Leans Illusion in Hexapod Simulator Facilitates Erroneous Responses to Artificial Horizon in Airline Pilots

OBJECTIVE

We tested whether a procedure in a hexapod simulator can cause incorrect assumptions of the bank angle (i.e., the "leans") in airline pilots as well as incorrect interpretations of the attitude indicator (AI).

BACKGROUND

The effect of the leans on interpretation errors has previously been demonstrated in nonpilots. In-flight, incorrect assumptions can arise due to misleading roll cues (spatial disorientation).

METHOD

Pilots (n = 18) performed 36 runs, in which they were asked to roll to wings level using only the AI. They received roll cues before the AI was shown, which matched with the AI bank angle direction in most runs, but which were toward the opposite direction in a leans-opposite condition (four runs). In a baseline condition (four runs), they received no roll cues. To test whether pilots responded to the AI, the AI sometimes showed wings level following roll cues in a leans-level condition (four runs).

RESULTS

Overall, pilots made significantly more errors in the leans-opposite (19.4%) compared to the baseline (6.9%) or leans-level condition (0.0%). There was a pronounced learning effect in the leans-opposite condition, as 38.9% of pilots made an error in the first exposure to this condition. Experience (i.e., flight hours) had no significant effects.

CONCLUSION

The leans procedure was effective in inducing AI misinterpretations and control input errors in pilots.

APPLICATION

The procedure can be used in spatial disorientation demonstrations. The results underline the importance of unambiguous displays that should be able to quickly correct incorrect assumptions due to spatial disorientation.

Fibronectin Glomerulopathy Confused with Glomerular Endothelial Injury in a Patient with Takotsubo Cardiomyopathy

A 46-year-old woman developed takotsubo cardiomyopathy and nephrotic syndrome. The first kidney biopsy suggested non-immune-complex-mediated membranoproliferative glomerulonephritis (MPGN), and she was diagnosed with glomerular endothelial injury associated with takotsubo cardiomyopathy. A second biopsy was performed two years later because of persistent proteinuria despite renin-angiotensin system inhibition. This biopsy indicated non-immune-complex-mediated MPGN, but a mesangial and subendothelial substance of a higher electron density than that in the first biopsy was detected, suggesting the possibility of glomerular disease with non-immune deposits rather than endothelial injury. Finally, she was diagnosed with fibronectin nephropathy. Although rare, fibronectin glomerulopathy should be considered in non-immune-complex-mediated MPGN.

Temporal disorientations and distortions during isolation

Understanding how the brain maps time is central to neuroscience, behavior, psychology, and cognition. Just as in spatial navigation, self-positioning in a temporal cognitive map depends on numerous factors that are both exogenous and endogenous (e.g. time of day and experienced durations, respectively). The deprivation of external temporal landmarks can greatly reduce the ability of participants to orient in time and to formulate an adequate endogenous representation of time. However, this area of investigation in humans shows a great paucity of empirical data. This article aims at unearthing some of the experimental work that has systematically explored how humans' awareness of time is affected by varying degrees of isolation protocols. The assessment of the literature on the impact of isolation (broadly construed) on human temporalities may contribute to contextualizing the temporal distortions and disorientations reported during the ongoing worldwide pandemic Covid-19.

Distinct clinical symptom patterns in patients hospitalised with COVID-19 in an analysis of 59,011 patients in the ISARIC-4C study

COVID-19 is clinically characterised by fever, cough, and dyspnoea. Symptoms affecting other organ systems have been reported. However, it is the clinical associations of different patterns of symptoms which influence diagnostic and therapeutic decision-making. In this study, we applied clustering techniques to a large prospective cohort of hospitalised patients with COVID-19 to identify clinically meaningful sub-phenotypes. We obtained structured clinical data on 59,011 patients in the UK (the ISARIC Coronavirus Clinical Characterisation Consortium, 4C) and used a principled, unsupervised clustering approach to partition the first 25,477 cases according to symptoms reported at recruitment. We validated our findings in a second group of 33,534 cases recruited to ISARIC-4C, and in 4,445 cases recruited to a separate study of community cases. Unsupervised clustering identified distinct sub-phenotypes. First, a core symptom set of fever, cough, and dyspnoea, which co-occurred with additional symptoms in three further patterns: fatigue and confusion, diarrhoea and vomiting, or productive cough. Presentations with a single reported symptom of dyspnoea or confusion were also identified, alongside a sub-phenotype of patients reporting few or no symptoms. Patients presenting with gastrointestinal symptoms were more commonly female, had a longer duration of symptoms before presentation, and had lower 30-day mortality. Patients presenting with confusion, with or without core symptoms, were older and had a higher unadjusted mortality. Symptom sub-phenotypes were highly consistent in replication analysis within the ISARIC-4C study. Similar patterns were externally verified in patients from a study of self-reported symptoms of mild disease. The large scale of the ISARIC-4C study enabled robust, granular discovery and replication. Clinical interpretation is necessary to determine which of these observations have practical utility. We propose that four sub-phenotypes are usefully distinct from the core symptom group: gastro-intestinal disease, productive cough, confusion, and pauci-symptomatic presentations. Importantly, each is associated with an in-hospital mortality which differs from that of patients with core symptoms.

