Design and Evaluation of Serial-Hybrid Vehicle Energy Gauges

This paper describes a usability study of serial-hybrid vehicle energy gauge designs. Eight gauges that were modified by design format (bars, dials), color (one color, two colors) and the type of information present (range information, no range information) were tested in a driving simulator under urban/suburban traffic conditions. Participants answered questions about the state of the battery and fuel tank separately and also answered questions that involved combining the information from both sources of energy. Comprehension was assessed based on accuracy and response times to the questions when a gauge was presented. Participants also completed subjective ratings of the gauges. Driving performance was assessed to determine if driving was affected by responding to gauge presentations. Overall, the results indicated that the bar design using two colors and including range information performed best when integration of the two energy sources was required. These attributes were also most preferred by participants in this study

The Evolution of Autonomic Space as a Method of Mental Workload Assessment for Driving

Because heart rate lacks diagnosticity, an autonomic space approach for the assessment of mental workload has been proposed. In addition to increasing the capability to identify differences between tasks, the autonomic space approach can be used to make better inferences about the psychological processes involved. In this paper, the approach and its application to a simulated driving task are discussed, as well as suggestions for future research and its development

Differential Effects of Focal and Ambient Visual Processing Demands on Driving Performance

In this study, the differential effects of focal and ambient visual demand on driving were investigated. Subjects participated in a dual-task experiment in which they performed a driving simulation task and a focal or ambient side-task. It was predicted that the focal side-task would cause a significant deterioration in the maintenance of longitudinal control but not lateral control, while there should be no effects of the ambient side-task on driving performance. In general, the results suggest a differentiation in the processing demands of focal and ambient vision

The effects of instruction and environmental demand on state anxiety, driving performance and autonomic activity: Are ego-threatening manipulations effective?

A small yet emerging body of research on the relationship between anxiety and driving suggests that higher levels of state anxiety may lead to more dangerous driving behaviours. The aim of the current research was to investigate the effects of increased state anxiety on driving behaviours within a simulated environment using instructional sets to manipulate anxiety levels. In Study One, whilst a set of safety-related instructions were able to increase state anxiety, this did not result in changes to driving behaviours. In Study Two, ego-threatening instructions were not able to successfully increase state anxiety. This has implications regarding instructional sets in research, including their task relevance and the necessity for a motivational incentive. However, when changes in anxiety were considered regardless of instruction group, Study Two found changes in SDLP and skin conductance levels related to state anxiety increases. As these effects were context specific, it is argued that some of these changes may be due to poorer processing efficiency, leading to suggestions about the types of behaviours that may need to be trained in potential therapies for those who show high state anxiety levels whilst driving

Deciphering Psychological-Physiological Mappings While Driving and Performing a Secondary Memory Task

An autonomic space model of sympathetic and parasympathetic influences on the heart has been proposed as a method of deciphering psychological-physiological mappings for driving-related tasks. In the current study, we explore the utility of the autonomic space model for deciphering mappings in a driving simulation environment by comparing a single-task driving-only condition to two dual-task, driving-with-a-secondary-workingmemory task conditions. Although limited by a small sample size, the results illustrate the advantages physiological measures can have over performance measures for detecting changes in the psychological process required for drivingrelated task performance. Future research will include a repetition of this same study with more subjects as well the collection of on-the-road autonomic nervous system data

Doxorubicin-induced chronic dilated cardiomyopathy—the apoptosis hypothesis revisited

The chemotherapeutic agent doxorubicin (DOX) has significantly increased survival rates of pediatric and adult cancer patients. However, 10% of pediatric cancer survivors will 10–20 years later develop severe dilated cardiomyopathy (DCM), whereby the exact molecular mechanisms of disease progression after this long latency time remain puzzling. We here revisit the hypothesis that elevated apoptosis signaling or its increased likelihood after DOX exposure can lead to an impairment of cardiac function and cause a cardiac dilation. Based on recent literature evidence, we first argue why a dilated phenotype can occur when little apoptosis is detected. We then review findings suggesting that mature cardiomyocytes are protected against DOX-induced apoptosis downstream, but not upstream of mitochondrial outer membrane permeabilisation (MOMP). This lack of MOMP induction is proposed to alter the metabolic phenotype, induce hypertrophic remodeling, and lead to functional cardiac impairment even in the absence of cardiomyocyte apoptosis. We discuss findings that DOX exposure can lead to increased sensitivity to further cardiomyocyte apoptosis, which may cause a gradual loss in cardiomyocytes over time and a compensatory hypertrophic remodeling after treatment, potentially explaining the long lag time in disease onset. We finally note similarities between DOX-exposed cardiomyocytes and apoptosis-primed cancer cells and propose computational system biology as a tool to predict patient individual DOX doses. In conclusion, combining recent findings in rodent hearts and cardiomyocytes exposed to DOX with insights from apoptosis signal transduction allowed us to obtain a molecularly deeper insight in this delayed and still enigmatic pathology of DC

Preparing the Cardiovascular Workforce to Care for Oncology Patients: JACC Review Topic of the Week.

