Reducing younger and older adults' spatial disorientation during indoor-outdoor transitions: Effects of route alignment and visual access on wayfinding

Getting lost could lead to frustration, anxiety, and even fatal accidents. Previous research primarily focused on disorientation in indoor or outdoor environments separately. The indoor-outdoor transition received little attention, yet it is in this complex transition that individuals often lose their way. Therefore, the effects of indoor-outdoor route alignment, visual access, and age on wayfinding performance and spatial cognition were examined. Twenty older adults (aged 18-25) and twenty young adults (aged 65-82) participated in an experiment through desktop Virtual Reality (VR). They traversed indoor-outdoor environments and were informed within a building to quickly navigate an item inside another building. They also drew the route map. Participants repeated tasks in four different environments. Their spatial cognition and wayfinding performance were analyzed. Four main findings were derived. Firstly, the accuracy of global representation of the routes in the indoor-outdoor route alignment environment was higher than that in the non-aligned environment. Secondly, in environments with higher visual access, the accuracy of global representation of the routes for older adults was higher than that with lower visual access. Thirdly, enhancing visual access attenuated the negative impact of the non-aligned route on global representation of the routes. This effect is particularly beneficial for older adults. Fourthly, the younger adults outperformed the older adults in both wayfinding performance and global representation of the routes in indoor-outdoor environments. This difference could potentially be attributed to variations in education level, mental rotation ability, and digital experience. These findings provide valuable implications for urban design and wayfinding strategies.

Perception of illusory clusters: the role of native timing

We explore the influence of native timing patterns on nonnative speech perception, by asking whether a nonnative CVCV sequence can be perceived as CCV when the temporal organization of nonnative CVCV is similar to native CCV. To explore this question, Georgian listeners are tested on a CCa-CVCá discrimination in French. Georgian has a rich word-onset cluster inventory, with component consonants loosely timed. The loose timing often, though not always, results in a schwa-like CC transition. French, the stimulus language, exhibits tighter timing in biconsonantal clusters, no vocalic transitions, and a reduced non-prominent first vowel in CVCá sequences. We hypothesize that the cross-language difference in inter-consonantal timing can facilitate the perception of an illusory cluster when Georgian listeners hear French CVCá. The findings reveal such perceptual confusion, particularly in the CCa-CøCá contrast in which the nonnative /ø/ is phonetically similar to the CC transition in Georgian, both in terms of temporal organizations and tongue shape. This confirms the possibility of illusory clusters, which is consistent with the interpretation that Georgian listeners utilize their knowledge of how word-onset CC clusters are temporally implemented in their native language when responding to the task. We propose that the timing pattern may constitute language-specific knowledge and that it can influence the perceptual assimilation patterns in nonnative speech perception.

[Guide for the treatment of acute altered mental status. Iberoamerican Academy of Pediatric Neurology]

In pediatric patients, an acute altered mental status refers to a sudden and significant change in a child's brain function and level of consciousness. It may manifest as confusion, disorientation, agitation, lethargy or even a loss of consciousness. This condition is a medical emergency, and requires immediate evaluation and attention. There are several causes of acute altered mental status in children, including infections of the central nervous system such as meningitis or encephalitis, traumatic brain injury, metabolic disorders, seizures and poisoning, among others. The aim of this study was to analyse, prepare and classify the current literature in order to determine the best recommendations for the treatment of cases of acute altered mental status with various causes in pediatric patients. The study was based on opinions from experts in the field in order to classify the recommendations, and was submitted to the scientific committee of the Iberoamerican Academy of Pediatric Neurology for review. Our guide is an aid for the treatment of this non-specific symptom based on a basic and advanced approach, which can be applied by any pediatric neurologist.

The effect of participation in support groups on retirement syndrome in older adults

BACKGROUND

Retirement and aging are phenomena that often occur simultaneously and lead to various physical and psychological changes in older adults. Retirement syndrome consists of symptoms such as feelings of emptiness, loneliness, uselessness, lack of clear understanding of future conditions and dissatisfaction with one's performance after retirement. This phenomenon requires interventions to adapt to these changes. Considering the supportive role of nurses, the formation of support groups as an effective intervention in adapting to transitional stages is emphasized.

AIMS

This study aims to investigate the effect of older adults' participation in support groups on retirement syndrome.

METHODS

This Quasi-experimental study recruited a total of 80 retired older adults meeting the inclusion criteria from three Retirement Associations (Retirement centers for social security retirees are among the institutions that have been set up by the government and this organization to provide face-to-face and offline services to social security retirees, as well as providing some facilities to this segment of the society). in Iran, Research samples were randomly assigned to two intervention and control groups. The demographic questionnaire and retirement syndrome questionnaire were completed by both groups at the beginning of the study. Then, four support group sessions lasting 60 to 90 min were held twice a week for the support group, and eight weeks after the end of the intervention, the questionnaires were completed for both groups. The data were analyzed using statistical tests in SPSS version 16. The significance level was set at p < 0.05 for all tests.

RESULTS

The results of the covariance analysis showed that after the intervention, the feelings of helplessness and failure (p < 0.001), feelings of older and idleness (p = 0.027), and feelings of confusion and conflict (p = 0.002) were significantly less in the support group compared to the control group. In addition, the Feeling of trying and new direction (p < 0.001) was higher after the intervention. The paired t-test results showed that in the support group, the feelings of helplessness and failure (p < 0.001), feelings of older and idleness (p = 0.004), and feelings of confusion and conflict (p < 0.001) significantly decreased after the intervention compared to before it, while the feelings of trying and new direction (p = 0.004) significantly increased. Therefore, the results showed that after the intervention, there was a statistically significant difference between the two groups in all components of the retirement syndrome.

CONCLUSION

The results of this study show that participation of retired older adults in support groups can significantly improve all components of retirement syndrome, leading to an improvement in their quality of life and satisfaction.

Welfare of invertebrates: a pilot study on a new land snail stunning technique

The almost complete absence of regulations to protect invertebrates is a common condition in legal systems, including the European one, especially when it comes to invertebrates intended for human consumption. Thus, in the vast majority of cases, edible invertebrates do not receive even the most basic protection at slaughter. Despite recent research indicating that invertebrates are capable of feeling pain and stress, the humane step of stunning is not used on them. This is also the case for land snails, which are gastropod invertebrates whose consumption has now reached significant levels, already involving tonnes and that is expected to increase significantly as edible snail farming becomes more popular as a relatively low-cost, easy-to-perform, and sustainable alternative animal husbandry, thereby making land snails an increasingly economically important species. This paper presents and investigates a proposed stunning method based on the immersion of mollusks in CO2-supplemented and refrigerated water that could be used in the snail meat production chain to reduce the slaughter suffering of millions of these invertebrates. To this end, body condition descriptors (hemolymph parameters) in snails were determined before and after CO2 treatment in cold water, while generating useful data for defining a preliminary set of reference intervals for basal values.

