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Introduction: Cardiorespiratory monitoring is used in the neonatal intensive care unit (NICU) to assess the clinical status of newborn infants and detect critical deteriorations in cardiorespiratory function. Currently, heart rate (HR) is monitored by electrocardiography (ECG) and respiration by chest impedance (CI). Disadvantages of current monitoring techniques are usage of wired adhesive electrodes which may damage the skin and hinder care. The Bambi® belt is a wireless and non-adhesive alternative that enables cardiorespiratory monitoring by measuring electrical activity of the diaphragm via transcutaneous electromyography. A previous study showed feasibility of the Bambi® belt and this study compares the belt performance to ECG and CI., Methods and Analysis: This multicentre non-inferiority paired study will be performed in the NICU of the Máxima Medical Center (MMC) in Veldhoven and the Emma Children's Hospital, Amsterdam University Medical Centre (AmsterdamUMC) in Amsterdam, The Netherlands. 39 infants in different postmenstrual age groups (minimally 10 infants<30 weeks, between 30-32 weeks and >32 weeks) will be recruited. These infants will be monitored with the Bambi® belt in addition to standard ECG and CI for 24 hours. The primary outcome is the HR, studied with three criteria: (1) the limits of agreement of the HR measurements in terms of the second-to-second difference in the HR between the belt and standard ECG, (2) the detection of cardiac events consisting of bradycardia and tachycardia and (3) the quality of HR-monitoring. The secondary outcome is the respiratory rate (RR), studied with the criteria (1) agreement in RR-trend monitoring, (2) apnoea and tachypnoea detection and (3) reliable registrations., Ethics and Dissemination: This protocol was approved by the Medical Ethical Committee of the MMC and the Central Committee for Human Research. The MMC started patient recruitment in July and the AmsterdamUMC in August 2021. The results will be presented at conferences and published in peer-reviewed journals., Trial Registration Number: NL9480., Competing Interests: Competing interests: Bambi Medical B.V. supports the study by a financial grant and use of equipment free of charge. Data collection, analysis, interpretation and reporting will be done independent of Bambi Medical B.V., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In recent years, noncontact measurements of vital signs using cameras received a great amount of interest. However, some questions are unanswered: (i) Which vital sign is monitored using what type of camera? (ii) What is the performance and which factors affect it? (iii) Which health issues are addressed by camera-based techniques? Following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, we conduct a systematic review of continuous camera-based vital sign monitoring using Scopus, PubMed, and the Association for Computing Machinery (ACM) databases. We consider articles that were published between January 2018 and April 2021 in the English language. We include five vital signs: heart rate (HR), respiratory rate (RR), blood pressure (BP), body skin temperature (BST), and oxygen saturation (SpO 2 ). In total, we retrieve 905 articles and screened them regarding title, abstract, and full text. One hundred and four articles remained: 60, 20, 6, 2, and 1 of the articles focus on HR, RR, BP, BST, and SpO 2 , respectively, and 15 on multiple vital signs. HR and RR can be measured using red, green, and blue (RGB) and near-infrared (NIR) as well as far-infrared (FIR) cameras. So far, BP and SpO 2 are monitored with RGB cameras only, whereas BST is derived from FIR cameras only. Under ideal conditions, the root mean squared error is around 2.60 bpm, 2.22 cpm, 6.91 mm Hg, 4.88 mm Hg, and 0.86 °C for HR, RR, systolic BP, diastolic BP, and BST, respectively. The estimated error for SpO 2 is less than 1%, but it increases with movements of the subject and the camera-subject distance. Camera-based remote monitoring mainly explores intensive care, post-anaesthesia care, and sleep monitoring, but also explores special diseases such as heart failure. The monitored targets are newborn and pediatric patients, geriatric patients, athletes (e.g., exercising, cycling), and vehicle drivers. Camera-based techniques monitor HR, RR, and BST in static conditions within acceptable ranges for certain applications. The research gaps are large and heterogeneous populations, real-time scenarios, moving subjects, and accuracy of BP and SpO 2 monitoring.

Wearables are valuable solutions for monitoring a variety of physiological parameters. Their application in cardiorespiratory monitoring may significantly impact global health problems and the economic burden related to cardiovascular and respiratory diseases. Here, we describe a soft biosensor capable of monitoring heart (HR) and respiratory (RR) rates simultaneously. We show that a skin-interfaced biosensor based on fiber optics (i.e., the smart patch) is capable of estimating HR and RR by detecting local ribcage strain caused by breathing and heart beating. The system addresses some of the main technical challenges that limit the wide-scale use of wearables, such as the simultaneous monitoring of HR and RR via single sensing modalities, their limited skin compliance, and low sensitivity. We demonstrate that the smart patch estimates HR and RR with high fidelity under different respiratory conditions and common daily body positions. We highlight the system potentiality of real-time cardiorespiratory monitoring in a broad range of home settings.

Objective. Monitoring heart rate (HR) and respiratory rate (RR) is essential in preterm infants and is currently measured with ECG and chest impedance (CI), respectively. However, in current clinical practice these techniques use wired adhesive electrodes which can cause skin damage and hinder parent-infant interaction. Moreover, CI is not always reliable. We assessed the feasibility of a wireless dry electrode belt to measure HR and RR via transcutaneous diaphragmatic electromyography (dEMG). Approach. In this prospective, observational study, infants were monitored up to 72 h with the belt and standard CI. Feasibility of the belt was expressed by its ability to retrieve a respiratory waveform from dEMG, determining the percentage of time with stable respiration data without signal errors ('lead-off' and Bluetooth Loss Error, 'BLE'), skin-friendliness of the belt (skin score) and by exploring the ability to monitor trends in HR and RR with the belt. Main results. In all 19 included infants (median gestational age 27.3 weeks) a respiratory waveform could be obtained. The amount of signal errors was low (lead-off 0.5% (IQR 0.1-1.6) and BLE 0.3% (IQR 0.1-0.9)) and 76.5% (IQR 69.3-80.0) of the respiration measurement was stable. No adverse skin effects were observed (median skin score of 3(3-4)). A similar HR and RR trend between the belt and CI was observed. Significance. Dry electrodes incorporated in a non-adhesive belt can measure dEMG in preterm infants. The belt provided a HR and RR trend similar to CI. Future studies are required to investigate the non-inferiority of the belt as a cardiorespiratory monitor compared to CI., (© 2022 Institute of Physics and Engineering in Medicine.)

This study investigated the benefits of using a biofeedback intervention programme to train children in controlling their heart rate variability (HRV) through slow-paced breathing in real time. HRV biofeedback interventions focused on showing subjects to breathe such that their HRV numbers rise, improving their self-regulation. The HRV biofeedback intervention, focused on breathing, was conducted with primary education students aged between 7 and 11 years. The programme consisted of five biofeedback sessions, where students were taught to breathe six long and slow pairs of breaths per minute, to increase their HRV. After participation in the programme, students, regardless of gender, increased their HRV in a statistically significant fashion with a large effect, but this effect was not the same for all ages. HRV biofeedback interventions are rarely applied in schools and given the effectiveness of the intervention to improve HRV in children, the applied implications of our results in educational settings are discussed, especially taking into account the children's ages.

Background: Studies using somatic pain models have shown the hypoalgesic effects of slow, deep breathing. We evaluated the effect of slow, deep breathing on visceral pain and explored putative mediating mechanisms including autonomic and emotional responses., Methods: Fifty-seven healthy volunteers (36 females, mean age = 22.0 years) performed controlled, deep breathing at a slow frequency (6 breaths per minute), controlled breathing at a normal frequency (14 breaths per minute; active control), and uncontrolled breathing (no-treatment control) in randomized order. Moderate painful stimuli were given during each condition by delivering electrical stimulation in the distal esophagus. Participants rated pain intensity after each stimulation. Heart rate variability and self-reported arousal were measured during each condition., Key Results: Compared to uncontrolled breathing, pain intensity was lower during slow, deep breathing (Cohen's d = 0.40) and normal controlled breathing (d = 0.47), but not different between slow, deep breathing and normal controlled breathing. Arousal was lower (d = 0.53, 0.55) and heart rate variability was higher (d = 0.70, 0.86) during slow, deep breathing compared to the two control conditions. The effect of slow, deep breathing on pain was not mediated by alterations in heart rate variability or arousal but was moderated by pain catastrophizing., Conclusions and Inferences: Slow, deep breathing can reduce visceral pain intensity. However, the effect is not specific to the slow breathing frequency and is not mediated by autonomic or emotional responses, suggesting other underlying mechanisms (notably distraction). Whether a long-term practice of slow, deep breathing can influence (clinical) visceral pain warrants to be investigated., (© 2021 John Wiley & Sons Ltd.)