[Spontaneous intracranial hypotensioncan be confused with subdural haematoma]

Spontaneous intracranial hypotension is a rare condition, but due to increased awareness and better diagnostics it is more frequently reported. This is a case report of a 52-year-old male with sudden onset of vertigo and orthostatic headache. Initial workup was negative, but over the following six months symptoms progressed and bilateral hygromas were identified. Complete recovery was noted after two autologous blood patches. The importance of clinical presentation and differential diagnoses of spontaneous intracranial hypotension is emphasized.

Evaluating Olympic Pictograms Using Fuzzy TOPSIS-Focus on Judo, Taekwondo, Boxing, and Wrestling

It is necessary to evaluate whether Olympic pictograms are designed accurately and are easy to understand, so that they fulfill their intended functions and roles. Olympic pictograms are used to facilitate smooth communication at this large sporting event. However, viewers often find it challenging to understand the actual sport represented by the pictogram. This study evaluates the ranking of comprehensibility of the pictograms for judo, taekwondo, boxing, and wrestling used in six games, from the 27th Sydney Olympics in 2000 to the 32nd Tokyo Olympics in 2021. The evaluation was done using the fuzzy technique for order of preference by similarity to ideal solution (TOPSIS) method, a multi-criteria decision-making methodology commonly used in economics and other fields. Data collection was conducted from 10 May to 30 June 2021 for 44 general public and seven experts. The results are as follows. First, the pictograms from the 2008 Beijing Olympics ranked first in three sports: taekwondo, boxing, and wrestling, but there were no pictograms that consistently ranked first or sixth in all sports. Second, the sensitivity analysis result shows the possibility that the ranking would be reversed if the weight of the evaluation factors were changed. This study is expected to contribute to developing pictograms that can adequately convey the appropriate information regarding Olympic sports in the future.

The Prevalence of Amnestic and Non-Amnestic Mild Cognitive Impairment and Its Association with Different Lifestyle Factors in a South Italian Elderly Population

Mild Cognitive Impairment (MCI) is a transition stage between normal aging and dementia and can be useful to monitor the cognitive status of people at risk of dementias. Our aims were to investigate the prevalence of amnestic and non-amnestic MCI in a South Italian elderly population, and to identify socio-demographic, clinical and lifestyle factors associated with MCI. A cross-sectional retrospective population study on 839 community-dwelling participants over 60 years of age was carried out. Elderly people were administered a brief neuropsychological screening to identify their cognitive and functional status, and a questionnaire to investigate several socio-demographic, clinical, and lifestyle factors. Prevalence estimate for MCI was 12.0% (95% CI: 10.0–14.5%), for amnestic MCI was 7.4% (95% CI: 5.8–9.4%), and for non-amnestic MCI was 4.6% (95% CI: 3.4–6.4%), for people older than 60 years of age. Logistic regression models, corrected for age, sex, and education, revealed a significant association of MCI with the following factors: age, education, intellectual activities, and topographical disorientation. On the other hand, education, clinical factors (e.g., depression level and perceived physical pain), lifestyle factors (e.g., smoking, alcohol, and leisure/productive activities), dietary habits, quality of life, and self-reported topographical disorientation were non-significantly associated with MCI. Prevalence estimates and the association of MCI and its subtypes with risk and protective factors were discussed in comparison with the most recent systematic reviews and meta-analyses.

Evidence of disorientation towards immunization on online social media after contrasting political communication on vaccines. Results from an analysis of Twitter data in Italy

Background

In Italy, in recent years, vaccination coverage for key immunizations as MMR has been declining to worryingly low levels, with large measles outbreaks. As a response in 2017, the Italian government expanded the number of mandatory immunizations introducing penalties to unvaccinated children’s families. During the 2018 general elections campaign, immunization policy entered the political debate with the government in-charge blaming oppositions for fuelling vaccine scepticism. A new government (formerly in the opposition) established in 2018 temporarily relaxed penalties and announced the introduction of forms of flexibility.