Potential of GPT-4 for Detecting Errors in Radiology Reports: Implications for Reporting Accuracy

Background Errors in radiology reports may occur because of resident-to-attending discrepancies, speech recognition inaccuracies, and large workload. Large language models, such as GPT-4 (ChatGPT; OpenAI), may assist in generating reports. Purpose To assess effectiveness of GPT-4 in identifying common errors in radiology reports, focusing on performance, time, and cost-efficiency. Materials and Methods In this retrospective study, 200 radiology reports (radiography and cross-sectional imaging [CT and MRI]) were compiled between June 2023 and December 2023 at one institution. There were 150 errors from five common error categories (omission, insertion, spelling, side confusion, and other) intentionally inserted into 100 of the reports and used as the reference standard. Six radiologists (two senior radiologists, two attending physicians, and two residents) and GPT-4 were tasked with detecting these errors. Overall error detection performance, error detection in the five error categories, and reading time were assessed using Wald χ2 tests and paired-sample t tests. Results GPT-4 (detection rate, 82.7%;124 of 150; 95% CI: 75.8, 87.9) matched the average detection performance of radiologists independent of their experience (senior radiologists, 89.3% [134 of 150; 95% CI: 83.4, 93.3]; attending physicians, 80.0% [120 of 150; 95% CI: 72.9, 85.6]; residents, 80.0% [120 of 150; 95% CI: 72.9, 85.6]; P value range, .522-.99). One senior radiologist outperformed GPT-4 (detection rate, 94.7%; 142 of 150; 95% CI: 89.8, 97.3; P = .006). GPT-4 required less processing time per radiology report than the fastest human reader in the study (mean reading time, 3.5 seconds ± 0.5 [SD] vs 25.1 seconds ± 20.1, respectively; P < .001; Cohen d = -1.08). The use of GPT-4 resulted in lower mean correction cost per report than the most cost-efficient radiologist ($0.03 ± 0.01 vs $0.42 ± 0.41; P < .001; Cohen d = -1.12). Conclusion The radiology report error detection rate of GPT-4 was comparable with that of radiologists, potentially reducing work hours and cost. © RSNA, 2024 See also the editorial by Forman in this issue.

Medial positioning of the hippocampus and hippocampal fissure volume in developmental topographical disorientation

Developmental topographical disorientation (DTD) refers to the lifelong inability to orient by means of cognitive maps in familiar surroundings despite otherwise well-preserved general cognitive functions, and the absence of any acquired brain injury or neurological condition. While reduced functional connectivity between the hippocampus and other brain regions has been reported in DTD individuals, no structural differences in gray matter tissue for the whole brain neither for the hippocampus were detected. Considering that the human hippocampus is the main structure associated with cognitive map-based navigation, here, we investigated differences in morphological and morphometric hippocampal features between individuals affected by DTD (N = 20) and healthy controls (N = 238). Specifically, we focused on a developmental anomaly of the hippocampus that is characterized by the incomplete infolding of hippocampal subfields during fetal development, giving the hippocampus a more round or pyramidal shape, called incomplete hippocampal inversion (IHI). We rated IHI according to standard criteria and extracted hippocampal subfield volumes after FreeSurfer's automatic segmentation. We observed similar IHI prevalence in the group of individuals with DTD with respect to the control population. Neither differences in whole hippocampal nor major hippocampal subfield volumes have been observed between groups. However, when assessing the IHI independent criteria, we observed that the hippocampus in the DTD group is more medially positioned comparing to the control group. In addition, we observed bigger hippocampal fissure volume for the DTD comparing to the control group. Both of these findings were stronger for the right hippocampus comparing to the left. Our results provide new insights regarding the hippocampal morphology of individuals affected by DTD, highlighting the role of structural anomalies during early prenatal development in line with the developmental nature of the spatial disorientation deficit.

Disorienting or Transforming? Using the Arts and Humanities to Foster Social Advocacy

Introduction

The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education.

Methods

Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue.

Results

We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue.

Discussion

The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.

Gastrosplenic fistula due to splenic lymphoma: two case reports and review of the literature

BACKGROUND

Gastrosplenic fistula is a rare and potentially fatal complication of various conditions. Lymphoma is the most common cause. It can occur spontaneously or after chemotherapy. Gastrosplenic fistula diagnosis can be confused with a splenic abscess because of the presence of air into the mass. The computed tomography identification of the fistulous tract is the key to a right diagnosis. Treatment modalities include surgical resection, chemotherapy, or a combination of both.

CASE PRESENTATION

Here we report two patients with gastrosplenic fistula due to diffuse large B cell lymphoma. The first patient was a 54-year-old Caucasian woman with an enormous primary splenic diffuse large B cell lymphoma leading to the development of a spontaneous fistula in the stomach. The second patient was a 48-year-old Caucasian male patient with an enormous splenic diffuse large B cell lymphoma complicated by fistula after chemotherapy. Both patients died of septic shock several days after surgery.

CONCLUSION

Gastrosplenic fistula is a rare complication with a poor-prognosis, for which surgery is currently the preferred treatment.

Decoding the Debate: A Comparative Study of Brain-Computer Interface and Neurofeedback

Brain-Computer Interface (BCI) and Neurofeedback (NF) both rely on the technology to capture brain activity. However, the literature lacks a clear distinction between the two, with some scholars categorizing NF as a special case of BCI while others view BCI as a natural extension of NF, or classify them as fundamentally different entities. This ambiguity hinders the flow of information and expertise among scholars and can cause confusion. To address this issue, we conducted a study comparing BCI and NF from two perspectives: the background and context within which BCI and NF developed, and their system design. We utilized Functional Flow Block Diagram (FFBD) as a system modelling approach to visualize inputs, functions, and outputs to compare BCI and NF at a conceptual level. Our analysis revealed that while NF is a subset of the biofeedback method that requires data from the brain to be extracted and processed, the device performing these tasks is a BCI system by definition. Therefore, we conclude that NF should be considered a specific application of BCI technology. By clarifying the relationship between BCI and NF, we hope to facilitate better communication and collaboration among scholars in these fields.