Monitoring of respiration is a central task in clinical medicine, crucial to patient safety. Despite the uncontroversial role of altered respiratory frequency as an important sign of impending or manifest deterioration, reliable measurement methods are mostly lacking outside of intensive care units and operating theaters. Photoplethysmography targeting the central blood circulation in the sternum could offer accurate and inexpensive monitoring of respiration. Changes in blood flow related to the different parts of the respiratory cycle are used to identify the respiratory pattern. The aim of this observational study was to compare photoplethysmography at the sternum to standard capnography in healthy volunteers. Bland Altman analysis showed good agreement (bias -0.21, SD 1.6, 95% limits of agreement -3.4 to 2.9) in respiratory rate values. Photoplethysmography provided high-quality measurements of respiratory rate comparable to capnographic measurements. This suggests that photoplethysmography may become a precise, cost-effective alternative for respiratory monitoring., (© 2021 The Authors. Journal of Biophotonics published by Wiley-VCH GmbH.)

Allergic rhinitis (AR) is a chronic inflammatory disorder associated with a high prevalence of anxiety symptoms and respiratory disorders that adversely affect the quality of life. Studies have shown that allergen exposure induces anxiety-like behaviors. On the other hand, stress impairs the breathing pattern. However, the effect of stress on respiration and the relationship between anxiety-like behavior and stress-induced changes in breathing pattern has not been evaluated in AR. We assessed the impact of ovalbumin (OVA)-induced anxiety-like behaviors on stress-induced breathing pattern changes. Our findings showed that the allergic rhinitis induced by OVA challenge in sensitized rats induces anxiety-like behavior. Also, we found that stress decreases respiratory irregularity and increases respiratory variability, as well as the synchronization between IBI and RV time-series in AR animals. Moreover, in AR animals, we found a significant positive correlation between anxiety-like behavior and respiratory irregularity under non-stress conditions. Besides, a significant negative correlation was observed under stress conditions. The findings showed that anxiety-related behaviors may contribute to respiratory impairments under stress conditions in AR., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Clinical research on the beneficial effects induced by slow-paced breathing has been increasingly extended in the past twenty years. Improvements in cardiovascular functioning, executive functions, or stress management appear to be among the most prominent observations in these studies. However, the mechanisms underlying these effects are multiple and complex. This review will focus on the importance of reducing breathing rate at the resonant frequency (~ 0.1 Hz), which increases cardiac oscillations, thus reflecting improved vagally-mediated heart rate variability and baroreflex sensitivity. These effects are achieved through temporal coherence of respiratory, blood pressure, and cardiac phases, which are the origin of multiple peripheral benefits. In return, vagal afferents, which send inputs to interoceptive areas, are stimulated for longer and more intensely than when breathing spontaneously. In limbic areas, which may also be stimulated through larger cerebral blood flow oscillations and increases in oxygen delivery, interoceptive activation produces a cascade of neural activations that may be at the origin of the central benefits of deep and slow-paced breathing., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

This study sought to investigate whether slow deep breathing (SDB) facilitates reversal learning. We also explored whether SDB modulates the renewal effect. After learning a series of cue-outcome associations (early acquisition phase) in a predictive learning task, 37 participants paced their breathing according to a normal (NPB group; 0.2 Hz) or a slow (SDB group; 0.1 Hz) pattern while completing the reversal and renewal phases. Response correctness, heart rate variability (HRV, i.e., Root mean square of successive differences), and respiratory rate were assessed. Findings indicated that both groups adopted the targeted breathing pattern. As expected, the SDB (vs. NPB) group displayed a steeper rise in HRV from early acquisition to the later phases of the task during which the breathing manipulation took place. However, the performance of the NPB and SDB groups did not significantly differ in any phase of the predictive learning task. Despite the inconclusive findings on the effect of SDB on reversal and renewal, these results confirm that SDB can be performed while performing a learning task., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Heart rate (HR) and respiratory rate ( f R ) can be estimated by processing videos framing the upper body and face regions without any physical contact with the subject. This paper proposed a technique for continuously monitoring HR and f R via a multi-ROI approach based on the spectral analysis of RGB video frames recorded with a mobile device (i.e., a smartphone's camera). The respiratory signal was estimated by the motion of the chest, whereas the cardiac signal was retrieved from the pulsatile activity at the level of right and left cheeks and forehead. Videos were recorded from 18 healthy volunteers in four sessions with different user-camera distances (i.e., 0.5 m and 1.0 m) and illumination conditions (i.e., natural and artificial light). For HR estimation, three approaches were investigated based on single or multi-ROI approaches. A commercially available multiparametric device was used to record reference respiratory signals and electrocardiogram (ECG). The results demonstrated that the multi-ROI approach outperforms the single-ROI approach providing temporal trends of both the vital parameters comparable to those provided by the reference, with a mean absolute error (MAE) consistently below 1 breaths·min -1 for f R in all the scenarios, and a MAE between 0.7 bpm and 6 bpm for HR estimation, whose values increase at higher distances.

Allergic asthma affects both the respiratory function and central nervous system. Communication between the amygdala and respiratory control system is critical for regulating breathing function. To date, no study provides the effect of allergic inflammation on amygdala-respiration coupling. Here, we simultaneously recorded respiration and local field potentials of the amygdala during awake immobility in a rat model of allergic asthma. A decreased synchrony was found between amygdala and respiration in asthmatic rats. Allergen also reduced the modulatory effect of the respiration phase on amygdala power at delta, theta and gamma2 (80-120 Hz) frequencies. Moreover, in the animal model of allergic asthma, delta and theta oscillations strongly coordinate local gamma2 activity in the amygdala. These findings suggest that allergen can induce brain alterations and therefore shed light on future works to address how disruption of amygdala-respiration coupling contributes to respiratory dysfunction in allergic asthma., (Copyright © 2021 Elsevier B.V. All rights reserved.)

