing and access to care. MethodsThis cross-sectional qualitative study was conducted in Namanve Industrial Park and surrounding communities in Mukono District, Uganda, as part of a baseline assessment to inform a planned health education intervention. Data were collected through focus group discussions (FGDs) and key informant interviews (KIIs) involving industrial workers, supervisors, health and safety personnel, teachers, school administrators, school nurses, and community stakeholders. Data were analysed using an inductive thematic analysis approach to identify unmet health needs and related systemic gaps. ResultsParticipants articulated multiple, interrelated unmet health needs spanning preventive and primary healthcare services, sexual and reproductive health, first aid and occupational safety, water, sanitation and hygiene (WASH), environmental health, and mental health and psychosocial support. Frequently reported gaps included limited access to routine screening and testing services, lack of essential commodities such as first aid supplies, sanitary pads, personal protective equipment, and soap, inadequate WASH infrastructure, insufficient mental health and counselling services, and structural barriers related to informal employment and poor living conditions. These unmet needs were commonly expressed through requests for materials and services, reflecting broader health system and institutional shortcomings rather than individual dependency. ConclusionThe findings demonstrate that unmet health needs in Namanve Industrial Park and surrounding communities are driven by systemic and structural gaps that constrain access to basic healthcare and preventive services. Addressing these needs requires integrated interventions that combine health education with improved service delivery, essential commodities, and supportive environments. Baseline evidence from this study provides critical guidance for designing context-appropriate, sustainable health interventions in industrial and peri-urban settings.

BackgroundSedation is a medically induced state implemented to facilitate procedures or care of critically ill patients in the Intensive Care Unit (ICU). Nurses ensure safe sedation by applying agitation scales to reduce complications. There is sufficient research evaluating nurses knowledge, attitudes, and practices regarding sedation for critically ill patients in the ICU of Tanzanian tertiary Hospitals. MethodsThis hospital-based cross-sectional study assessed nurses knowledge, attitudes, and practices on sedation in ICUs of three referral hospitals in Dar es Salaam, Tanzania. A sample of 163 nurses was recruited using stratified sampling. Data were collected through structured questionnaires and checklists, then analyzed with SPSS version 25. Variables with p [&le;] 0.2 entered multivariate regression; significance was set at p < 0.05, 95% confidence interval. ResultsMost participants were female (60.7%) with a mean age of 34.6 {+/-} 6.48 years. Of 163 nurses, 68.1% had adequate knowledge of sedation, though males were 38% less likely to demonstrate this (AOR = 0.377, 95% CI: 0.181-0.787, p = 0.009). Unfavourable attitudes were reported by 76.7% (n=125), while trained nurses were nearly twice as likely to show favorable attitudes (AOR = 2.53; 95% CI: 1.015-6.422; p = 0.046). Poor adherence was noted in 81.6% of respondents. Nurses aged 25-35 were 34% less likely to report poor adherence than those aged 45 and above (AOR = 0.344; 95% CI: 0.129-0.912; p = 0.032). ConclusionThis study identified adequate knowledge but negative attitudes and poor adherence among ICU nurses. Strengthening training, mentorship, and standardized protocols is crucial for enhancing sedation care and improving patient outcomes.

Distributed manufacturing of open-source hardware shows potential to offer accessible, affordable, and customizable solutions for users in low-resource contexts. Their real-world adoption, however, depends not only on the availability of openly shared designs but also on their replicability when fabricated in different local contexts. This work investigates the replicability of open-source hardware through a practical design-driven approach, using the development and experimental evaluation of a two-piece open-source forearm crutch as a case study. Replicability was considered from early-stage design and evaluated by introducing controlled variations from distributed manufacturing contexts, e.g., material feedstock, manufacturing equipment, and fabrication strategies. Four batches of crutches were fabricated and assembled, using virgin and recycled filaments on small- and large-format 3D printers. After the qualitative evaluation, mechanical static load testing was performed following ISO 11334:2007, together with economic analysis. Comparable mean load-bearing and consistent failure behavior were achieved across batches, making them suitable for use in pairs. Limited cost variability was achieved, supporting repairability and product lifecycle extension. Beyond the specific case study, replicability of open-source hardware needs to be considered as an early-stage design constraint by developing products that allow for variability from local contexts and by including product-specific approaches to assess replicability during development.