Bewilderment, aquilombar, and the antimanicolonial: three ideas to radicalize Brazilian Psychiatric Reform

This article is part of a study aimed to map antiracist knowledge and practices in mental health by monitoring the practices of three collectives of professionals working in/with the psychosocial care network in the city of São Paulo, allowing us to characterize their intervention strategies. To contribute to the conceptualization of this article, through a review of the decolonial literature, three major ideas have been outlined that have allowed us to give substance to the decolonization of Psychiatric Reform: bewilderment, which, in dialogue with Achille Mbembe and Frantz Fanon, invites us to affirm madness and blackness without, however, establishing fixations; the antimanicolonial, which occurs in the promotion of the free and countercultural exercise of imagining diasporas, in light of that proposed by Édouard Glissant, Paul Gilroy, and Lélia Gonzales regarding an Atlantic (de)orientation in which elements of the black diaspora and Latin America can re-signify blackness and unreason; and aquilombar, as a liberatory praxis whose genesis lies in the quilombos as a living metaphor for the radicalisation of relationships in differences, based on Abdias do Nascimento's quilombismo, Clóvis Moura's quilombagem, Beatriz Nascimento's (k)quilombo, and Mariléa de Almeida's devir quilomba.

Quantitative Evaluation of Large Language Models to Streamline Radiology Report Impressions: A Multimodal Retrospective Analysis

Background The complex medical terminology of radiology reports may cause confusion or anxiety for patients, especially given increased access to electronic health records. Large language models (LLMs) can potentially simplify radiology report readability. Purpose To compare the performance of four publicly available LLMs (ChatGPT-3.5 and ChatGPT-4, Bard [now known as Gemini], and Bing) in producing simplified radiology report impressions. Materials and Methods In this retrospective comparative analysis of the four LLMs (accessed July 23 to July 26, 2023), the Medical Information Mart for Intensive Care (MIMIC)-IV database was used to gather 750 anonymized radiology report impressions covering a range of imaging modalities (MRI, CT, US, radiography, mammography) and anatomic regions. Three distinct prompts were employed to assess the LLMs' ability to simplify report impressions. The first prompt (prompt 1) was "Simplify this radiology report." The second prompt (prompt 2) was "I am a patient. Simplify this radiology report." The last prompt (prompt 3) was "Simplify this radiology report at the 7th grade level." Each prompt was followed by the radiology report impression and was queried once. The primary outcome was simplification as assessed by readability score. Readability was assessed using the average of four established readability indexes. The nonparametric Wilcoxon signed-rank test was applied to compare reading grade levels across LLM output. Results All four LLMs simplified radiology report impressions across all prompts tested (P < .001). Within prompts, differences were found between LLMs. Providing the context of being a patient or requesting simplification at the seventh-grade level reduced the reading grade level of output for all models and prompts (except prompt 1 to prompt 2 for ChatGPT-4) (P < .001). Conclusion Although the success of each LLM varied depending on the specific prompt wording, all four models simplified radiology report impressions across all modalities and prompts tested. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Rahsepar in this issue.

CAT-Seg: cascaded medical assistive tool integrating residual attention mechanisms and Squeeze-Net for 3D MRI biventricular segmentation

Cardiac image segmentation is a critical step in the early detection of cardiovascular disease. The segmentation of the biventricular is a prerequisite for evaluating cardiac function in cardiac magnetic resonance imaging (CMRI). In this paper, a cascaded model CAT-Seg is proposed for segmentation of 3D-CMRI volumes. CAT-Seg addresses the problem of biventricular confusion with other regions and localized the region of interest (ROI) to reduce the scope of processing. A modified DeepLabv3+ variant integrating SqueezeNet (SqueezeDeepLabv3+) is proposed as a part of CAT-Seg. SqueezeDeepLabv3+ handles the different shapes of the biventricular through the different cardiac phases, as the biventricular only accounts for small portion of the volume slices. Also, CAT-Seg presents a segmentation approach that integrates attention mechanisms into 3D Residual UNet architecture (3D-ResUNet) called 3D-ARU to improve the segmentation results of the three major structures (left ventricle (LV), Myocardium (Myo), and right ventricle (RV)). The integration of the spatial attention mechanism into ResUNet handles the fuzzy edges of the three structures. The proposed model achieves promising results in training and testing with the Automatic Cardiac Diagnosis Challenge (ACDC 2017) dataset and the external validation using MyoPs. CAT-Seg demonstrates competitive performance with state-of-the-art models. On ACDC 2017, CAT-Seg is able to segment LV, Myo, and RV with an average minimum dice symmetry coefficient (DSC) performance gap of 1.165%, 4.36%, and 3.115% respectively. The average maximum improvement in terms of DSC in segmenting LV, Myo and RV is 4.395%, 6.84% and 7.315% respectively. On MyoPs external validation, CAT-Seg outperformed the state-of-the-art in segmenting LV, Myo, and RV with an average minimum performance gap of 6.13%, 5.44%, and 2.912% respectively.

Cutaneous skin defects overlying tangential gunshot wounds: A case series

In examining deaths resulting from gunshot wounds, it is important to describe the wound pathway created by the projectile. Forensic pathologists must identify all entrance and exit wounds and account for all projectiles. Occasionally, confusion arises as to whether a skin defect represents an entrance wound or not, an exit wound, or some other type of wound. Herein, we propose the descriptor "bullet track skin defect" as a formal description for a superficial skin defect created along the pathway of a projectile within the body. Specifically, we define the "bullet track skin defect" as a partial- or full-thickness skin defect produced by a projectile traveling beneath the skin in a relatively tangential fashion as part of a wound pathway within the body. It is somewhat analogous to a traditional graze or superficial tangential wound, wherein the projectile traveling outside the body strikes the skin tangentially from above, without entering the body. However, the projectile is already traveling within the body with the bullet track skin defect, disrupting the skin tangentially from below rather than from above, without exiting the body. Although these defects are not a common presentation of gunshot wounds, they are certainly not rare. With this case series, we suggest that such defects may be referred to as "bullet track skin defects." Alternative language that can substitute for "bullet track skin defects" includes "bullet track skin wounds" or "bullet track cutaneous defects."

The Siren Song of Synergy

SUMMARY

In ancient Greek mythology, sirens were creatures of stunning beauty whose mystical songs led sailors to sail their boats onto hidden rocks and into total destruction. In this issue, Mason-Osann and colleagues present data in the context of acute myelogenous leukemia to suggest that while synergy may show initial attractions in drug combinations, it may carry with it hazards previously unforeseen. See related article by Mason-Osann et al., p. 95 (1).

Associations between Toxoplasma gondii seropositivity and psychopathological manifestations in schizophrenic patients: A single-center study from Ecuador

BACKGROUND

Schizophrenia, a complex neuropsychiatric disorder, is believed to be influenced by various factors including environmental exposures. A potential environmental factor is the infection by the obligate intracellular parasitic protozoan, Toxoplasma gondii which affects neurotransmitter levels, which could potentially exacerbate, trigger symptoms of schizophrenia or make them worst.

OBJECTIVE

To investigate the association between Toxoplasma gondii seropositivity and psychopathological presentation in persons with schizophrenia in Ecuador.

