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Background: Flying accuracy is influenced by pilots' affective reactions to task demands. A better understanding of task-related emotions and flying performance is needed to enhance pilot training. Objective: Understand pilot trainees' performance and emotional dynamics (intensity, frequency and variability) based on training phase and difficulty level in a flight simulator. Methods: Twenty-three volunteers performed basic flight manoeuvres. Trials were divided into three phases: Introduction (trials 1-7), session A (trials 8-15) and session B (trials 16-22). Three task difficulty levels were implemented (low, medium and high). Flying performance was evaluated using root mean square error (RMSE) and expert ratings. Emotional intensity was inferred from physiological (electrodermal activity) and behavioural (facial expressions) emotional responses. Emotional variability was calculated to understand fluctuations among multiple emotions. Emotional responses were mapped into task-relevant emotions, like sadness with boredom, and fear with anxiety. Results and Conclusions: The most frequent facial expressions neutral, anger and surprise. Neutral and anger were interpreted as deep focus states. Surprise was likely a response to unexpected events. Flying performance and emotional dynamics varied across training phases and difficulty levels. During introduction, performance was less accurate, and emotions were less frequent. During session A, performance improved while participants experienced more physiological arousal and emotional variability. During session B, performance was the most accurate. In high-difficulty tasks, performance was the least accurate, participants expressed emotions with more frequency, more variability and higher physiological arousal. Future studies can use simulated flying tasks for trainees to familiarize with their emotional reactions to task demands expecting to improve training outcomes.

BackgroundAI-CAC provides more actionable information than the Agatston coronary artery calcium (CAC) score. We have recently shown in the MESA (Multi-Ethnic Study of Atherosclerosis) that AI-CAC automated left atrial (LA) volumetry enabled prediction of atrial fibrillation (AF) as early as 1 year.ObjectivesIn this study, the authors evaluated the performance of AI-CAC LA volumetry versus LA measured by human experts using cardiac magnetic resonance imaging (CMRI) for predicting incident AF and stroke and compared them with Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF) risk score, Agatston score, and N-terminal pro b-type natriuretic peptide (NT-proBNP).MethodsWe used 15-year outcomes data from 3,552 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) who underwent both CAC scans and CMRI in the MESA baseline examination. CMRI LA volume was previously measured by human experts. Data on NT-proBNP, CHARGE-AF risk score, and the Agatston score were obtained from MESA. Discrimination was assessed using the time-dependent area under the curve.ResultsOver 15 years follow-up, 562 cases of AF and 140 cases of stroke accrued. The area under the curve for AI-CAC versus CMRI volumetry for AF (0.802 vs 0.798) and stroke (0.762 vs 0.751) were not significantly different. AI-CAC LA significantly improved the continuous net reclassification index for prediction of 5-year AF when added to CHARGE-AF risk score (0.23), NT-proBNP (0.37, 0.37), and Agatston score (0.44) (P for all

This study compared the prognostic value of quantified thoracic artery calcium (TAC) including aortic arch on chest CT and coronary artery calcium (CAC) score on ECG-gated cardiac CT.MethodsA total of 2412 participants who underwent both chest CT and ECG-gated cardiac CT at the same period were included in the Multi-Ethnic Study of Atherosclerosis Exam 5. All participants were monitored for incident atherosclerotic cardiovascular disease (ASCVD) events. TAC is defined as calcification in the ascending aorta, aortic arch and descending aorta on chest CT. The quantification of TAC was measured using the Agatston method. Time-dependent receiver-operating characteristic (ROC) curves were used to compare the prognostic value of TAC and CAC scores.ResultsParticipants were 69±9 years of age and 47% were male. The Spearman correlation between TAC and CAC scores was 0.46 (p

IntroductionCoronary artery calcium (CAC) scans contain useful information beyond the Agatston CAC score that is not currently reported. We recently reported that artificial intelligence (AI)-enabled cardiac chambers volumetry in CAC scans (AI-CAC™) predicted incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis (MESA). In this study, we investigated the performance of AI-CAC cardiac chambers for prediction of incident heart failure (HF).MethodsWe applied AI-CAC to 5750 CAC scans of asymptomatic individuals (52% female, White 40%, Black 26%, Hispanic 22% Chinese 12%) free of known cardiovascular disease at the MESA baseline examination (2000-2002). We used the 15-year outcomes data and compared the time-dependent area under the curve (AUC) of AI-CAC volumetry versus NT-proBNP, Agatston score, and 9 known clinical risk factors (age, gender, diabetes, current smoking, hypertension medication, systolic and diastolic blood pressure, LDL, HDL for predicting incident HF over 15 years.ResultsOver 15 years of follow-up, 256 HF events accrued. The time-dependent AUC [95% CI] at 15 years for predicting HF with AI-CAC all chambers volumetry (0.86 [0.82,0.91]) was significantly higher than NT-proBNP (0.74 [0.69, 0.77]) and Agatston score (0.71 [0.68, 0.78]) (p ​