This study validated a more exact automated method of determining cardiovascular resonance frequency (RF) against the "stepped" protocol described by Lehrer et al. (Appl Psychophysiol Biofeedback 25(3):177-191, https://doi.org/10.1023/a:1009554825745 , 2000; in Foundations of heart rate variability biofeedback: A book of readings, The Association for Applied Psychophysiology and Biofeedback, pp 9-19, 2016). Thirteen participants completed a 15-min RF determination session by each method. The "stepped" protocol assesses HRV in five 3-min stationary windows from 4.5 to 6.5 breaths per minute (bpm), decreasing in 0.5 bpm steps. Multiple criteria, subjectively weighted by the clinician, determines RF. For this study, the proposed method used a sliding window with a fixed rate of change (67.04 ms per breath) at each of 78 breath cycles ranging from 4.25 to 6.75 bpm. Its algorithm analyzes IBI to locate the midpoint of the 1-min region of stable maximum peak-trough variability. RF is quantified from breath duration at that point. The software generates a visual display of superimposed HR and breathing data. Thus, the new method fully automates RF determination. Eleven of the 13 matched pairs fell within the 0.5 bpm resolution of the stepped method. Comparisons of LF power generated by the autoregressive (AR) spectral method showed a strong correlation in LF power production by the stepped and sliding methods (R = 0.751, p = 0.000). The "sliding" pacing protocol was favored by 69% of participants (p < 0.02). The new, fully-automated, method may facilitate both in-person and remote HRV biofeedback training. Software is available open-source., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Perinatal inflammation triggers breathing disturbances early in life and affects the respiratory adaptations to challenging conditions, including the generation of amplitude long-term facilitation (LTF) by acute intermittent hypoxia (AIH). Some of these effects can be avoided by anti-inflammatory treatments like minocycline. Since little is known about the effects of perinatal inflammation on the inspiratory rhythm generator, located in the preBötzinger complex (preBötC), we tested the impact of acute lipopolysaccharide (LPS) systemic administration (sLPS), as well as gestational LPS (gLPS) and gestational chronic IH (gCIH), on respiratory rhythm generation and its long-term response to AIH in a brainstem slice preparation from neonatal mice. We also evaluated whether acute minocycline administration could influence these effects. We found that perinatal inflammation induced by sLPS or gLPS, as well as gCIH, modulate the frequency, signal-to-noise ratio and/or amplitude (and their regularity) of the respiratory rhythm recorded from the preBötC in the brainstem slice. Moreover, all these perinatal conditions inhibited frequency LTF and amplitude long-term depression (LTD); gCIH even induced frequency LTD of the respiratory rhythm after AIH. Some of these alterations were not observed in slices pre-treated in vitro with minocycline, when compared with slices obtained from naïve pups, suggesting that ongoing inflammatory conditions affect respiratory rhythm generation and its plasticity. Thus, it is likely that alterations in the inspiratory rhythm generator and its adaptive responses could contribute to the respiratory disturbances observed in neonates that suffered from perinatal inflammatory challenges., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Cold-water coral (CWC) reefs are numerous and widespread along the Norwegian continental shelf where oil and gas industry operate. Uncertainties exist regarding their impacts from operational discharges to drilling. Effect thresholds obtained from near-realistic exposure of suspended particle concentrations for use in coral risk modeling are particularly needed. Here, nubbins of Desmophyllum pertusum (Lophelia pertusa) were exposed shortly (5 days, 4h repeated pulses) to suspended particles (bentonite BE; barite BA, and drill cuttings DC) in the range of ~ 4 to ~ 60 mg.l-1 (actual concentration). Physiological responses (respiration rate, growth rate, mucus-related particulate organic carbon OC and particulate organic nitrogen ON) and polyp mortality were then measured 2 and 6 weeks post-exposure to assess long-term effects. Respiration and growth rates were not significantly different in any of the treatments tested compared to control. OC production was not affected in any treatment, but a significant increase of OC:ON in mucus produced by BE-exposed (23 and 48 mg.l-1) corals was revealed 2 weeks after exposure. Polyp mortality increased significantly at the two highest DC doses (19 and 49 mg.l-1) 2 and 6 weeks post-exposure but no significant difference was observed in any of the other treatments compared to the control. These findings are adding new knowledge on coral resilience to short realistic exposure of suspended drill particles and indicate overall a risk for long-term effects at a threshold of ~20 mg.l-1., Competing Interests: This study and the writing of the manuscript was financed by Equinor AS. There are no patents, products in development or marketed products associated with this research to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Behavioural and electrophysiological studies point to an apparent influence of the state of respiration, i.e., whether we inhale or exhale, on brain activity and cognitive performance. Still, the prevalence and relevance of such respiratory-behavioural relations in typical sensory-cognitive tasks remain unclear. We here used a battery of six tasks probing sensory detection, discrimination and short-term memory to address the questions of whether and by how much behaviour covaries with the respiratory cycle. Our results show that participants tend to align their respiratory cycle to the experimental paradigm, in that they tend to inhale around stimulus presentation and exhale when submitting their responses. Furthermore, their reaction times, but not so much their response accuracy, consistently and significantly covary with the respiratory cycle, differing between inhalation and exhalation. This effect is strongest when analysed contingent on the respiratory state around participants' responses. The respective effect sizes of these respiration-behaviour relations are comparable to those seen in other typical experimental manipulations in sensory-cognitive tasks, highlighting the relevance of these effects. Overall, our results support a prominent relation between respiration and sensory-cognitive function and show that sensation is intricately linked to rhythmic bodily or interoceptive functions., (© 2022. The Author(s).)

The high moisture level of exhaled gases unavoidably limits the sensitivity of breath analysis via wearable bioelectronics. Inspired by pulmonary lobe expansion/contraction observed during respiration, a respiration-driven triboelectric sensor (RTS) was devised for simultaneous respiratory biomechanical monitoring and exhaled acetone concentration analysis. A tin oxide-doped polyethyleneimine membrane was devised to play a dual role as both a triboelectric layer and an acetone sensing material. The prepared RTS exhibited excellent ability in measuring respiratory flow rate (2-8 L/min) and breath frequency (0.33-0.8 Hz). Furthermore, the RTS presented good performance in biochemical acetone sensing (2-10 ppm range at high moisture levels), which was validated via finite element analysis. This work has led to the development of a novel real-time active respiratory monitoring system and strengthened triboelectric-chemisorption coupling sensing mechanism.

The exact fabrication of precise three-dimensional structures for piezoresistive sensors necessitates superior manufacturing methods or tooling, which are accompanied by time-consuming processes and the potential for environmental harm. Herein, we demonstrated a method for in situ synthesis of zinc oxide nanorod (ZnO NR) arrays on graphene-treated cotton and paper substrates and constructed highly sensitive, flexible, wearable, and chemically stable strain sensors. Based on the structure of pine trees and needles in nature, the hybrid sensing layer consisted of graphene-attached cotton or paper fibers and ZnO NRs, and the results showed a high sensitivity of 0.389, 0.095, and 0.029 kPa -1 and an ultra-wide linear range of 0-100 kPa of this sensor under optimal conditions. Our study found that water absorption and swelling of graphene fibers and the associated reduction of pore size and growth of zinc oxide were detrimental to pressure sensor performance. A random line model was developed to examine the effects of different hydrothermal times on sensor performance. Meanwhile, pulse detection, respiration detection, speech recognition, and motion detection, including finger movements, walking, and throat movements, were used to show their practical application in human health activity monitoring. In addition, monolithically grown ZnO NRs on graphene cotton sheets had been integrated into a flexible sensing platform for outdoor UV photo-indication, which is, to our knowledge, the first successful case of an integrated UV photo-detector and motion sensor. Due to its excellent strain detection and UV detection abilities, these strategies are a step forward in developing wearable sensors that are cost-controllable and high-performance.

Concealed Information Tests (CIT) are administered to verify whether suspects recognize certain features from a crime. Whenever it is presumed that innocent suspects were contaminated with critical information (e.g., the perpetrator had a knife), the examiner may ask more detailed questions (e.g., specific types of knives) to prevent false positives. However, this may increase the number of false negatives if the true perpetrator fails to discern specific details from its plausible irrelevant controls, or because detailed crime-scene information may be forgotten. We examined whether presenting items at the exemplar level protects against contamination, and whether it compromises the sensitivity in a physiological CIT. Participants (N = 142) planned a mock-robbery, with critical items encoded either at the category or at the exemplar level. The CIT was administered immediately or after a 1-week-delay, with questions phrased at the categorical or exemplar level. There were no effects of time delay. Results revealed that when item detailedness was congruent at encoding and testing, the SCR, HR, and RLL showed larger differential responses, as compared with incongruent conditions. Participants contaminated with crime knowledge at the categorical level did not show a CIT-effect for crime details at the exemplar level, suggesting detailed questions may counter the leakage problem. Asking questions at the exemplar level did not reduce the CIT detection efficiency as compared to asking questions at the categorical level. The importance of congruency between encoding and testing provides examiners with a challenge, as it is difficult to estimate how details are naturally encoded., (© 2021 The Authors. Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

It is significant to monitor respiration conveniently and in real time for people suffering from respiratory diseases. Polymer optical fibers (POFs) have the advantages of flexibility and light weight, which is highly desirable for wearable respiratory monitoring. However, in most current applications, the POFs are stitched on the textile substrates in the form of macro-bending. This method is complex to fix the bending with certain curvatures and uncomfortable compared with the POF sensors woven into the textile. In this paper, a respiratory fabric sensor based on the side luminescence and photosensitivity mechanism of POF is proposed and demonstrated. The 750µm-diameter POFs were woven into a fabric as warp and laser marking was performed at their designed positions to make them release or couple light. The spacing change between the POFs caused by the respiratory movement accordingly makes the light intensity change in the photosensitive fiber. We chose four fabric widths (10cm, 8cm, 6cm and 4cm) and four fabric weaves (plain weave, honeycomb weave, 1/3 right twill weave and 8/3 warp satin weave) to implement the full-factor experiment for exploring the measurement effect of the respiratory fabric sensor. The result is that the fabric with width of 4cm and weave of 8/3 warp satin is optimal. The calm and deep respiratory tests of the human chest and abdomen in sitting and standing posture were carried out and the test performance of the fabric sensor is almost comparable to that of the medical monitor. The proposed respiratory fabric sensor is comfortable, easily woven and high in precision, which is expected to realize industrialized scale production.