METHODS

This study was conducted at the Neuroscience Institute of Guayaquil, Ecuador. Among 368 inpatients, 104 were selected based on specific inclusion and exclusion criteria. Descriptive statistics captured patient characteristics and mental health outcomes. Logistic regression models estimated the effect of toxoplasmosis on various mental health outcomes, controlling for demographic and health-related variables.

RESULTS

86.5% of participants were seropositive for toxoplasmosis. Toxoplasma-seropositive schizophrenic patients had a lower risk of depression but a significantly higher risk of disorientation. The most prevalent mental health outcomes were Language Impairments (70.2%) and Bizarre Behavior (76.0%).

CONCLUSION

Our findings suggest that Toxoplasma gondii seropositivity may have specific effects on mental functions in schizophrenic patients, particularly reducing the risk of depression but increasing the risk of disorientation. Further studies are required to clarify these associations and the potential underlying mechanisms.

Evaluating Large Language Models for the National Premedical Exam in India: Comparative Analysis of GPT-3.5, GPT-4, and Bard

BACKGROUND

Large language models (LLMs) have revolutionized natural language processing with their ability to generate human-like text through extensive training on large data sets. These models, including Generative Pre-trained Transformers (GPT)-3.5 (OpenAI), GPT-4 (OpenAI), and Bard (Google LLC), find applications beyond natural language processing, attracting interest from academia and industry. Students are actively leveraging LLMs to enhance learning experiences and prepare for high-stakes exams, such as the National Eligibility cum Entrance Test (NEET) in India.

OBJECTIVE

This comparative analysis aims to evaluate the performance of GPT-3.5, GPT-4, and Bard in answering NEET-2023 questions.

METHODS

In this paper, we evaluated the performance of the 3 mainstream LLMs, namely GPT-3.5, GPT-4, and Google Bard, in answering questions related to the NEET-2023 exam. The questions of the NEET were provided to these artificial intelligence models, and the responses were recorded and compared against the correct answers from the official answer key. Consensus was used to evaluate the performance of all 3 models.

RESULTS

It was evident that GPT-4 passed the entrance test with flying colors (300/700, 42.9%), showcasing exceptional performance. On the other hand, GPT-3.5 managed to meet the qualifying criteria, but with a substantially lower score (145/700, 20.7%). However, Bard (115/700, 16.4%) failed to meet the qualifying criteria and did not pass the test. GPT-4 demonstrated consistent superiority over Bard and GPT-3.5 in all 3 subjects. Specifically, GPT-4 achieved accuracy rates of 73% (29/40) in physics, 44% (16/36) in chemistry, and 51% (50/99) in biology. Conversely, GPT-3.5 attained an accuracy rate of 45% (18/40) in physics, 33% (13/26) in chemistry, and 34% (34/99) in biology. The accuracy consensus metric showed that the matching responses between GPT-4 and Bard, as well as GPT-4 and GPT-3.5, had higher incidences of being correct, at 0.56 and 0.57, respectively, compared to the matching responses between Bard and GPT-3.5, which stood at 0.42. When all 3 models were considered together, their matching responses reached the highest accuracy consensus of 0.59.

CONCLUSIONS

The study's findings provide valuable insights into the performance of GPT-3.5, GPT-4, and Bard in answering NEET-2023 questions. GPT-4 emerged as the most accurate model, highlighting its potential for educational applications. Cross-checking responses across models may result in confusion as the compared models (as duos or a trio) tend to agree on only a little over half of the correct responses. Using GPT-4 as one of the compared models will result in higher accuracy consensus. The results underscore the suitability of LLMs for high-stakes exams and their positive impact on education. Additionally, the study establishes a benchmark for evaluating and enhancing LLMs' performance in educational tasks, promoting responsible and informed use of these models in diverse learning environments.

Food intolerances

ABSTRACT

Food intolerances are prevalent and often confused with food allergies. This article reviews the complex landscape of adverse reactions to food, distinguishing between immune-mediated responses (food allergies) and nonimmune reactions (food intolerances). It also explores specific food intolerances such as lactose intolerance, nonceliac gluten sensitivity, fructose intolerance, and salicylate sensitivity.

Using Galvanic Vestibular Stimulation to Induce Post-Roll Illusion in a Fixed-Base Flight Simulator

INTRODUCTION: The illusions of head motion induced by galvanic vestibular stimulation (GVS) can be used to compromise flight performance of pilots in fixed-base simulators. However, the stimuli used in the majority of studies fail to mimic disorientation in realistic flight because they are independent from the simulated aircraft motion. This study investigated the potential of bilateral-bipolar GVS coupled to aircraft roll in a fixed-base simulator to mimic vestibular spatial disorientation illusions, specifically the "post-roll illusion" observed during flight.METHODS: There were 14 nonpilot subjects exposed to roll stimuli in a flight simulator operating in a fixed-base mode. GVS was delivered via carbon rubber electrodes on the mastoid processes. The electrical stimulus was driven by the high-pass filtered aircraft roll rate to mimic the semicircular canals' physiological response. The post-roll test scenarios excluded outside visual cues or instruments and required subjects to actively maintain a constant bank angle after an abrupt stop following a passive prolonged roll maneuver. The anticipated outcome was an overshot in roll elicited by the GVS signal.RESULTS: The responses across subjects showed large variability, with less than a third aligning with the post-roll illusion. Subjective ratings suggest that the high-pass filtered GVS stimuli were mild and did not induce a clear sense of roll direction. However, uncontrolled head movements during stimulation might have obscured the intended effects of GVS-evoked illusory head movements.CONCLUSION: The mild and transient GVS stimuli used in this study, together with the uncontrolled head movements, did not convincingly mimic the post-roll illusion.Houben MMJ, Stuldreher IV, Forbes PA, Groen EL. Using galvanic vestibular stimulation to induce post-roll illusion in a fixed-base flight simulator. Aerosp Med Hum Perform. 2024; 95(2):84-92.

An Attentive Blank Stare Under Simulator-induced Spatial Disorientation Events

OBJECTIVE

This study investigated the effect of the spatial disorientation (SD) events on an attentive blank stare in the cockpit scene and demonstrated how much the flight task and visual delayed discrimination task were competing for the pilots' attention.

BACKGROUND

SD in flight is the leading cause of human error-related aircraft accidents in the military, general and commercial aviation, and has been an unsolved problem since the inception of flight. In-flight safety research, visually scanning cockpit instruments, and detecting changes are critical countermeasures against SD.

METHOD

Thirty male military pilots were performing a dual task involving piloting a flight simulator and visual change detection, while eye movements were obtained using an eye tracker.

RESULTS

Pilots made more flight errors and spent less time gazing at the area of change in SD-conflict than in non-conflict flights. The vestibular origin SD-conflict led not only to deteriorated piloting and visual scanning but also to problems coordinating overt and covert attention, resulting in lower noticeability of visual changes despite gazing at them.