BackgroundLipedema is a chronic condition characterized by disproportionate adipose tissue accumulation, pain, and sensitivity, often influenced by hormonal fluctuations. Despite its prevalence, the specific impact of exogenous hormones on the disease course remains understudied. ObjectiveTo investigate the association between hormonal contraceptive use and the presence and severity of lipedema in Brazilian women. MethodsA cross-sectional study was conducted at Amato - Instituto de Medicina Avancada using a structured online questionnaire administered between August and November 2025. Brazilian women aged 18 years or older with suspected or diagnosed lipedema were included. The questionnaire assessed demographic and clinical characteristics, history of contraceptive use, lipedema symptoms, and impact on quality of life. Symptom scores (0-8 points) and quality of life impact scores (0-15 points) were calculated. Statistical analyses included Chi-square and Kruskal-Wallis tests, Spearman correlations, and logistic and linear regressions. ResultsA total of 637 women participated, with a mean age of 41.8 {+/-} 8.7 years and a mean BMI of 28.9 {+/-} 6.4 kg/m{superscript 2}. Of the participants, 491 (77.1%) had a confirmed diagnosis of lipedema. It was observed that 58.8% of users reported symptom worsening after contraceptive use (p<0.001). Free-text analysis revealed that 15.1% of participants experienced the onset of lipedema symptoms concurrently with the start of contraceptive use. Weight gain as a side effect was strongly associated with worsening. In multivariate logistic regression, symptom score (OR=1.562, p<0.001) and age at menarche (OR=0.746, p=0.0135) were significant predictors of worsening. Regarding impact on quality of life, BMI (beta=0.364) and pain (beta=0.641) were independent predictors. Conclusions: This study demonstrates a significant association between hormonal contraceptive use and self-reported worsening of lipedema symptoms. These results have potential implications for individualized contraceptive counseling for women with lipedema and reinforce the need for prospective investigations to confirm the nature and direction of this association.

ObjectiveThis binational cross-centre study analyses a consented audiological-vestibular test battery for characterising age-related hearing loss, enabling precise phenotyping of suprathreshold functional, physiological, and vestibular factors beyond audibility. DesignStatistical analysis of centre effects to assess comparability of the test battery measured at two centres (Germany and France); statistical analysis of age and pure-tone average (PTA) effects per test to identify potential covariates. Samplen = 55 (39 German and 16 French) participants with hearing thresholds better than the age-dependent median of the PTA, aged 40 years or older. ResultsAge- and PTA-dependent reference data were derived. Due to negligible centre effects, all data were pooled across centres. Age and PTA effects were identified for some tests, especially for audiological-functional tests. No age effects were found for vestibular tests. ConclusionsNormative values for a clinically feasible, multidimensional audiological-vestibular test battery were provided, including several measures whose age and PTA dependencies were previously unclear. Age and PTA should be considered as covariates for interpretation of these tests in future applications such as, e.g., phenotype-genotype relations in specified cohorts.

Purposeto describe HRV metrics in Covid-19 patients at admission in the ICU and its relationship with mortality and invasive mechanical ventilation (IMV). Heart rate variability (HRV) in sitting position in critically ill patients has not been explored. Methodswe conducted a prospective single-centre observational study. Adult patients admitted in the ICU with respiratory failure due to RT-PCR-confirmed SARS-CoV-2 but not under IMV were included. Electrocardiogram was recorded at least for 15 minutes at 500 Hz during a stable sitting condition. Power spectrum was obtained using wavelets. Very low frequency (VLF), low frequency (LF) and high frequency (HF) powerbands were calculated and then normalized to total power (VLFn%, LFn% and HFn%). We also analyzed non-linear HRV dynamics. Results27 patients were included. LFn% was lower in non-survivors (4.5 vs 8 %, p=0.015) and related to 28-day mortality (OR 0.61; 95% CI: 0.32 to 0.9, P=0.05). In a robust generalized Gamma linear model, we found that detrended fluctuation analysis alpha 2 (DFA2) (RR 0.092; bootstrapped 95% CI: 0.031-0.361, P=0.003), admission APACHE II score (RR 1.084; bootstrapped 95% CI: 1.046 to 1.123, P=0.002) and SAF index (RR 0.985; bootstrapped 95% CI: 0.982 - 0.990, P<0.001) were associated with longer ICU LOS. Conclusionsdiminished normalized LF power was associated with 28-day mortality in univariate analysis among critically ill COVID-19 patients on spontaneous ventilation, potentially reflecting an altered autonomic response in early severe COVID-19. Normalized and absolute VLF power should be considered when analyzing HRV in ICU patients. DFA2 was the HRV variable with the strongest association with ICU LOS. These exploratory results could be helpful to design newer tools for early prognostication in COVID-19 patients.