High flow nasal cannula (HFNC) is used to treat acute hypoxemic respiratory failure (AHRF) even outside the ICU and the ROX index (pulse oximetry/fraction of inspired oxygen/respiratory rate) may predict HFNC failure., Objective: The purpose of this investigation was therefore to verify whether the ROX index is an accurate predictor of HFNC failure for COVID-19 patients treated outside the intensive care unit (ICU) and to evaluate the validity of the previously suggested threshold., Design: Multicenter study. Retrospective observational analysis of prospectively collected data., Setting: 3 centres specialized in non-invasive respiratory support (Buenos Aires, Argentina; Bolzano and Treviso, Italy). Patients treated outside the ICU were analysed MEASUREMENTS: The variables to calculate the ROX index were collected during the first day of therapy at 2, 6, 12 and 24 hours and then recorded every 24 hours. HFNC failure was defined as escalation of respiratory support to invasive mechanical ventilation (IMV) or death., Main Results: A total of 35 (29%) patients failed HFNC and required intubation. ROC analysis identified the 12-hour ROX index as the best predictor of intubation with an AUC of 0.7916[CI 95% 0.6905-0.8927] and the best threshold to be 5.99[Specificity 96% Sensitivity 62%]. In the survival analysis, a ROX value <5.99 was associated with an increased risk of failure (p = 0008 log - rank test). The threshold of 4,9 identified by Roca as the best predictor in non-COVID patients, was not able to discriminate between success and failure (p = 0.4 log-rank test) in our patients., Conclusions: ROX index may be useful in guiding the clinicians in their decision to intubate patients, especially in patients with moderate ARF, treated therefore outside the ICU. Indeed, it also demonstrates a different threshold value than reported for non-COVID patients, possibly related to the different mechanisms of hypoxia., (Copyright © 2021 Sociedade Portuguesa de Pneumologia. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Clinicians use several measures to ascertain whether individual patients will tolerate liberation from mechanical ventilation, including the rapid shallow breathing index (RSBI)., Research Question: Given varied use of different thresholds, patient populations, and measurement characteristics, how well does RSBI predict successful extubation?, Study Design and Methods: We searched six databases from inception through September 2019 and selected studies reporting the accuracy of RSBI in the prediction of successful extubation. We extracted study data and assessed quality independently and in duplicate., Results: We included 48 studies involving RSBI measurements of 10,946 patients. Pooled sensitivity for RSBI of < 105 in predicting extubation success was moderate (0.83 [95% CI, 0.78-0.87], moderate certainty), whereas specificity was poor (0.58 [95% CI, 0.49-0.66], moderate certainty) with diagnostic ORs (DORs) of 5.91 (95% CI, 4.09-8.52). RSBI thresholds of < 80 or 80 to 105 yielded similar sensitivity, specificity, and DOR. These findings were consistent across multiple subgroup analyses reflecting different patient characteristics and operational differences in RSBI measurement., Interpretation: As a stand-alone test, the RSBI has moderate sensitivity and poor specificity for predicting extubation success. Future research should evaluate its role as a permissive criterion to undergo a spontaneous breathing trial (SBT) for patients who are at intermediate pretest probability of passing an SBT., Trial Registry: PROSPERO; No.: CRD42020149196; URL: www.crd.york.ac.uk/prospero/., (Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)

Brainstem respiratory neuronal network significantly contributes to cough motor pattern generation. Neuronal populations in the pre-Bötzinger complex (PreBötC) represent a substantial component for respiratory rhythmogenesis. We studied the role of PreBötC neuronal excitation and inhibition on mechanically induced tracheobronchial cough in 15 spontaneously breathing, pentobarbital anesthetized adult cats (35 mg/kg, iv initially). Neuronal excitation by unilateral microinjection of glutamate analog d,l-homocysteic acid resulted in mild reduction of cough abdominal electromyogram (EMG) amplitudes and very limited temporal changes of cough compared with effects on breathing (very high respiratory rate, high amplitude inspiratory bursts with a short inspiratory phase, and tonic inspiratory motor component). Mean arterial blood pressure temporarily decreased. Blocking glutamate-related neuronal excitation by bilateral microinjections of nonspecific glutamate receptor antagonist kynurenic acid reduced cough inspiratory and expiratory EMG amplitude and shortened most cough temporal characteristics similarly to breathing temporal characteristics. Respiratory rate decreased and blood pressure temporarily increased. Limiting active neuronal inhibition by unilateral and bilateral microinjections of GABA A receptor antagonist gabazine resulted in lower cough number, reduced expiratory cough efforts, and prolongation of cough temporal features and breathing phases (with lower respiratory rate). The PreBötC is important for cough motor pattern generation. Excitatory glutamatergic neurotransmission in the PreBötC is involved in control of cough intensity and patterning. GABA A receptor-related inhibition in the PreBötC strongly affects breathing and coughing phase durations in the same manner, as well as cough expiratory efforts. In conclusion, differences in effects on cough and breathing are consistent with separate control of these behaviors. NEW & NOTEWORTHY This study is the first to explore the role of the inspiratory rhythm and pattern generator, the pre-Bötzinger complex (PreBötC), in cough motor pattern formation. In the PreBötC, excitatory glutamatergic neurotransmission affects cough intensity and patterning but not rhythm, and GABA A receptor-related inhibition affects coughing and breathing phase durations similarly to each other. Our data show that the PreBötC is important for cough motor pattern generation, but cough rhythmogenesis appears to be controlled elsewhere.

Meditation is a consciousness state associated with specific physiological and neural correlates. Numerous investigations of these correlates reported controversial results which prevented a consistent depiction of the underlying neurophysiological processes. Here we investigated the dynamics of multiple neurophysiological indicators during a staged meditation session. We measured the physiological changes at rest and during the guided Taoist meditation in experienced meditators and naive subjects. We recorded EEG, respiration, galvanic skin response, and photoplethysmography. All subjects followed the same instructions split into 16 stages. In the experienced meditators group we identified two subgroups with different physiological markers dynamics. One subgroup showed several signs of general relaxation evident from the changes in heart rate variability, respiratory rate, and EEG rhythmic activity. The other subgroup exhibited mind concentration patterns primarily noticeable in the EEG recordings while no autonomic responses occurred. The duration and type of previous meditation experience or any baseline indicators we measured did not explain the segregation of the meditators into these two groups. These results suggest that two distinct meditation strategies could be used by experienced meditators, which partly explains the inconsistent results reported in the earlier studies evaluating meditation effects. Our findings are also relevant to the development of the high-end biofeedback systems., Competing Interests: The authors have declared that no competing interests exist.

This preregistered, randomized field experiment tested the effectiveness of a brief deep breathing intervention on children's concurrent physiological arousal in naturalistic settings (N  = 342; M age  = 7.48 years; 46% female; 53% Asian, 26% White; 21% other race/ethnicity). The treatment consisted of an animated video that introduced deep breathing as a self-regulation strategy and scaffolded the child in taking a few slow-paced breaths, while the control group watched an informational video featuring similar animated images. Respiratory sinus arrhythmia (RSA) and heart rate (HR) were measured while children were sitting still (baseline) and subsequently while watching 1-min videos. Relative to baseline arousal, RSA increased and HR decreased only in response to the deep-breathing treatment video. Effects were larger in the second 30-s epoch of the video, which included most of the deep breathing practice. RSA fully mediated the intervention's effects on HR. By analyzing all children exposed to intervention video regardless of their engagement in the deep breathing practice (intention-to-treat design) and by using easily scalable treatment videos, the study identifies an effective and pragmatic approach to reducing children's physiological arousal in everyday, group settings. Implications for advancing applied developmental psychophysiological research are discussed., (© 2021 Wiley Periodicals LLC.)