The mechanisms of hepatic stellate cell (HSC) activation and the development of liver fibrosis are not fully understood. Here, we show that deletion of a nuclear seven transmembrane protein, TM7SF3, accelerates HSC activation in liver organoids, primary human HSCs, and in vivo in metabolic-dysfunction-associated steatohepatitis (MASH) mice, leading to activation of the fibrogenic program and HSC proliferation. Thus, TM7SF3 knockdown promotes alternative splicing of the Hippo pathway transcription factor, TEAD1, by inhibiting the splicing factor heterogeneous nuclear ribonucleoprotein U (hnRNPU). This results in the exclusion of the inhibitory exon 5, generating a more active form of TEAD1 and triggering HSC activation. Furthermore, inhibiting TEAD1 alternative splicing with a specific antisense oligomer (ASO) deactivates HSCs in vitro and reduces MASH diet-induced liver fibrosis. In conclusion, by inhibiting TEAD1 alternative splicing, TM7SF3 plays a pivotal role in mitigating HSC activation and the progression of MASH-related fibrosis.

Abstract Background Providing and improving relationship-centered care has gained increased importance in long-term care. However, quality improvement strategies are predominantly based on quantitative quality measures for care professionals. Therefore, the aim of this study was to explore how narrative data collected with Connecting Conversations is used in evaluation meetings to improve RCC. Methods A qualitative approach using structured observations was used. The participants were care professionals, residents and family members from two nursing home wards. The participating wards organized evaluation meetings to discuss the experienced quality of care based on narrative data collected with Connecting Conversations. To analyze the process of improving RCC, the organization of these meetings and the content were observed by independent researchers, and detailed notes were taken. The data were analyzed thematically by using conventional content analysis. Results In total, three evaluation meetings were organized. Primarily, care professionals were invited to discuss the results of the interviews. One ward organized a meeting for care professionals, residents and family members, and the other decided not to invite them. The discussion of themes related to experienced quality of care within the evaluation meetings was less profound than during the interviews. In total, 12 overarching themes concerning experienced quality of care were discussed in the Connecting Conversations' interviews. Nine themes were also mentioned in one or more evaluation meetings (i.e., activities for residents, personalized attention and preferences of residents, feeling at home and communication within the care triad). Conclusion When using narrative data on quality of care to improve relationship-centered care, the full potential of narrative data is underutilized as discussions focussed on incidental problem solving rather than deeper reflections on the meaning of events in providing relationship-centered care. Establishing trust within the care triad of care professionals, family members, and residents is essential to improve relationship-centered care collaboratively.

Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) in the multi-ethnic study of atherosclerosis during 15 years of follow-up, 1773 CVD events accrued. The AUC at 1-, 5-, 10-, and 15-year follow-up for AI-CAC vs. Agatston score was (0.784 vs. 0.701), (0.771 vs. 0.709), (0.789 vs. 0.712) and (0.816 vs. 0.729) (p

Pseudoaneurysm is a rare but fatal complication of myocardial infarction (MI). With the advances in cardiovascular disease detection and treatments, fatal structural complications post-MI are now rare. When they occur, advanced diagnostic modalities can be used for early diagnosis, aiding surgical planning, and improving prognosis. In our case, post-MI left ventricle pseudoaneurysm complicated by hemopericardium was diagnosed using cardiac computed tomography angiography (CCTA). Use of attenuation measurement on CCTA helped diagnose active extravasation into the hemopericardium. This case highlights the high index of suspicion needed for rare but fatal complications post-MI and the utility of CCTA in their management.