Objectives and methods

First, we supplied a definition of disorientation, as the “lack of well-established and resilient opinions among individuals, therefore causing them to change their positions as a consequence of sufficient external perturbations”. Second, procedures for testing for the presence of both short and longer-term collective disorientation in Twitter signals were proposed. Third, a sentiment analysis on tweets posted in Italian during 2018 on immunization topics, and related polarity evaluations, were used to investigate whether the contrasting announcements at the highest political level might have originated disorientation amongst the Italian public.

Results

Vaccine-relevant tweeters’ interactions peaked in response to main political events. Out of retained tweets, 70.0% resulted favourable to vaccination, 16.4% unfavourable, and 13.6% undecided, respectively. The smoothed time series of polarity proportions exhibit frequent large changes in the favourable proportion, superimposed to a clear up-and-down trend synchronized with the switch between governments in Spring 2018, suggesting evidence of disorientation among the public.

Conclusions

The reported evidence of disorientation for opinions expressed in online social media shows that critical health topics, such as vaccination, should never be used to achieve political consensus. This is worsened by the lack of a strong Italian institutional presence on Twitter, calling for efforts to contrast misinformation and the ensuing spread of hesitancy. It remains to be seen how this disorientation will impact future parents’ vaccination decisions.

[How the DSM helps psychiatry move forward]

The prospect of 'disease' in psychiatry has been debated for centuries. In the 21st century, this discussion often focusses on the usefulness of DSM classifications, the diagnostic manual of psychiatry. This criticism on the DSM is exemplary for our struggle to understand, classify and treat psychiatric problems. However, we tend to forget that the DSM system has provided a wealth of knowledge and structure to psychiatric care and science. Moreover, there is no elaborated alternative and an abolishment of the DSM will lead to confusion and polarisation. We should not throw the baby out with the bathwater. In this perspective, we argue how we can build on decades of experience with the DSM and how historical weighting and accurate use of the DSM can offer fertile grounds for refinement and precision of diagnostics in psychiatry.

How to deal with the consent of adults with cognitive impairment involved in European geriatric living labs?

BACKGROUND

Living labs are realistic environments designed to create links between technology developers and end-users (i.e. mostly older adults). Research in LLH (Living labs in health) covers a wide range of studies from non-interventional studies to CT (clinical trials) and should involve patients with neurocognitive disorders. However, the ethical issues raised by the design, development, and implementation of research and development projects in LLH have been the subject of only little interest thus far.

OBJECTIVE

Our aim was to determine a pragmatic, ethical and regulatory correct approach to seek the informed consent of patients with neurocognitive disorders according to the different types of studies carried out in European LLH, with a focus on the French context.

METHODS

A narrative review of regulatory texts and clinical articles was conducted, and a pragmatic procedure to determine the decision-making capacity of older adults in LLH was proposed.

RESULTS

Individuals must be adequately informed and freely agree to participate in CT. The capacity to consent should be assessed in CT including cognitively impaired older adults. We propose the following steps: first to assess for delirium using the 4 'A's Test (4AT) or the 3-min Diagnostic interview for Confusion Assessment Method (3D-CAM), second to search for medical history of major neurocognitive disorder, and third to assess the decision capacity using the University of California, San Diego Brief Assessment of Capacity to Consent (UBACC).

CONCLUSIONS

Including individuals with neurocognitive disorders in research implies using an efficient and pragmatic strategy to inform participants and obtain their consent. The tool we offer here may be useful in the routine operation of LLH but can also be extended to all CT with this population.

Ectopic right thoracic kidney associated with Bochdalek hernia as the cause of diagnostic confusion

A 61-year-old man who was a psychiatric patient and an alcoholic was admitted to hospital after a fall in his bathroom. He showed signs of hemorrhagic shock, and CT scans showed the presence of the right kidney and part of the right retroperitoneum in the right hemithorax, surrounded by liquid. Surgery showed that the right hemidiaphragm was intact and that no intraabdominal viscera prolapsed into thoracic cavity. The bleeding in the right retroperitoneum was evacuated. The surgical report also stated that "the right kidney and ureter were explored and no injuries or active bleeding were found". The patient died the third day after admission. Autopsy revealed a livid swelling covered with parietal pleura in the right half of the thoracic cavity, behind the costophrenic sinus, about 20 × 15x12 cm in size, filled with about 1500 ml of blood, with ectopic right kidney in the right half of the thorax, slightly rotated posteriorly and downwards. The kidney was smaller (80 g in weight), compared to the normally positioned enlarged left kidney (300 g). The right hemidiaphragm was also intact with small Bochdalek's foramen behind the posterior edge, with communication between the right retropleural and retroperitoneal spaces, through which intact elongated right renal artery (15 cm), vein (14 cm) and ureter were passing. The cause of death was hemorrhagic shock due to retroperitoneal bleeding, with coagulation disorder as possible contributing factor. Intrathoracic kidneys may pose many diagnostic and management dilemmas for clinicians and pathologists. Association between a Bochdalek hernia and an intrathoracic renal ectopia is very rare and may be confusing for doctors in different clinical situations.