Background: Breathing frequency is rarely measured during a field walking test since the current monitoring system using a face mask is cumbersome for older adults. For effective clinical application, we aimed to validate the new respiratory monitor using wearable strain sensors during a 6-min walk test (6MWT) in young adults and patients with chronic obstructive pulmonary disease (COPD)., Methods: The study included young adults and patients with stable COPD voluntarily recruited from three hospitals. Breathing frequency during 6MWT were measured by the strain sensor and a nasal capnometer. Total breathing frequencies were measured by the capnometer. The Bland-Altman method was used to estimate the mean limit of agreement for breathing frequency., Results: A total of 23 young adults (age = 23.1 ± 3.7, mean ± SD) and 50 patients with COPD (age = 75.2 ± 7.2, %FEV1 = 59.1 ± 19.7) were analyzed. During the entire test period, the total breathing frequencies were measured based on an average of 252 ± 46 breaths, and the total breathing frequency was higher in patients with COPD than in young adults (mean difference = -3.349, p < 0.0013). The mean difference in breathing frequency between the strain sensors and capnometer was -0.28 (95%CI: 0.75 to 0.20), and the limit of agreement ranged from -4.1 to 3.6. The CI of the limit of agreement included the limit of equivalence (4 counts/min)., Conclusions: The novel respiratory monitor with wearable sensors achieved the target accuracy in both young adults and patients with COPD in the 6MWT., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Dogs differ greatly in size, heart (HR) and breathing rates (BR). In addition, they have a clear Respiratory Sinus Arrhythmia (RSA) at rest. Therefore, better than any other mammalian species, dogs offer an opportunity to test whether resting RSA varies with body weight, HR or BR. Sequences of inter-beat-intervals (IBI, ms) a few-minutes long were collected in twenty-three resting dogs of different sizes, together with pneumograms. IBI variability was quantified by standard time-domain criteria. From beat-to-beat instantaneous heart rate (hR, beats/min), RSA was the difference between inspiratory peak (hR-peak) and expiratory trough (hR-trough), in percent of mean HR. RSA averaged 40.1 % ±4.5, or more than three times that of humans, with large inter-animal variability. On average, RSA contributed 38 % of the total IBI variability. RSA did not differ between sexes and did not correlate with body weight. It had modest negative correlations with HR (P < 0.05) and BR (P < 0.05), and a very strong negative correlation with hR-trough (P < 0.001). In two separate dogs, during panting, RSA was absent. In the transition from resting to panting, RSA continued like at rest for several breaths, despite the tachypnea, underlying the importance of central mechanisms in the origin of RSA. In conclusion, RSA in dogs is very large and explains less than half of their sinus arrhythmia. Rather than HR, BR or hR-peak, changes in the vago-sympathetic control, represented by hR-trough, are the most likely source of variability of RSA among subjects., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Background: Experimental and pilot clinical data suggest that spontaneously breathing patients with sepsis and septic shock may present increased respiratory drive and effort, even in the absence of pulmonary infection. The study hypothesis was that respiratory drive and effort may be increased in septic patients and correlated with extrapulmonary determinant and that high-flow nasal cannula may modulate drive and effort., Methods: Twenty-five nonintubated patients with extrapulmonary sepsis or septic shock were enrolled. Each patient underwent three consecutive steps: low-flow oxygen at baseline, high-flow nasal cannula, and then low-flow oxygen again. Arterial blood gases, esophageal pressure, and electrical impedance tomography data were recorded toward the end of each step. Respiratory effort was measured as the negative swing of esophageal pressure (ΔPes); drive was quantified as the change in esophageal pressure during the first 500 ms from start of inspiration (P0.5). Dynamic lung compliance was calculated as the tidal volume measured by electrical impedance tomography, divided by ΔPes. The results are presented as medians [25th to 75th percentile]., Results: Thirteen patients (52%) were in septic shock. The Sequential Organ Failure Assessment score was 5 [4 to 9]. During low-flow oxygen at baseline, respiratory drive and effort were elevated and significantly correlated with arterial lactate (r = 0.46, P = 0.034) and inversely with dynamic lung compliance (r = -0.735, P < 0.001). Noninvasive support by high-flow nasal cannula induced a significant decrease of respiratory drive (P0.5: 6.0 [4.4 to 9.0] vs. 4.3 [3.5 to 6.6] vs. 6.6 [4.9 to 10.7] cm H2O, P < 0.001) and effort (ΔPes: 8.0 [6.0 to 11.5] vs. 5.5 [4.5 to 8.0] vs. 7.5 [6.0 to 12.6] cm H2O, P < 0.001). Oxygenation and arterial carbon dioxide levels remained stable during all study phases., Conclusions: Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula., (Copyright © 2021, the American Society of Anesthesiologists. All Rights Reserved.)

While there is an increasing shift in cognitive science to study perception of naturalistic stimuli, this study extends this goal to naturalistic contexts by assessing physiological synchrony across audience members in a concert setting. Cardiorespiratory, skin conductance, and facial muscle responses were measured from participants attending live string quintet performances of full-length works from Viennese Classical, Contemporary, and Romantic styles. The concert was repeated on three consecutive days with different audiences. Using inter-subject correlation (ISC) to identify reliable responses to music, we found that highly correlated responses depicted typical signatures of physiological arousal. By relating physiological ISC to quantitative values of music features, logistic regressions revealed that high physiological synchrony was consistently predicted by faster tempi (which had higher ratings of arousing emotions and engagement), but only in Classical and Romantic styles (rated as familiar) and not the Contemporary style (rated as unfamiliar). Additionally, highly synchronised responses across all three concert audiences occurred during important structural moments in the music-identified using music theoretical analysis-namely at transitional passages, boundaries, and phrase repetitions. Overall, our results show that specific music features induce similar physiological responses across audience members in a concert context, which are linked to arousal, engagement, and familiarity., (© 2021. The Author(s).)

We compared cardiopulmonary responses to arm-ergometry in individuals with cervical spinal cord injury (C-SCI) and able-bodied controls. We hypothesized that individuals with C-SCI would have higher respiratory frequency (f b ) but lower tidal volume (VT) at a given work rate and dynamically hyperinflate during exercise, whereas able-bodied individuals would not. Participants completed pulmonary function testing, an arm-ergometry test to exhaustion, and a sub-maximal exercise test consisting of four-minute stages at 20, 40, 60, and 80% peak work rate. Able-bodied individuals completed a further sub-maximal test with absolute work rate matched to C-SCI. During work rate matched sub-maximal exercise, C-SCI had smaller VT (main effect p < 0.001) compensated by an increased f b (main effect p = 0.009). C-SCI had increased end-expiratory lung volume at 80% peak work rate vs. rest (p < 0.003), whereas able-bodied did not. In conclusion, during arm-ergometry, individuals with C-SCI exhibit altered ventilatory patterns characterized by reduced VT, higher f b , and dynamic hyperinflation that may contribute to the observed reduced aerobic exercise capacity., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Heart rate variability (HRV) is a well-established surrogate of cardiac and emotional health that reflects the balance between sympathetic and parasympathetic activity of the autonomic nervous system. We examined the impact of manipulating exhalation to inhalation ratio (E:I) on HRV, without altering the intrinsic breathing rate of healthy individuals. We hypothesized that a longer exhalation relative to inhalation (E:I > 1) would shift HRV metrics in a direction consistent with increased parasympathetic activity. Twenty-eight individuals (16 young [6M, age = 21-28];12 older adults [6M, age = 66-80]) completed a task during which they paced breathing according to their intrinsic respiratory rate, but altered onset of exhalation and inhalation according to 1:1 sound cue (equal exhalation and inhalation duration) or 2:1 cue (exhalation twice as long as inhalation). Paced 1:1 breathing followed these task conditions to examine residual effects. Estimates of actual E:I ratio based on thoracic movement were 1.08(0.16) for 1:1 task and 1.33(0.20) for 2:1 task, which were significantly different from one another. HRV metrics derived from electrocardiogram included root mean square of the successive differences between normal heartbeats (RMSSD) and high-frequency (HF) HRV. Analyses of HRV metrics by block showed that RMSSD and HF-HRV were higher in the 2:1 task condition compared to 1:1. Time series analysis showed that HF-HRV increased after the end of the 2:1 task block and remained elevated for four minutes. These findings suggest that longer duration of exhalation relative to inhalation, without altering breathing rate, acutely increased RMSSD and HF-HRV, consistent with enhancement of cardiac vagal tone., (© 2021 Society for Psychophysiological Research.)