CONCLUSION

Our study shows that looking at a given area in space is not a sufficient condition for effective covert attention allocation and the correct response to a visual stimulus. It seems to be important to make pilots aware of this during SD training.

APPLICATION

To reduce change blindness, some strategies, such as reducing the number of secondary tasks is extremely valuable. Particular efforts should also be focused on improving the design of the aircraft cockpit by increasing the conspicuousness of critical information.

Orientation Comes First: Becoming Aware of Spatial Disorientation Interferes with Cognitive Performance

BACKGROUND

Previous research has shown that experiencing motion stimuli negatively impacts cognitive performance.

OBJECTIVE

In the current study, we investigate whether this impact relates to Type-II spatial disorientation (SD), to motion stimulus magnitude, or to an interaction of these factors.

METHOD

Stimuli for participants (n = 23) consisted of Earth-vertical yaw rotations on a rotating chair in a completely darkened room. In the surprise condition, the stimulus started with subthreshold acceleration, followed by suprathreshold deceleration to a non-zero velocity, inducing a sensation of rotation that is opposite to the actual rotation revealed when the lights were switched on. In the no-surprise condition, the same changes in velocity were used, but starting from (almost) zero velocity, which induced a sensation of rotation in the same direction as the actual rotation. Participants performed a self-paced arithmetic task and measurement of their cognitive performance started after the environment was revealed. Stimulus magnitude was operationalized through higher or lower peak suprathreshold deceleration.

RESULTS

The results revealed that counting speed decreased significantly when participants were surprised, constituting a large effect size. The proportion of counting errors likewise increased significantly when participants were surprised, but only in the high-magnitude condition.

APPLICATION

The findings suggest that surprise caused by the recognition of SD has an involuntary disruptive effect on cognition, which may impact performance of piloting tasks. These results are relevant when modeling motion stimuli effects on performance, and when developing SD awareness training for pilots.

Swin-Transformer -YOLOv5 for lightweight hot-rolled steel strips surface defect detection algorithm

An essential industrial application is the examination of surface flaws in hot-rolled steel strips. While automatic visual inspection tools must meet strict real-time performance criteria for inspecting hot-rolled steel strips, their capabilities are constrained by the accuracy and processing speed of the algorithm used to identify defects. To solve the problems of poor detection accuracy, low detection efficiency, and unsuitability of low computing power platforms of the hot-rolled strip surface defect detection algorithm The Swin-Transformer-YOLOv5 model based on the improved one-stage detector is proposed. By employing GhostNet, the model's lightweight design, and guaranteed detection accuracy are both achieved. The C3 module introduces Swin-Transformer to address the issues of cluttered backdrops of defect photos and easily confused defect categories. With the addition of the CoordAttention module, the model's capacity to extract defective features is improved, and its performance keeps getting better. The issue of huge differences in different scales and poor detection of small flaws is resolved by employing BiFPN for feature fusion, and the detector's capacity to adapt to targets of different scales is improved. The experimental results demonstrate that the improved Swin-Transformer-Yolov5 model significantly outperforms the industry-standard target detection algorithms, and the model's mAP value still improves by 8.39% over the original model while reducing the number of parameters, GFLOPs, and weight by 36.6%, 40.0%, and 34.7%, respectively. The model is better suited for use on low-arithmetic platforms as a result.

Competency versus proficiency: trying to develop an understanding of these terms in the context of practice learning

The language of nurse education in the UK has shifted from 'competency' to 'proficiency' since 2018. The shift in language has been poorly articulated leaving individual higher education institutions, practice supervisors and assessors to interpret what these terms mean in relation to assessing student nurses. There appeared to be some confusion regarding the interpretation of the term proficiency among those who engaged in an exchange on the topic via Twitter. Students may focus on the procedure-based checklists within the standards. The relationship between proficiency and implementing a person-centred approach to care remains unclear.

Quantifying effectiveness and best practices for bumblebee identification from photographs

Understanding pollinator networks requires species level data on pollinators. New photographic approaches to identification provide avenues to data collection that reduce impacts on declining bumblebee species, but limited research has addressed their accuracy. Using blind identification of 1418 photographed bees, of which 561 had paired specimens, we assessed identification and agreement across 20 bumblebee species netted in Montana, North Dakota, and South Dakota by people with minimal training. An expert identified 92.4% of bees from photographs, whereas 98.2% of bees were identified from specimens. Photograph identifiability decreased for bees that were wet or matted; bees without clear pictures of the abdomen, side of thorax, or top of thorax; bees photographed with a tablet, and for species with more color morphs. Across paired specimens, the identification matched for 95.1% of bees. When combined with a second opinion of specimens without matching identifications, data suggested a similar misidentification rate (2.7% for photographs and 2.5% specimens). We suggest approaches to maximize accuracy, including development of rulesets for collection of a subset of specimens based on difficulty of identification and to address cryptic variation, and focused training on identification that highlights detection of species of concern and species frequently confused in a study area.

Agony of akathisia: a case of sodium valproate-induced akathisia

Akathisia is a subjective feeling of restlessness that often results in a compulsion to move. Drug-related causes are the most common aetiologies. It can often be confused with restless legs syndrome (RLS). We describe a case of valproate-induced akathisia that improved with drug cessation. This case reports a rare but treatable adverse effect of sodium valproate and highlights the importance of differentiating akathisia from RLS.

Optimizing health service location in a highly urbanized city: Multi criteria decision making and P-Median problem models for public hospitals in Jeddah City, KSA

Rapid urbanization and population growth have increased the need for optimizing the location of health services in highly urbanized countries like Kingdom of Saudi Arabia (KSA). This study employs a multiple-criteria decision making (MCDM) approach, e.g., fuzzy overlay technique by combining the P-Median location-allocation model, for optimizing health services. First, a geodatabase, containing public hospitals, road networks and population districts, was prepared. Next, we investigated the location and services of five public hospitals in Jeddah city of KSA, by using a MCDM model that included a fuzzy overlay technique with a location-allocation model. The results showed that the allocated five hospitals served 94 out of 110 districts in the study area. Our results suggested additional hospitals must be added to ensure that the entire city is covered with timely hospital services. To improve the existing situation, we prioritized demand locations using the maximize coverage (MC) location problem model. We then used the P-Median function to find the optimal locations of hospitals, and then combined these two methods to create the MC-P-Median optimizer. This optimizer eliminated any unallocated or redundant information. Health planners can use this model to determine the best locations for public hospitals in Jeddah city and similar settings.