Severe neonatal hyperbilirubinemia remains a leading cause of preventable neonatal morbidity and mortality in low- and middle-income countries (LMICs), where unreliable electricity supply, limited specialist availability, and high treatment costs constrain access to effective phototherapy. There is limited evidence on scalable, climate-resilient phototherapy solutions suitable for decentralised care delivery. We conducted a multicentre implementation study evaluating a fully solar-powered total-body phototherapy system deployed across tertiary and grassroots healthcare facilities in Nigeria between February 2024 and January 2026. The study followed a phased design: (1) specialist-controlled observational deployment at a tertiary hospital, (2) corroborative deployment at additional tertiary centres across climatic regions, and (3) task-shifted grassroots implementation in mission-owned hospitals. Neonates with moderate-to-severe hyperbilirubinemia were treated according to standard clinical protocols. Primary outcomes were successful reduction of bilirubin to [&le;]11.5 mg/dL, treatment duration, safety, and operational feasibility under electricity-independent conditions. Across all phases, nearly 2000 neonates have been screened and more than 650 neonates received treatment with the solar-powered phototherapy system. All treated neonates achieved bilirubin reduction to the predefined safety threshold, with a mean treatment duration of 19.2 {+/-} 13 hours during the initial observational phase. No treatment interruptions due to power failure occurred, and no phototherapy-related adverse events, neurological complications, or treatment-related mortality were observed. Treatment was safely delivered by junior clinicians and health assistants under task-shifted models in grassroots settings. The intervention eliminated the need for exchange blood transfusion among treated neonates and substantially reduced hospitalisation duration compared with conventional care pathways. This study demonstrates that fully solar-powered phototherapy can be safely, effectively, and sustainably implemented across multiple levels of the health system in a low-resource setting. By removing dependence on grid electricity and specialist personnel, the intervention addresses key structural barriers to neonatal care while supporting task shifting and climate-resilient service delivery. The findings support policy consideration of decentralised, infrastructure-independent phototherapy as a strategy to reduce neonatal morbidity and mortality in LMICs.

BackgroundRisk screening for pre-eclampsia relies on accurate gestational age assessment, but routine access to ultrasound-based gestational dating remains challenging in many low- and middle-income countries (LMICs). As part of the formative work for the "Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening" (PEARLS) trial, we aim to validate and implement an Artificial Intelligence (AI)-based algorithm for estimation of gestational age, using blind sweeps done with a handheld ultrasound device. This study protocol outlines the accuracy cohort for AI-based gestational age estimation in participating facilities in Ghana, Kenya, and South Africa. MethodsThis multi-country prospective cohort study will recruit 969 pregnant women at 13 health facilities across Kenya, Ghana and South Africa. The eligible population are pregnant women presenting for antenatal visit from 11+0 to 13+6 weeks gestation. Eligible women will have a gestational age assessment by a trained sonographer using fetal biometry (reference standard), followed by gestational age estimation conducted by a trained midwife using the AI-based Intelligent Ultrasound ScanNav FetalCheck system (experimental). Both conventional and AI-based gestational age scans will be conducted with the General Electric (GE) VScanTM Air platform. Women will return for a second visit between 14+0 and 27+6 weeks gestation (week of visit is randomly selected) for an assessment with both conventional and AI-based ultrasound. The primary objective is to determine the accuracy and precision of gestational age estimation using an AI ultrasound system in first and second trimesters, as compared to gestational age estimation using crown-rump length (CRL) measurement by conventional ultrasound in first trimester (11+0 to 13+6 weeks). DiscussionThe study will provide critical evidence on the accuracy of a point-of-care, AI-based gestational age estimation ultrasound algorithm in sub-Saharan African settings. This study will inform the design of the PEARLS trial, as well as provide vital evidence for expanding implementation of ultrasound-based gestational age assessment for women in Africa.