Purpose: To identify the changes of ventilation ([Formula: see text] E ), tidal volume (V T ) and respiratory frequency (fr) at different incremental step test intensities during maturation of children and adolescents., Methods: A semi-longitudinal study was conducted on 68 healthy untrained boys and girls aged 11-17 years. The subjects were separated into three distinct age groups. [Formula: see text] E , V T and fr parameters were evaluated annually during 3 years by modifying incremental step test intensities according to ventilatory threshold (V Th ) level (30, 60 and 90% of [Formula: see text]O 2max ). Absolute and relative values of ventilatory responses were analyzed and compared according to age and developmental phase., Results: (1) Height, weight, lean body mass and vital capacity increased significantly from 11 to 17 years of age. (2) [Formula: see text]O 2max , [Formula: see text] E , and V T increased during maturation even when exercise intensity changed, especially from 11 to 15 years of age. On the other hand, fr showed a decreasing trend., Conclusion: Increases of V T are the main reason for [Formula: see text] E increases during maturation of children. fr decreased independently of total body mass during maturation. [Formula: see text] E .kg -1 was stable despite intensity variations. V T .kg -1 increased significantly from 11 to 15 years then stabilized at 17 years. Lean body mass seems to explain the evolution of V T .kg -1 during maturation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: This study aimed to investigate the association between hyperglycemia and body mass index (BMI), along with other associated comorbidities in hospitalized COVID-19 patients among the Indonesian population., Patients and Methods: This was a retrospective study conducted at Hasan Sadikin Hospital, Bandung between March 1, 2020, and August 30, 2020. Data were analyzed using the chi-square test for categorical data and unpaired t-test and Mann-Whitney alternative test for numerical data using SPSS version 24.0 (IBM SPSS Statistics for Windows, Version 24.0. IBM, Armonk, NY, USA) and GraphPad Prism version 7.0 for Windows., Results: A total of 142 hospitalized COVID-19 patients were documented between March and August 2020 at the Hasan Sadikin Hospital. Among the 142 patients, 116 (81.7%) survived, while 26 (18.3%) died. Sex, age, BMI, number of comorbidities, heart rate, respiratory rate, peripheral oxygen saturation, platelet count, random blood glucose (RBG), and length of stay (LOS) were significantly associated with mortality. Multivariate analyses demonstrated that admission RBG levels > 140 mg/dl were independently associated with an increased risk of mortality in COVID-19 patients (OR 4.3, 95% CI 1.1-17.5, p = 0.043), while BMI > 25 kg/m2 was significantly associated with reduced mortality (OR, 0.22; 95% CI 0.05-0.88, p = 0.033)., Conclusions: Admission hyperglycemia, indicated by an increase in RBG levels >140 mg/dL, is independently associated with an increased risk of mortality in hospitalized COVID-19 patients, while obesity (BMI >25 kg/m2) might have protective properties against the risk of death.

During the first outbreak of Coronavirus disease 2019 (COVID-19) Emergency Departments (EDs) were overcrowded. Hence, the need for a rapid and simple tool to support clinical decisions, such as the ROX index (Respiratory rate - OXygenation), defined as the ratio of peripheral oxygen saturation and fraction of inspired oxygen, to respiratory rate. The aim of the study was to evaluate the accuracy of the ROX index in predicting hospitalization and mortality in patients with a diagnosis of COVID-19 in the ED. The secondary outcomes were to assess the number of readmissions and the variations in the ROX index between the first and the second admission. This was an observational prospective monocentric study, carried out in the ED of Sant'Orsola-Malpighi Hospital in Bologna, Italy. Five hundred and fifty-four consecutive patients with COVID-19 were enrolled and the ROX index was calculated. Patients were followed until hospital discharge or death. A ROX index value < 25.7 was associated with hospitalization (area under the curve [AUC] = 0.737, 95% CI 0.696-0.779, p < 0.001). The ROX index < 22.3 was statistically related to higher 30-day mortality (AUC = 0.764, 95% CI 0.708-0.820, p < 0.001). Eight patients were discharged and returned to the ED within the subsequent 7 days, their mean ROX index was 30.3 (6.2; range 21.9-39.4) at the first assessment and 24.6 (5.5; 14.5-29.5) at the second assessment, (p = 0.012). The ROX index, together with laboratory, imaging and clinical findings, correlated with the need for hospital admission, mechanical ventilation and mortality risk in COVID-19 patients., (© 2021. Società Italiana di Medicina Interna (SIMI).)

This study investigated whether transcutaneous auricular vagus nerve stimulation (taVNS) enhances reversal learning and augments noradrenergic biomarkers (i.e., pupil size, cortisol, and salivary alpha-amylase [sAA]). We also explored the effect of taVNS on respiratory rate and cardiac vagal activity (CVA). Seventy-one participants received stimulation of either the cymba concha (taVNS) or the earlobe (sham) of the left ear. After learning a series of cue-outcome associations, the stimulation was applied before and throughout a reversal phase in which cue-outcome associations were changed for some (reversal), but not for other (distractor) cues. Tonic pupil size, salivary cortisol, sAA, respiratory rate, and CVA were assessed at different time points. Contrary to our hypothesis, taVNS was not associated with an overall improvement in performance on the reversal task. Compared to sham, the taVNS group performed worse for distractor than reversal cues. taVNS did not increase tonic pupil size and sAA. Only post hoc analyses indicated that the cortisol decline was steeper in the sham compared to the taVNS group. Exploratory analyses showed that taVNS decreased respiratory rate but did not affect CVA. The weak and unexpected effects found in this study might relate to the lack of parameters optimization for taVNS and invite to further investigate the effect of taVNS on cortisol and respiratory rate., (© 2021 Society for Psychophysiological Research.)

Slow, deep breathing (SDB) is a common pain self-management technique. Stimulation of the arterial baroreceptors and vagal modulation are suggested, among others, as potential mechanisms underlying the hypoalgesic effects of SDB. We tested whether adding an inspiratory load to SDB, which results in a stronger baroreceptor stimulation and vagal modulation, enhances its hypoalgesic effects. Healthy volunteers performed SDB (controlled at 0.1 Hz) with and without an inspiratory threshold load. Controlled breathing (CB) at a normal frequency (0.23 Hz) was used as an active control. Each condition lasted 90 s, included an electrical pain stimulation on the hand, and was repeated four times in a randomized order. Pain intensity, self-reported emotional responses (arousal, valence, dominance), and cardiovascular parameters (including vagally-mediated heart rate variability) were measured per trial. A cover story was used to limit the potential effect of outcome expectancy. Pain intensity was slightly lower during SDB with load compared with normal-frequency CB, but the effect was negligible (Cohens d < 0.2), and there was no other difference in pain intensity between the conditions. Heart rate variability was higher during SDB with/without load compared with normal-frequency CB. Using load during SDB was associated with higher heart rate variability, but less favorable emotional responses. These findings do not support the role of baroreceptor stimulation or vagal modulation in the hypoalgesic effects of SDB. Other mechanisms, such as attentional modulation, warrant further investigation., (© 2021 Society for Psychophysiological Research.)

Why obstructive sleep apnea (OSA) treatment does not completely restore healthy metabolic physiology is unclear. In rats, the need for respiratory homeostasis maintenance following airway obstruction (AO) is associated with a loss of thermoregulation and abnormal metabolic physiology that persists following successful obstruction removal. Here, we explored the effect of two different types of tracheal narrowing, i.e., AO and mild airway obstruction (mAO), and its removal on respiratory homeostasis and metabolic physiology. We show that after ten weeks, mAO vs. AO consumes sufficient energy that is required to maintain respiratory homeostasis and thermoregulation. Obstruction removal was associated with largely irreversible increased feeding associated with elevated serum ghrelin, hypothalamic growth hormone secretagogue receptor 1a, and a phosphorylated Akt/Akt ratio, despite normalization of breathing and energy requirements. Our study supports the need for lifestyle eating behavior management, in addition to endocrine support, in order to attain healthy metabolic physiology in OSA patients., (© 2021. The Author(s).)