Abstract Coronary artery calcium (CAC) scans contain valuable information beyond the Agatston Score which is currently reported for predicting coronary heart disease (CHD) only. We examined whether new artificial intelligence (AI) applied to CAC scans can predict non-CHD events, including heart failure, atrial fibrillation, and stroke. We applied AI-enabled automated cardiac chambers volumetry and calcified plaque characterization to CAC scans (AI-CAC) of 5830 asymptomatic individuals (52.2% women, age 61.7 ± 10.2 years) in the multi-ethnic study of atherosclerosis during 15 years of follow-up, 1773 CVD events accrued. The AUC at 1-, 5-, 10-, and 15-year follow-up for AI-CAC vs. Agatston score was (0.784 vs. 0.701), (0.771 vs. 0.709), (0.789 vs. 0.712) and (0.816 vs. 0.729) (p

Abstract The objective of pilot training is to equip trainees with the knowledge, judgment, and skills to maintain control of an aircraft and respond to critical flight tasks. The present research aims to investigate changes in trainees’ cognitive control levels during a pilot training process while they underwent basic flight maneuvers. EEG microstate analysis was applied together with spectral power features to quantitatively monitor trainees’ cognitive control under varied flight tasks during different training sessions on a flight simulator. Not only could EEG data provide an objective measure of cognitive control to complement the current subjective assessments, but the application of EEG microstate analysis is particularly well-suited for capturing rapid dynamic changes in cognitive states that may happen under complex human activities in conducting flight maneuvers. Comparisons were conducted between two types of tasks and across different training stages to monitor how pilot trainees’ cognitive control responds to varied flight task types and training stages. The present research provides insights into the changes in trainees’ cognitive control during a pilot training process and highlights the potential of EEG microstate analysis for monitoring cognitive control.

Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.

ObjectiveThis study aims to investigate the relationship between the subjective performance evaluations on pilot trainees' aircraft control abilities and their brainwave dynamics reflected in the results from EEG microstate analysis. Specifically, we seek to identify correlations between distinct microstate patterns and each dimension included in the subjective flight control evaluations, shedding light on the neurophysiological mechanisms underlying aviation expertise and possible directions for future improvements in pilot training.BackgroundProficiency in aircraft control is crucial for aviation safety and modern aviation where pilots need to maneuver aircraft through an array of situations, ranging from routine takeoffs and landings to complex weather conditions and emergencies. However, the neurophysiological aspects of aviation expertise remain largely unexplored. This research bridges the gap by examining the relationship between pilot trainees' specific brainwave patterns and their subjective evaluations of flight control levels, offering insights into the cognitive underpinnings of pilot skill efficiency and development.MethodEEG microstate analysis was employed to examine the brainwave dynamics of pilot trainees while they performed aircraft control tasks under a flight simulator-based pilot training process. Trainees' control performance was evaluated by experienced instructors across five dimensions and their EEG data were analyzed to investigate the associations between the parameters of specific microstates with successful aircraft control.ResultsThe experimental results revealed significant associations between aircraft control levels and the parameters of distinct EEG microstates. Notably, these associations varied across control dimensions, highlighting the multifaceted nature of control proficiency. Noteworthy correlations included positive correlations between microstate class E and class G with aircraft control, emphasizing the role of attentional processes, perceptual integration, working memory, cognitive flexibility, decision-making, and executive control in aviation expertise. Conversely, negative correlations between microstate class C and class F with aircraft control indicated links between pilot trainees' cognitive control and their control performance on flight tasks.ConclusionThe findings underscore the multidimensional nature of aircraft control proficiency and emphasize the significance of attentional and cognitive processes in achieving aviation expertise. These neurophysiological markers offer a basis for designing targeted pilot training programs and interventions to enhance trainees' aircraft control skills.

Pregnancy leads to significant changes in renal physiology, which result in increases in glomerular filtration rate (GFR) and enhanced protein excretion. These changes may continue in the postnatal period and might be observed for 5–6 months after birth. Once confirmed, proteinuria warrants investigation and close surveillance. Clinicians should establish the level of excretory kidney function and the presence or absence of proteinuria at booking/diagnosis. A history of proteinuria, PET and anti-hypertensive requirements in previous pregnancies is a helpful guide to what to expect in the current pregnancy. Maternal physiological adaptations mean that yet-undiagnosed kidney disease is unmasked during pregnancy. New onset of proteinuria before 20 weeks’ gestation (with or without kidney impairment) suggests known or previously undetected kidney disease. As pregnancy evolves, hyperfiltration may lead to increasing proteinuria, posing a diagnostic challenge in the diagnosis and recognition of pre-eclampsia. This article was written as a guide for the evaluation and management of proteinuria in pregnancy, as well as appreciating diagnostic dilemmas.