Vestibular migraine and persistent postural perceptual dizziness

Dizziness is a common symptom among patients in primary care, general neurology, and headache clinic practices. Vestibular migraine is conceptualized as a condition of recurrent attacks of vestibular symptoms attributed to migraine. It is now considered the most common cause of spontaneous episodic vertigo. Persistent postural-perceptual dizziness (PPPD) has more recently been defined based on four previous clinical entities as a syndrome of chronic daily dizziness, unsteadiness, or nonspinning vertigo that fluctuates and is exacerbated by postural, motion, or visual factors. Although PPPD is more often precipitated by other conditions causing vertigo, unsteadiness, or dizziness, it is discussed at length in this chapter because vestibular migraine is among the most common triggers for development of PPPD. Pathophysiology of each is incompletely understood, and with lack of biomarkers, the diagnosis of each rests on consensus-derived, symptom-based criteria. Areas of uncertainty exist regarding some overlapping symptoms that may create potential diagnostic confusion between the conditions. This chapter provides a comprehensive review of the current state of vestibular migraine and PPPD, including diagnostic and management guidance for when they occur separately, together, or along with other common comorbidities.

Improving wayfinding in hospitals for people with diverse needs and abilities: An exploratory approach based on multi-criteria decision making

Hospital wayfinding systems that are based solely on signage do not provide adequate solutions for wayfinding needs, especially for users with impairments. Moreover, the interaction between user characteristics and the inner space of the building also determines wayfinding efficiency. The aims of this study, therefore, were to identify architectural features that affect spatial orientation and wayfinding behaviors; demonstrate the implementation of a multi-criteria decision-making (MCDM) approach for improving wayfinding in a diverse range of users; and produce a set of quantitative values (i.e., weights) for each selected architectural feature, based on the individual's preferences. Doing so could enable the formulating of practical design guidelines for hospital buildings, tailored to the needs and abilities of the users, to minimize disorientation and confusion - as demonstrated in this paper through a case study. The MCDM approach was chosen as it is based on observations whereby wayfinding resembles a continuous decision-making process, throughout which, users continuously select those architectural features that they perceive as having the greatest wayfinding value.

A Qualitative Study on the Psychological Experience of Emergency Department Medical Staff Caring for Patients with Suicide Attempts in Northeastern Sichuan

The purpose of this study was to explore the psychological experiences of emergency department staff in northeastern Sichuan when treating patients with suicide attempts and to provide a theoretical basis for developing appropriate clinical interventions and improving mental health services for suicidal patients. Sixteen emergency department staff members who met recruitment requirements at two hospitals in Nanchong, China, were interviewed using Colizzi descriptive phenomenological analysis. The interviews were in-depth and semi-structured. The qualitative analysis of this study revealed three main themes: (1) aspects of the emotional experience that may be detrimental to helping people in crisis (e.g., sympathy and regret, confusion and bewilderment, worry and stress); (2) aspects of the cognitive experience (e.g., inability to deal with patients' psychological issues and having new perspective on the medical profession); and (3) raising awareness of mental health services. Future reform efforts should consider training medical staff in suicide prevention knowledge and communication skills, using a compassion-centered approach to alleviate the suffering of patients who attempt suicide, using the Safety Screening Scale (PSS-3), providing counselors for patients, developing family-focused interventions, and involving family members in suicide risk prevention and treatment.

Giant chess game enhances spatial navigational skills in 6-years-old children: preliminary findings

The game of chess is a valuable extracurricular activity for children, with positive effects on their cognitive skills and academic achievements. We investigated the extent to which the Giant Chess Game (GCG) played on a giant chessboard enhances working memory in "navigational-vista" space and "reaching" space. We also assessed if the GCG enhances mental rotation skills. For 10 weeks, 15 children (GCG group) were involved in a giant chess class, while 15 gender and age-matched children were involved in standard didactics (control group-CG). Children were tested twice, before (T0) and after (T1) the GCG, by tasks aimed at measuring: visuo-spatial working memory (VSWM) in the navigational-vista space (Walking Corsi test); VSWM in the reaching space (Corsi Block-Tapping task); mental rotation (Rotating Flowers test). We found that the GCG group significantly improved its performance more than the CG in VSWM in both navigational-vista space and reaching space, as well as in mental rotation. Our results suggest that the GCG has positive effects on visuo-spatial abilities underlying topographical skills. Therefore, the training using GCG can help enhancing spatial ability and may have a role in contrasting the spreading of navigational deficits such as the Developmental Topographical Disorientation (DTD).

CT Colonography Reporting and Data System (C-RADS): Version 2023 Update

The CT Colonography Reporting and Data System (C-RADS) has withstood the test of time and proven to be a robust classification scheme for CT colonography (CTC) findings. C-RADS version 2023 represents an update on the scheme used for colorectal and extracolonic findings at CTC. The update provides useful insights gained since the implementation of the original system in 2005. Increased experience has demonstrated confusion on how to classify the mass-like appearance of the colon consisting of soft tissue attenuation that occurs in segments with acute or chronic diverticulitis. Therefore, the update introduces a new subcategory, C2b, specifically for mass-like diverticular strictures, which are likely benign. Additionally, the update simplifies extracolonic classification by combining E1 and E2 categories into an updated extracolonic category of E1/E2 since, irrespective of whether a finding is considered a normal variant (category E1) or an otherwise clinically unimportant finding (category E2), no additional follow-up is required. This simplifies and streamlines the classification into one category, which results in the same management recommendation.

Accuracy of dental age estimations based on individual teeth and staging system comparisons

AIM

To investigate whether a specific tooth or teeth provide the most accurate estimation of chronological age (CA), and determine which of the three staging systems studied represents dental development for an individual tooth.

METHOD

Data were collected from 400 digital panoramic radiographs of healthy Saudi children aged 6.00-15.99 years. Each permanent tooth on the left side was evaluated to determine its developmental stage and dental age using the methods by Moorrees, Fanning, and Hunt (MFH) (1963), as adapted by Smith (1991), Gleiser and Hunt (1955), and Nicodemo et al. (1974). The accuracy (bias) of each tooth type and stage was assessed in relation to the CA, the teeth and the methods were compared, and the accuracy of age estimation using all teeth and the most accurate tooth in each method were compared.

RESULTS

Regarding staging systems, comparatively, Gleiser and Hunt's method had the lowest bias for the lower first molar (-0.50 ± 1.05 years). Nicodemo et al.'s method had a lower bias for all other mandibular teeth compared to the MFH method. For individual teeth using the MFH method, the most and least accurate teeth for the combined sexes were the lower central incisor (-0.59 ± 0.77 years) and the lower first molar (-1.54 ± 0.93 years), respectively. No significant difference was found between the biases when using the lower central incisor alone and when using all teeth for the combined sexes. For individual teeth using Nicodemo et al.'s method, the most and least accurate teeth for combined sexes were the upper central incisor (-0.03 ± 1.01 years) and the lower first molar (-1.08 ± 1.59 years), respectively. A significant difference was found between the biases using the upper central incisor alone and all teeth for the combined sexes, with the upper central incisor exhibiting the lowest bias (P=0.028).