Background: While previous studies have demonstrated a complex visual scene search elicits a robust neurovascular coupling (NVC) response, it is unknown how the duration of visual stimuli presentation influences NVC metrics. This study examined how stimuli duration, in addition to biological sex and self-reported engagement impact NVC responses., Methods: Participants (n = 20, female = 10) completed four visual paradigms. Three involved simple visual shapes presented at 0.5-, 2-, and 4-s intervals in randomized orders. The fourth paradigm was a complex visual scene search ("Where's Waldo?"). Participants completed eight cycles of 20-s eyes-closed followed by 40-s eyes-open. Transcranial Doppler ultrasound indexed posterior and middle cerebral artery velocities (PCA and MCA). Participants self-reported their engagement following each task (1 [minimal] to 10 [maximal])., Results: The "Where's Waldo?" task evoked greater PCA percent increase (all p < 0.001) and area under the curve during the first 30-s of the task (all p < 0.001) compared to simple shapes. Females displayed greater absolute baseline and peak PCA and MCA velocities across all tasks (all p < 0.002). Subjective engagement displayed moderate correlation levels with PCA percent increase (Spearman ρ = 0.58) and area under the curve (Spearman ρ = 0.60) metrics in males, whereas these were weak for females (Spearman ρ = 0.43 and ρ = 0.38, respectively)., Conclusions: The complex visual paradigm "Where's Waldo?" greatly augmented the signal-to-noise ratio within the PCA aspects of the NVC response compared to simple shapes. While both sexes had similar NVC responses, task engagement was more related to NVC metrics in males compared to females. Therefore, future NVC investigations should consider task engagement when designing studies., (© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

It is often assumed that distracting attention from unpleasant body sensations evoked by physical exertion can alleviate perceived fatigue and increase physical performance. Also, the higher acuity of perception of heartbeats was associated with less physical performance in one study with sedentary participants. The current study was designed to shed more light on these associations. In a within-subject experiment, 98 students characterized by regular physical activity completed the Schandry-task assessing cardioceptive accuracy and cycled for 15 min on a bicycle ergometer at a convenient pace, listening to their own breathing through a headset (internal attention condition) or to distracting noises (external attention condition). Physical performance (number of pedal turns), physical exertion (heart rate), and self-reported fatigue were assessed for both tasks. Frequentist and Bayesian analyses showed no impact of the direction of attention and cardioceptive accuracy on physical performance, exertion, and perceived fatigue. In fact, the lack of association between cardioceptive accuracy and performance and perceived fatigue was more probable than the alternative hypothesis. Impact of distraction and cardioceptive accuracy on subjective and objective characteristics of physical exercise in the aerobic domain may be different for physically active and sedentary individuals. Future research in this area should systematically explore the background of these differences., (© 2021 The Authors. Psychophysiology published by Wiley Periodicals LLC on behalf of Society for Psychophysiological Research.)

This study aimed to examine whether the end-tidal partial pressure of CO 2 (PEtCO 2 ) affects the concentration of oxygenated hemoglobin (O 2 Hb) measured by near-infrared spectroscopy (NIRS). Participants were examined under the conditions of normal and increased ventilation. We measured O 2 Hb, mean blood pressure, skin blood flow, PEtCO 2 , respiratory rate, and minute volume at 30 % of the maximum oxygen uptake during exercise. ΔO 2 Hb and PEtCO 2 during exercise were lower in the increased ventilation than in the normal ventilation condition. Pearson's product-moment correlation analysis showed a significant positive correlation between ΔO 2 Hb and ΔMAP, ΔSBF, and PEtCO 2 . Correlation coefficients were 0.249 (p < 0.001) for ΔMAP, 0.343 (p < 0.001) for ΔSBF, and 0.315 (p < 0.001) for PEtCO 2 . In conclusion, we identified increased ventilation during bicycle ergometer exercise as a significant factor associated with significantly low PEtCO 2 and ΔO 2 Hb., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Falling asleep is common in fMRI studies. By using long eyelid closures to detect microsleep onset, we showed that the onset and termination of short sleep episodes invokes a systematic sequence of BOLD signal changes that are large, widespread, and consistent across different microsleep durations. The signal changes are intimately intertwined with shifts in respiration and heart rate, indicating that autonomic contributions are integral to the brain physiology evaluated using fMRI and cannot be simply treated as nuisance signals. Additionally, resting state functional connectivity (RSFC) was altered in accord with the frequency of falling asleep and in a manner that global signal regression does not eliminate. Our findings point to the need to develop a consensus among neuroscientists using fMRI on how to deal with microsleep intrusions. SIGNIFICANCE STATEMENT: Sleep, breathing and cardiac action are influenced by common brainstem nuclei. We show that falling asleep and awakening are associated with a sequence of BOLD signal changes that are large, widespread and consistent across varied durations of sleep onset and awakening. These signal changes follow closely those associated with deceleration and acceleration of respiration and heart rate, calling into question the separation of the latter signals as 'noise' when the frequency of falling asleep, which is commonplace in RSFC studies, correlates with the extent of RSFC perturbation. Autonomic and central nervous system contributions to BOLD signal have to be jointly considered when interpreting fMRI and RSFC studies., Competing Interests: Declaration of Competing Interest The authors declare no competing interests., (Copyright © 2021. Published by Elsevier Inc.)

Plasticity in the cardiac function of a marine mammal facilitates rapid adjustments to the contrasting metabolic demands of breathing at the surface and diving during an extended apnea. By matching their heart rate ( f H ) to their immediate physiological needs, a marine mammal can improve its metabolic efficiency and maximize the proportion of time spent underwater. Respiratory sinus arrhythmia (RSA) is a known modulation of f H that is driven by respiration and has been suggested to increase cardiorespiratory efficiency. To investigate the presence of RSA in cetaceans and the relationship between f H , breathing rate ( f R ) and body mass ( M b ), we measured simultaneous f H and f R in five cetacean species in human care. We found that a higher f R was associated with a higher mean instantaneous f H (i f H ) and minimum i f H of the RSA. By contrast, f H scaled inversely with M b such that larger animals had lower mean and minimum i f H s of the RSA. There was a significant allometric relationship between maximum i f H of the RSA and M b , but not f R , which may indicate that this parameter is set by physical laws and not adjusted dynamically with physiological needs. RSA was significantly affected by f R and was greatly reduced with small increases in f R . Ultimately, these data show that surface f H s of cetaceans are complex and the f H patterns we observed are controlled by several factors. We suggest the importance of considering RSA when interpreting f H measurements and particularly how f R may drive f H changes that are important for efficient gas exchange. This article is part of the theme issue 'Measuring physiology in free-living animals (Part I)'.