Emotions and mood swings of pharmacy students in the context of the coronavirus disease of 2019 pandemic

INTRODUCTION

The coronavirus disease of 2019 pandemic has changed university routines affecting student mental health. The aims of this study were to survey aspects related to mental health of pharmaceutical course students considering previous and current contexts.

METHODS

The Depression, Anxiety, and Stress Scale (DASS-21), Impact of Event Scale-Revised, and Brunel Mood Scale were used. DASS-21 was completed pre- and post-pandemic. The validity and reliability of the data were verified. The prevalence (95% CI) of mental health symptoms was estimated. The relationship between the time spent watching/reading the news and mean scales scores was evaluated (Pearson's correlation coefficient).

RESULTS

The prevalence of depression symptoms in students pre-pandemic was 66.7% (95% CI = 65.3-68.1) and during the pandemic was 81% (95% CI = 79.8-82.2). More than 70% (95% CI = 69.8-72.6) of participants had some psychological impact as a result of the pandemic (mild: 16.7% [95% CI = 15.6-17.8]; moderate: 9.1% [95% CI = 8.2-10]; severe: 45.4% [95% CI = 43.9-46.9]). High values of tension, depressed mood, mental confusion, and anger were observed. There was a significant correlation between the time spent following the news of the pandemic and symptoms of anxiety (r = 0.356; P < .001), stress (r = 0.248; P = .014), hyperarousal (r = 0.322; P ≤ 0.001), and intrusion (r = 0.21; P = .039).

CONCLUSIONS

Students are highly vulnerable to depressive symptoms and mood swings due to the pandemic. These findings deserve consideration mainly from mental health professionals, but also from managers and educators.

Mode displaying mouse cursors for reducing input language mode confusion: Utility and user attitude evaluation

Users frequently commit typing errors due to input language mode confusion (ILMC) when switching between multiple languages. This study evaluated two mode display cursors (MDCs) as a potential solution to ILMC: the monochrome and color-changing MDCs. Two experiments were conducted to evaluate the two MDCs in different dimensions of usability. Experiment 1 evaluated the effects of MDCs on ILMC and related typing errors and Experiment 2, on self-reported preference, acceptance and annoyance. In Experiment 1, 45 participants were divided into three groups, that each performed multi-language typing using an ordinary mouse cursor and the two MDCs. The color-changing MDC was found to significantly reduce ILMC and related typing errors compared to the ordinary mouse cursor (p < .001). In Experiment 2, 30 participants performed three typical computer tasks using both MDCs. The mean annoyance rating was significantly larger for the color-changing MDC than for the monochrome MDC (p = .037).

The relationship between mental and physical space and its impact on topographical disorientation

We generate mental representations of space to facilitate our ability to remember things and navigate our environment. Many studies implicitly assume that these representations simply reflect the environments that they represent without considering other factors that influence the extent to which this is the case. Here, we bring together findings from cognitive psychology, environmental psychology, geography, urban planning, and neuroscience to discuss how internalizing the environment involves a complex interplay between bottom-up and top-down mental processes and depends on key characteristics of the physical environment itself. We describe how mental space is structured, the ways in which mental and physical space converge and diverge, and the disparate but complementary techniques used to assess these relationships. Finally, we contextualize this knowledge in the clinical populations affected by acquired and developmental topographical disorientation, exploring mechanisms that cause these patients to get lost in familiar surroundings.