CONCLUSIONS

Comparatively, Nicodemo et al.'s method had the lowest bias for all teeth except for the lower first molar, where Gleiser and Hunt's method had the lowest bias. This, however, should not be confused with precision. MFH's staging system was more representative of dental development for an individual tooth. For combined sexes, the lower central and lateral incisors were the most accurate teeth using the MFH method. The upper central incisor and lower first premolar were the most accurate teeth using Nicodemo et al.'s method. The lower first molar was the least accurate tooth using both methods.

Understanding of Depressive Symptomatology across Major Depressive Disorder and Bipolar Disorder: A Network Analysis

Background and Objectives: Depressive symptoms are prominent in both major depressive disorder (MDD) and bipolar disorder (BD). However, comparative research on the network structure of depressive symptoms in these two diagnostic groups has been limited. This study aims to compare the network structure of depressive symptoms in MDD and BD, providing a deeper understanding of the depressive symptomatology of each disorder. Materials and Methods: The Zung Self-Rating Depressive Scale, a 20-item questionnaire, was administered to assess the depressive symptoms in individuals with MDD (n = 322) and BD (n = 516). A network analysis was conducted using exploratory graph analysis (EGA), and the network structure was analyzed using regularized partial correlation models. To validate the dimensionality of the Zung SDS, principal component analysis (PCA) was adopted. Centrality measures of the depressive symptoms within each group were assessed, followed by a network comparison test between the two groups. Results: In both diagnostic groups, the network analysis revealed four distinct categories, aligning closely with the PCA results. "Depressed affect" emerged as the most central symptom in both MDD and BD. Furthermore, non-core symptoms, "Personal devaluation" in MDD and "Confusion" in BD, displayed strong centrality. The network comparison test did not reveal significant differences in the network structure between MDD and BD. Conclusions: The absence of significant differences in the network structures between MDD and BD suggests that the underlying mechanisms of depressive symptoms may be similar across these disorders. The identified central symptoms, including "Depressed affect", in both disorders and the distinct non-core symptoms in each highlight the complexity of the depressive symptomatology. Future research should focus on validating these symptoms as therapeutic targets and incorporate various methodologies, including non-metric dimension reduction techniques or canonical analysis.

Navigating the twilight years: Supporting older adults' orientation and wayfinding in senior living facilities

In their twilight years, spatial disorientation can cause significant challenges for older adults, leading them to become perpetually disoriented or rely more on environmental cues and others for navigation. Unfortunately, wayfinding within senior living facilities is often an afterthought for senior living facility planners. This study explores the lived experiences of older adults coping with spatial disorientation and wayfinding in senior living facilities and the consequential impact on their physical, social, and psychosocial well-being. Data were collected from 28 older adults in six senior living facilities within three urban locations. The study used one-on-one, semi-structured, in-depth interviews and the Modified Stevick-Colaizzi-Keen analysis method guided by Moustakas' transcendental phenomenology. Five primary themes emerged: spatial disorientation, wayfinding, self-evident stimuli, visual cues and constancies, and digital wayfinding decision junctions. Through a "looking out from the inside" approach, the findings have valuable implications for academics, senior-friendly environments, government policymakers, hospitality and healthcare industries.

Medical Misnomers Are Murky: Time to Memorialize and Rename

Misnomers have dogged medical practice seemingly since its inception. They may arise out of initial misunderstanding of the underlying disease process, a fanciful personification of the disease itself, or simple confusion encountered early in the disease's discovery. Misnomers are not harmless. By increasing unneeded complexity, they add to challenges in medical education without increasing understanding. Practicing clinicians may experience difficulties in communicating with patients. For example, a diagnosis of "ringworm" may be made but the patient may not understand why an antiparasitic is not being prescribed, requiring an explanation that it is a dermatophytic condition and not a parasitic one. Although no randomized controlled trial can be conducted, misnomers can arguably create unconscious bias in clinician minds about the underlying pathophysiology of different conditions. We aim to end the cycle of misinformation by pointing out some common misnomers and encouraging alternate names that are more accurate, either novel or already in use. We invite the reader to send us more examples from their field.

[Influenza-associated acute necrotizing encephalitis: unknown makes undertreated?]

BACKGROUND

Influenza-associated acute necrotizing encephalitis (ANE) is a very rare, but severe complication from influenza infection.

CASE DESCRIPTION

We present a 48 year old male who presented with fever, malaise, confusion and altered mental status (E4M5V2) and influenza A infection. He quickly develops convulsions after which he is intubated and admitted to the Intensive Care Unit following which he remains comatose (E1M1V1). The diagnosis of influenza associated acute necrotizing encephalitis is made based on his neurological symptoms, generalized slowing on electro-encephalogram, classic bilateral findings on MRI in the thalamus and basal ganglia and proven influenza infection in the cerebrospinal fluid.

CONCLUSION

Acute necrotising encephalitis is a severe complication from a common infection. It is advised to consider early MRI imaging in patients with influenza and fitting neurological symptoms and to consider treatment with corticosteroids.

Activation extending based on long-range dependencies for weakly supervised semantic segmentation

Weakly supervised semantic segmentation (WSSS) principally obtains pseudo-labels based on the class activation maps (CAM) to handle expensive annotation resources. However, CAM easily involves false and local activation due to the the lack of annotation information. This paper suggests weakly supervised learning as semantic information mining to extend object mask. We proposes a novel architecture to mining semantic information by modeling through long-range dependencies from in-sample and inter-sample. Considering the confusion caused by the long-range dependencies, the images are divided into blocks and carried out self-attention operation on the premise of fewer classes to obtain long-range dependencies, to reduce false predictions. Moreover, we perform global to local weighted self-supervised contrastive learning among image blocks, and the local activation of CAM is transferred to different foreground area. Experiments verified that superior semantic details and more reliable pseudo-labels are captured through these suggested modules. Experiments on PASCAL VOC 2012 demonstrated the proposed model achieves 76.6% and 77.4% mIoU in val and test sets, which is superior to the comparison baselines.