Even though recent studies reported a positive inspiratory muscle training (IMT) effect on cardiovascular autonomic modulation, its underlying mechanisms as the breathing pattern remain unclear. The study aimed to investigate the IMT effects on resting heart rate variability (HRV), spontaneous baroreflex sensitivity (BRS), and spontaneous breathing pattern in older women. Fourteen healthy older women participated in this study, allocated in IMT (50 % MIP; n = 8) or Sham (5% MIP; n = 6) protocols for four weeks. Blood pressure, heart rate, and ventilatory data were continuously recorded before and after interventions. After four weeks, IMT-group increased maximal inspiratory pressure and vagal-mediated HRV, following by the reduction of sympatho-mediated HRV and the inspiratory time during the spontaneous breathing cycle compared to Sham-group, but did not change BRS. Therefore, the shorter inspiratory time suggests a putative mechanism behind improved vagal-mediated HRV post-IMT in older women., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Assessing the relationship between thoracoabdominal mobility (TAM) in newborns (NBs) is relevant for a greater understanding of pulmonary kinematics. This study aimed to assess the association between TAM, hours of life and respiratory rate (RR) in term NBs. Healthy NBs were included in the sample. They were filmed for 2 min, with markers in the lateral region of the trunk, delimiting the thoracic and abdominal areas. TAM and RR were assessed using a MATLAB® routine. For kinematic analysis, an algorithm created graphs presenting thoracoabdominal mobility. A total of 26 NBs were evaluated. TAM was the only variable that exhibited a statistically significant intergroup difference, showing that the fewer the hours of life, the greater the mobility. Simple linear regression analysis showed that RR can explain 31% of the variation in abdominal mobility (p = 0.002). Thus, the fewer the hours of life, the greater the TAM of NBs, with a predominance of abdominal compartment mobility., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Interval timing, the ability to encode and retrieve the memory of intervals from seconds to minutes, guides fundamental animal behaviors across the phylogenetic tree. In Pavlovian fear conditioning, an initially neutral stimulus (conditioned stimulus, CS) predicts the arrival of an aversive unconditioned stimulus (US, generally a mild foot-shock) at a fixed time interval. Although some studies showed that temporal relations between CS and US events are learned from the outset of conditioning, the question of the memory of time and its underlying neural network in fear conditioning is still poorly understood. The aim of the present study was to investigate the role of the dorsal striatum in timing intervals in odor fear conditioning in male rats. To assess the animal's interval timing ability in this paradigm, we used the respiratory frequency. This enabled us to detect the emergence of temporal patterns related to the odor-shock time interval from the early stage of learning, confirming that rats are able to encode the odor-shock time interval after few training trials. We carried out reversible inactivation of the dorsal striatum before the acquisition session and before a shift in the learned time interval, and measured the effects of this treatment on the temporal pattern of the respiratory rate. In addition, using intracerebral microdialysis, we monitored extracellular dopamine level in the dorsal striatum throughout odor-shock conditioning and in response to a shift of the odor-shock time interval. Contrary to our initial predictions based on the existing literature on interval timing, we found evidence suggesting that transient inactivation of the dorsal striatum may favor a more precocious buildup of the respiratory frequency's temporal pattern during the odor-shock interval in a manner that reflected the duration of the interval. Our data further suggest that the conditioning and the learning of a novel time interval were associated with a decrease in dopamine level in the dorsal striatum, but not in the nucleus accumbens. These findings prompt a reassessment of the role of the striatum and striatal dopamine in interval timing, at least when considering Pavlovian aversive conditioning., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: To assess feasibility of transcutaneous electromyography of the diaphragm (dEMG) as a monitoring tool for vital signs and diaphragm activity in the delivery room (DR)., Design: Prospective observational study., Setting: Delivery room., Patients: Newborn infants requiring respiratory stabilisation after birth., Interventions: In addition to pulse oximetry (PO) and ECG, dEMG was measured with skin electrodes for 30 min after birth., Outcome Measures: We assessed signal quality of dEMG and ECG recording, agreement between heart rate (HR) measured by dEMG and ECG or PO, time between sensor application and first HR read-out and agreement between respiratory rate (RR) measured with dEMG and ECG, compared with airway flow. Furthermore, we analysed peak, tonic and amplitude diaphragmatic activity from the dEMG-based respiratory waveform., Results: Thirty-three infants (gestational age: 31.7±2.8 weeks, birth weight: 1525±661 g) were included.18%±14% and 22%±21% of dEMG and ECG data showed poor quality, respectively. Monitoring HR with dEMG was fast (median 10 (IQR 10-11) s) and accurate (intraclass correlation coefficient (ICC) 0.92 and 0.82 compared with ECG and PO, respectively). RR monitoring with dEMG showed moderate (ICC 0.49) and ECG low (ICC 0.25) agreement with airway flow. Diaphragm activity started high with a decreasing trend in the first 15 min and subsequent stabilisation., Conclusion: Monitoring vital signs with dEMG in the DR is feasible and fast. Diaphragm activity can be detected and described with dEMG, making dEMG promising for future DR studies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)

The aim of the study was to evaluate and compare the maximal oxygen uptake ([Formula: see text]O 2max ) achieved during incremental and decremental protocols in highly trained athletes. Nineteen moderate trained runners and rowers completed, on separate days, (i) an initial incremental [Formula: see text]O 2max test (INC) on a treadmill, followed by a verification phase (VER); (ii) a familiarization of a decremental test (DEC); (iii) a tailored DEC; (iv) a test with decremental and incremental phases (DEC-INC); (v) and a repeated incremental test (INC F ). During each test [Formula: see text]O 2 , carbon dioxide production, ventilation, heart and breath rates and ratings of perceived exertion were measured. No differences were observed in [Formula: see text]O 2max between INC (61.3 ± 5.2 ml kg -1  min -1 ) and DEC (61.1 ± 5.1 ml kg -1  min -1 ; average difference of ~ 11.58 ml min -1 ; p = 0.831), between INC and DEC-INC (60.9 ± 5.3 ml kg -1  min -1 ; average difference of ~ 4.8 ml min -1 ; p = 0.942) or between INC and INC F (60.7 ± 4.4 ml kg -1  min -1 ; p = 0.394). [Formula: see text]O 2max during VER (59.8 ± 5.1 ml kg -1  min -1 ) was 1.50 ± 2.20 ml kg -1  min -1 lower (~ 2.45%; p = 0.008) compared with values measured during INC. The typical error in the test-to-test changes for evaluating [Formula: see text]O 2max over the five tests was 2.4 ml kg -1  min -1 (95% CI 1.4-3.4 ml kg -1  min -1 ). Decremental tests do not elicit higher [Formula: see text]O 2max than incremental tests in trained runners and rowers, suggesting that a plateau in [Formula: see text]O 2 during the classic incremental and verification tests represents the maximum ceiling of aerobic power.

This study examined the effect of altered body weight (BW) and body fat content on exercise performance and recovery. Nine horses were divided into two groups, and changes in BW and fat content were induced by feeding a high (HA) or restricted (RA) energy allowance for 36 days in a cross-over design. In the last week of each treatment, BW and body condition score (BCS) were recorded, body fat percentage was estimated using ultrasound, and a standardized incremental treadmill exercise test (SET) and competition-like field test were performed (scored by judges blinded to treatments). Blood samples were collected, and heart rate (HR), rectal temperature (RT), and respiratory rate (RR) were also recorded. Objective locomotion analyses were performed before and after the field test. Body weight, body fat percentage, and BCS were higher (5-8%) in HA than in RA horses (p < 0.05). In SET, HA horses showed higher HR, plasma lactate concentration, RR, and RT than RA horses (p < 0.05), and lower V La4 , hematocrit (Hct), plasma glucose, and plasma NEFA concentrations (p < 0.05). Hct was also lower in HA horses in the field test, while RA horses showed higher scores (p < 0.05). After both tests, resting plasma lactate concentrations were reached faster in RA than in HA horses (p < 0.05). Objective locomotion asymmetry was higher in HA than in RA (p < 0.05). These results clearly show that increased BW and body fat content in horses lower physiological fitness in terms of V La4 , plasma lactate removal, Hct levels, plasma glucose availability and reduce true performance evaluated by blinded judges., (© 2021 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Background: The World Health Organization (WHO) recommends the use of tachypnea as a proxy to the diagnosis of pneumonia., Objective: The purpose of this study was to examine the relationship between body temperature alterations and respiratory rate (RR) difference (RRD) in children with acute respiratory infections(ARI)., Methods: This cross-sectional study included 297 children with age 2-60 months who presented with cough and fever at the pediatric emergency and outpatient clinics in the Department of Pediatrics, Baskent University Hospital, from January 2016 through June 2018. Each parent completed a structured questionnaire to collect background data. Weight and height were taken. Body temperature, respiratory rate, presence of the chest indrawing, rales, wheezing and laryngeal stridor were also recorded. RRD was defined as the differences in RR at admission and after 3 days of treatment., Results: Both respiratory rate and RRD were moderately correlated with body temperature (r=0.71, p<0.001 and r=0.65, p<0.001; respectively). For every 1°C increase in temperature, RRD increased by 5.7/minutes in overall, 7.2/minute in the patients under 12 months of age, 6.4/minute in the female. The relationship between body temperature and RRD wasn't statistically significant in patients with rhonchi, chest indrawing, and low oxygen saturation., Conclusion: Respiratory rate should be evaluated according to the degree of body temperature in children with ARI. However, the interaction between body temperature and respiratory rate could not be observed in cases with rhonchi and severe pneumonia., (© 2021 Ozdemır B et al.)