Nuclear energy accounts for ≈10% of global energy production, positioning it as a promising solution for achieving carbon neutrality amid escalating concerns over climate change. Nonetheless, the effective management of radioactive waste, which can remain hazardous for up to one hundred thousand years, presents considerable challenges that must be addressed to uphold public trust and safeguard environmental safety. This review outlines the fundamental stages of nuclear decommissioning including strategic planning, decontamination, dismantling, remediation, encapsulation, deregulation, and site reuse as a critical component of sustainable environmental practices. The review also highlights the significance of efficient decontamination processes in reducing waste generation. Various decontamination techniques, including mechanical, electromechanical, chemical, and advanced methods such as laser and plasma decontamination, are evaluated for their effectiveness and limitations. Moreover, the review emphasizes the need to enhance the recovery and recycling of ion exchange resin and potential radionuclides during decontamination processes to minimize waste and to address the depletion of potential radionuclide resources. Future research should prioritize the development of innovative techniques for decontamination and radioactive waste management, fostering sustainable decommissioning and supporting the ongoing development of nuclear energy in an environmentally responsible manner.

OBJECTIVE: This study aims to evaluate image quality in patients with heart rates above or equal to 70 beats per minute (bpm), performed on a 16 cm scanner (256-slice General Electric Revolution) in comparison to a CT scanner with only 4 cm of coverage (64 slice Volume CT). BACKGROUND: Recent advancements in image acquisition, such as whole-heart coverage in a single rotation and post-processing methods in coronary computed tomographic angiography (CCTA), include motion-correction algorithms, such as SnapShot Freeze (SSF), which improve temporal resolution and allow for the assessment of coronary artery disease (CAD) with lower motion scores and better image qualities. Studies from the comprehensive evaluation of high temporal- and spatial-resolution cardiac CT using a wide coverage system (CONVERGE) registry (a multicenter registry at four centers) have shown the 16 cm CT scanner having a better image quality in comparison to the 4 cm scanner. However, these studies failed to include patients with undesirable or high heart rates due to well-documented poor image acquisition on prior generations of CCTA scanners. METHODS: A prospective, observational, multicenter cohort study comparing image quality, quantitively and qualitatively, on scans performed on a 16 cm CCTA in comparison to a cohort of images captured on a 4 cm CCTA at four centers. Participants were recruited based on broad inclusion criteria, and each patient in the 16 cm CCTA arm of the study received a CCTA scan using a 256-slice, whole-heart, single-beat scanner. These patients were then matched by age, gender, and heart rate to patients who underwent CCTA scans on a 4 cm CT scanner. Image quality was graded based on the signal-to-noise ratio, contrast-to-noise ratio, and on a Likert scale of 0-4: 0, very poor-4, excellent. RESULTS: 104 patients were evaluated for this study. The mean heart rate was 75 ± 7 in the 4 cm scanner and 75 ± 7 in the 16 cm one (p = 0.426). The signal-to-noise and contrast-to-noise ratios were higher in the 16 cm scanner (p = 0.0001). In addition, more scans were evaluated as having an excellent quality on the 16 cm scanner than on the 4 cm scanner (p < 0.0001) based on a 4-point Likert scale. CONCLUSIONS: The 16 cm scanner has a superior image quality for fast heart rates compared to the 4 cm scanner. This study shows that there is a significantly higher frequency of excellent and good studies showing better contrast-to-noise and signal-to-noise ratios with the 16 cm scanner compared to the 4 cm scanner.

Trisomy 13 is a rare chromosomal disorder in which all or a percentage (mosaicism) of cells contain an extra 13th chromosome. Sinus of Valsalva aneurysms are rare, with an incidence of 0.1% to 3.5% of all congenital heart defects. This article reports the case of a patient with trisomy 13 with a new systolic murmur found to have a ruptured sinus of Valsalva aneurysm diagnosed on coronary computed tomography angiography. This is the first case to report sinus of Valsalva aneurysm rupture secondary to Streptococcus viridans endocarditis in a patient with trisomy 13 syndrome and highlights the importance of coronary computed tomography angiography in noninvasive imaging and surgical planning.