Electroencephalogram (EEG) assessment of brain activity before and after electrical stunning in the Nile crocodile (Crocodylus niloticus)

Electrical stunning is used to capture crocodiles to perform routine management procedures. It is essential from a welfare point that electrical stunning must cause unconsciousness in animals. However, there is no information of whether or not electrical stunning causes unconsciousness in the Nile crocodile (Crocodylus niloticus). The purpose of the study was to assess brain activity before and after electrical stunning in crocodiles using a 5-channel referential electroencephalogram analysis to determine consciousness. Behavioural indicators and electroencephalogram recordings of 15 captive-bred crocodiles were captured and analysed using power spectral density analysis immediately before and after stunning and then at 60 s intervals until 5 min post-stunning. A standardised stun of 170 Volts was applied for 5-7 s on the wetted neck. Unconsciousness was defined as a decrease in alpha wave power and increase in delta wave power. Three of the electroencephalograms could not be assessed. Unconsciousness was identified in 6 out of 12 crocodiles and lasted for an average for 120 s. An increase in electroencephalogram waveform amplitude and tonic-clonic seizure-like waveform activity and behaviour indicators were not reliable indicators of unconsciousness. Further research should be focused on improving the efficiency and reliability of electrical stunning.

Effects of low-level RF fields reveal complex pattern of magnetic input to the avian magnetic compass

The avian magnetic compass can be disrupted by weak narrow-band and broadband radio-frequency (RF) fields in the lower MHz range. However, it is unclear whether disruption of the magnetic compass results from the elimination of the perception pattern produced by the magnetic field or from qualitative changes that make the pattern unrecognizable. We show that zebra finches trained in a 4-arm maze to orient relative to the magnetic field are disoriented when tested in the presence of low-level (~ 10 nT) Larmor-frequency RF fields. However, they are able to orient when tested in such RF fields if trained under this condition, indicating that the RF field alters, but does not eliminate, the magnetic input. Larmor-frequency RF fields of higher intensities, with or without harmonics, dramatically alter the magnetic compass response. In contrast, exposure to broadband RF fields in training, in testing, or in both training and testing eliminates magnetic compass information. These findings demonstrate that low-level RF fields at intensities found in many laboratory and field experiments may have very different effects on the perception of the magnetic field in birds, depending on the type and intensity of the RF field, and the birds' familiarity with the RF-generated pattern.

Distress, burden, and wellbeing in siblings of people with mental illness: a mixed studies systematic review and meta-analysis

BACKGROUND

Family members of people with mental illness (MI) may experience a host of psychological adversities such as increased stress, burden, and reduced wellbeing. However, relatively little is known about siblings. This study aimed to characterise the experience of distress (viz. depressive and anxiety symptoms), burden, and wellbeing in siblings of people with MI.

METHODS

Studies reporting on quantitative measures of depression, anxiety, burden, or wellbeing in siblings; and/or qualitative findings on siblings' experience were eligible. The literature search was conducted up until 20th October 2022.

RESULTS

Sixty-two studies comprising data from 3744 siblings were included. The pooled mean percentage of depressive symptoms fell in the mild range at 15.71 (k = 28, N = 2187, 95% CI 12.99-18.43) and anxiety symptoms fell in the minimal range at 22.45 (k = 16, N = 1122, 95% CI 17.09-27.80). Moderator analyses indicate that siblings of people with a schizophrenia spectrum disorder experience greater depressive symptoms than siblings of people with other types of MI (β = -16.38, p < 0.001). Qualitative findings suggest that individuals may be particularly vulnerable during their siblings' illness onset and times of relapse. Limited communication, confusion about MI, and the need to compensate may contribute to siblings' distress and/or burden. Siblings' experience of wellbeing and caregiving were closely related.

CONCLUSION

This review highlights the complex psychological experience of siblings and the need for greater research and clinical support for this important yet often overlooked cohort.

How the black hole illusion environment affects operational performance at different flight phases in aviation

The black hole illusion (BHI) is a subtype of spatial disorientation that can result in fatal consequences in aviation. Research on the BHI has generally focused on altitude deviation, and few studies have examined the effect across different flight phases. In a simulation-based experiment, 18 participants performed 12 simulated approach and landing tasks in normal and BHI environments. Flight performance was analyzed with 14 flight parameters and was compared across five points and three phases, which were referenced from a National Transportation Safety Board report and other previous studies. Results showed that multiple flight parameters were significantly impaired and that their influences varied from the initial approach to the final touchdown. In the BHI environment, participants tended to descend aggressively during the approach phase and flew a lower but similar glidepath during the last approach phase. They might have realized the abnormal situation induced by the BHI but usually were unable to recover from the dangerous maneuver in time. Additionally, the result of glide path error, one of the most commonly used variables in previous BHI research, was only significant during the last approach phase. Flight stability was also impaired in the BHI environment. This is the first study to systematically analyze the BHI effects on multiple flight parameters at different flight phases. The use of this experimental paradigm could facilitate future research to evaluate and prevent the BHI in a more comprehensive way.

Screening of potential biomarkers for polycystic ovary syndrome and identification of expression and immune characteristics

BACKGROUND

Polycystic ovary syndrome (PCOS) seriously affects the fertility and health of women of childbearing age. We look forward to finding potential biomarkers for PCOS that can aid clinical diagnosis.

METHODS

We acquired PCOS and normal granulosa cell (GC) expression profiles from the Gene Expression Omnibus (GEO) database. After data preprocessing, differentially expressed genes (DEGs) were screened by limma package, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis and Gene Set Enrichment Analysis (GSEA) were performed. Recursive feature elimination (RFE) algorithm and the least absolute shrinkage and selection operator (LASSO) Cox regression analysis were used to acquire feature genes as potential biomarkers. Time-dependent receiver operator characteristic curve (ROC curve) and Confusion matrix were used to verify the classification performance of biomarkers. Then, the expression characteristics of biomarkers in PCOS and normal cells were analyzed, and the insulin resistance (IR) score of samples was computed by ssGSEA. Immune characterization of biomarkers was evaluated using MCP counter and single sample gene set enrichment analysis (ssGSEA). Finally, the correlation between biomarkers and the scores of each pathway was assessed.

RESULTS

We acquired 93 DEGs, and the enrichment results indicated that most of DEGs in PCOS group were significantly enriched in immune-related biological pathways. Further screening results indicated that JDP2 and HMOX1 were potential biomarkers. The area under ROC curve (AUC) value and Confusion matrix of the two biomarkers were ideal when separated and combined. In the combination, the training set AUC = 0.929 and the test set AUC = 0.917 indicated good diagnostic performance of the two biomarkers. Both biomarkers were highly expressed in the PCOS group, and both biomarkers, which should be suppressed in the preovulation phase, were elevated in PCOS tissues. The IR score of PCOS group was higher, and the expression of JDP2 and HMOX1 showed a significant positive correlation with IR score. Most immune cell scores and immune infiltration results were significantly higher in PCOS. Comprehensive analysis indicated that the two biomarkers had strong correlation with immune-related pathways.

CONCLUSION

We acquired two potential biomarkers, JDP2 and HMOX1. We found that they were highly expressed in the PCOS and had a strong positive correlation with immune-related pathways.