Cardiovascular disease and cancer are the 2 main causes of death in the United States. They intersect on multiple levels, sharing common causal mechanisms and epidemiological risk factors. The growing prevalence and complexity of cardiovascular disease and cancer have resulted in the development of the discipline of cardio-oncology. Preparing the cardiovascular workforce for the care of a growing population of cancer patients is necessary to enhance the delivery of high-quality cardiovascular care for patients with cancer. The goal of this review is to present the dedicated efforts of the cardio-oncology community to meet the growing need for education and training of cardiovascular practitioners providing care to cancer patients and survivors. Integration in general cardiology training programs and the efforts of the stakeholder organizations serve as an example of how a multidimensional, innovative approach can address provider education and training needs in a relatively new discipline

Rationale and Design of the SENECA (StEm cell iNjECtion in cAncer survivors) Trial

Objectives SENECA (StEm cell iNjECtion in cAncer survivors) is a phase I, randomized, double-blind, placebo-controlled study to evaluate the safety and feasibility of delivering allogeneic mesenchymal stromal cells (allo-MSCs) transendocardially in subjects with anthracycline-induced cardiomyopathy (AIC). Background AIC is an incurable and often fatal syndrome, with a prognosis worse than that of ischemic or nonischemic cardiomyopathy. Recently, cell therapy with MSCs has emerged as a promising new approach to repair damaged myocardium. Methods The study population is 36 cancer survivors with a diagnosis of AIC, left ventricular (LV) ejection fraction ≤40%, and symptoms of heart failure (NYHA class II-III) on optimally-tolerated medical therapy. Subjects must be clinically free of cancer for at least two years with a ≤ 30% estimated five-year risk of recurrence. The first six subjects participated in an open-label, lead-in phase and received 100 million allo-MSCs; the remaining 30 will be randomized 1:1 to receive allo-MSCs or vehicle via 20 transendocardial injections. Efficacy measures (obtained at baseline, 6 months, and 12 months) include MRI evaluation of LV function, LV volumes, fibrosis, and scar burden; assessment of exercise tolerance (six-minute walk test) and quality of life (Minnesota Living with Heart Failure Questionnaire); clinical outcomes (MACE and cumulative days alive and out of hospital); and biomarkers of heart failure (NT-proBNP). Conclusions This is the first clinical trial using direct cardiac injection of cells for the treatment of AIC. If administration of allo-MSCs is found feasible and safe, SENECA will pave the way for larger phase II/III studies with therapeutic efficacy as the primary outcome

Immune checkpoint inhibitor-associated myocarditis: a novel risk score

Background and aimsImmune checkpoint inhibitors (ICI) are associated with life-threatening myocarditis but milder presentations are increasingly recognized. The same autoimmune process that causes ICI myocarditis can manifest concurrent generalized myositis, myasthenia-like syndrome, and respiratory muscle failure. Prognostic factors for this 'cardiomyotoxicity' are lacking. The main aim of this study was to determine predictors and construct a risk score associated with negative outcomes in patients admitted for ICI myocarditis.MethodsA multicentre registry collected data retrospectively from 17 countries between 2014 and 2023. A multivariable Cox regression model was used to determine risk factors for the primary composite outcome: time to severe arrhythmia, heart failure, respiratory muscle failure, and/or cardiomyotoxicity-related death. Covariates included demographics, comorbidities, cardiomuscular symptoms, diagnostics, and treatments. Time-dependent covariates were used, and missing data were imputed. A point-based prognostic risk score was derived and externally validated.ResultsIn 748 patients (67% male, age 23-94 years), 30-day incidence of the primary composite outcome, cardiomyotoxic death, and overall death were 33%, 13%, and 17%, respectively. By multivariable analysis, the primary composite outcome was associated with active thymoma (hazard ratio [HR] 3.6, 95% confidence interval [CI] 1.7-7.7), presence of cardiomuscular symptoms (HR 2.6 [1.5-4.2]), low QRS voltage on presenting electrocardiogram (HR for ≤0.5 mV vs >1 mV 1.9 [1.1-3.1]), left ventricular ejection fraction (LVEF) < 50% (HR 1.7 [1.1-2.6]), and incremental troponin elevation (HR 1.8 [1.4-2.4], 2.9 [1.8-4.7], and 4.6 [2.3-9.3], for 20, 200, and 2000-fold above upper reference limit, respectively). A prognostic risk score developed using these parameters showed good performance; 30-day primary outcome incidence increased gradually from 4% (risk score = 0) to 81% (risk score ≥ 4). This risk score was externally validated in two independent French and US cohorts. This risk score was used prospectively in the external French cohort to identify low-risk patients who were managed with no immunosuppression resulting in no cardiomyotoxic events.ConclusionsICI-associated myocarditis can manifest with high morbidity and mortality. Myocarditis severity is associated with magnitude of troponin, thymoma, low QRS voltage, depressed LVEF, and cardiomuscular symptoms. A risk score incorporating these features performed well.Clinical trial registrationNCT04294771 and NCT05454527