Verbal Reports Influence on Pilot Flight Performance and Mental Stress Under Spatial Disorientation

BACKGROUND: Circumstances in flight can adversely affect a pilots spatial abilities and lead to spatial disorientation (SD), increasing the potential for fatal accidents. To systematically understand the impact of SD, it is important to quantitatively and qualitatively analyze pilots flight performance and mental stress, and to verify the effectiveness of verbal reports (VR) in enabling pilots to deal with an SD situation. This study investigated the effects of VR execution and type of SD on flight performance and mental stress.METHODS: SD simulation experiments were conducted on 30 Air Force fighter pilots (15 in the VR group and 15 in the non-VR group) with electrocardiography (ECG) sensors attached. The pilots gave their VRs by immediately verbalizing their attention to instrument information and six potentially disorientating scenarios were implemented in each flight phase. Flight performance was analyzed using instructor evaluation and self-evaluation scores, and mental stress was measured using heart rate variability (HRV) and perceived distress score.RESULTS: In maintaining flight performance, the VR group, respectively, had 8% and 10% higher scores for altitude and speed than the non-VR group. The self-evaluation scores were lowest for Coriolis, while Graveyard Spin was scored lowest in the instructor evaluations. Regarding mental stress, the VR group tended to have higher HFs and lower LF/HF ratios among HRV measures than the non-VR group, and an 11% lower perceived distress score. The highest perceived distress score was for Coriolis.DISCUSSION: We suggest that pilots can be assisted to understand and overcome SD situations through VR.Kang Y, Yun MH, Kim S. Verbal reports influence on pilot flight performance and mental stress under spatial disorientation. Aerosp Med Hum Perform. 2020; 91(12):948955.

What items should be included in an early warning score for remote assessment of suspected COVID-19? qualitative and Delphi study

BACKGROUND

To develop items for an early warning score (RECAP: REmote COVID-19 Assessment in Primary Care) for patients with suspected COVID-19 who need escalation to next level of care.

METHODS

The study was based in UK primary healthcare. The mixed-methods design included rapid review, Delphi panel, interviews, focus groups and software development. Participants were 112 primary care clinicians and 50 patients recovered from COVID-19, recruited through social media, patient groups and snowballing. Using rapid literature review, we identified signs and symptoms which are commoner in severe COVID-19. Building a preliminary set of items from these, we ran four rounds of an online Delphi panel with 72 clinicians, the last incorporating fictional vignettes, collating data on R software. We refined the items iteratively in response to quantitative and qualitative feedback. Items in the penultimate round were checked against narrative interviews with 50 COVID-19 patients. We required, for each item, at least 80% clinician agreement on relevance, wording and cut-off values, and that the item addressed issues and concerns raised by patients. In focus groups, 40 clinicians suggested further refinements and discussed workability of the instrument in relation to local resources and care pathways. This informed design of an electronic template for primary care systems.

RESULTS

The prevalidation RECAP-V0 comprises a red flag alert box and 10 assessment items: pulse, shortness of breath or respiratory rate, trajectory of breathlessness, pulse oximeter reading (with brief exercise test if appropriate) or symptoms suggestive of hypoxia, temperature or fever symptoms, duration of symptoms, muscle aches, new confusion, shielded list and known risk factors for poor outcome. It is not yet known how sensitive or specific it is.

CONCLUSIONS

Items on RECAP-V0 align strongly with published evidence, clinical judgement and patient experience. The validation phase of this study is ongoing.

TRIAL REGISTRATION NUMBER

NCT04435041.

The fog of war in the battle against COVID-19

The fog of war is a major obstacle for a fighting force trying to accomplish a goal, and it has been a significant barrier in the fight against COVID-19. This article discusses the factors that compounded a sense of confusion and created chaos in an already stressed healthcare system during the early stages of the COVID-19 pandemic.

Epilepsy as a key feature in two works of fantastic literature by Alfred Kubin and Hermann Weyl: With a brief review of epilepsy in fantastic literature

Among the many literary works of all styles and types referring to epilepsy, fantastic literature forms a distinct and interesting subgroup. The article draws attention to two such works belonging to early 20th century German avant-garde where epilepsy is a key feature. Of the authors, Austrian Alfred Kubin (1877-1959) was a renowned artist and illustrator whose only published (and illustrated) novel "The Other Side" (1909) can be understood as the narrative of a complex epileptic experience, perhaps a dreamy state. Of the other author, Hermann Weyl (1893-1960), very little is known. He was a Jewish neuropsychiatrist who emigrated from Nazist Germany to Argentina in 1933. His only published literary work, the novella "The Epileptic" (1927), displays high literary ambitions. The topic epilepsy provided for him the desired access to the fantastic realm, and his professionality enabled him to address with great expertise aspects as diverse as postictal psychosis and social stigmatization. Both works are, thus, valuable contributions to the tradition of epilepsy in fantastic literature. A brief review of the latter includes Edgar Allan Poe, Victor Hugo, Charles Dickens, Gustav Meyrink, Mervin Peake, Russell Hoban, Eraldo Baldini, Haruki Murakami, Adam Fawer, and Christoph Ransmayr.