A domain-specific language for managing ETL processes.

Maintenance of Data Warehouse (DW) systems is a critical task because any downtime or data loss can have significant consequences on business applications. Existing DW maintenance solutions mostly rely on concrete technologies and tools that are dependent on: the platform on which the DW system was created; the specific data extraction, transformation, and loading (ETL) tool; and the database language the DW uses. Different languages for different versions of DW systems make organizing DW processes difficult, as minimal changes in the structure require major changes in the application code for managing ETL processes. This article proposes a domain-specific language (DSL) for ETL process management that mitigates these problems by centralizing all program logic, making it independent from a particular platform. This approach would simplify DW system maintenance. The platform-independent language proposed in this article also provides an easier way to create a unified environment to control DW processes, regardless of the language, environment, or ETL tool the DW uses.

Neuro-ophthalmic imaging and visual assessment technology for spaceflight associated neuro-ocular syndrome (SANS).

Spaceflight associated neuro-ocular syndrome (SANS) refers to a unique collection of neuro-ophthalmic clinical and imaging findings observed in astronauts after long-duration spaceflight. Current in-flight and postflight imaging modalities (e.g., optical coherence tomography, orbital ultrasound, and funduscopy) have played an instrumental role in the understanding and monitoring of SANS development; however, the precise etiology for this neuro-ophthalmic phenomenon is still not completely understood. SANS may be a potential barrier to future deep space missions, and therefore it is critical to further elucidate the underlying pathophysiology for effective countermeasures. The complexity and unique limitations of spaceflight require careful consideration and integration of leading technology to advance our knowledge of this extraterrestrial syndrome. We describe the current neuro-ophthalmic imaging modalities and hypotheses that have improved our current understanding of SANS, discuss newer developments in SANS imaging (including noninvasive near-infrared spectroscopy) and summarize emerging research in the development of an aspirational future head-mounted virtual reality display with multimodal visual assessment technology for the detection of neuro-ocular findings in SANS.

Depression pandemic and cardiovascular risk in the COVID-19 era and long COVID syndrome: Gender makes a difference.

The ongoing COVID-19 pandemic highlighted a significant interplay between cardiovascular disease (CVD), COVID-19 related inflammatory status, and depression. Cardiovascular (CV) injury is responsible for a substantial percentage of COVID-19 deaths while COVID-19 social restrictions emerged as a non-negligible risk factor for CVD as well as a variety of mental health issues, and in particular, depression. Inflammation seems to be a shared condition between these two disorders. Gender represents a potential modifying factor both in CVD and depression, as well as in COVID-19 short- and long-term outcomes, particularly in cases involving long-term COVID complications. Results from emerging studies indicate that COVID-19 pandemic affected male and female populations in different ways. Women seem to experience less severe short-term complications but suffer worse long-term COVID complications, including depression, reduced physical activity, and deteriorating lifestyle habits, all of which may impact CV risk. Here, we summarize the current state of knowledge about the interplay between COVID-19, depression, and CV risk in women.

Prediction of Task Performance From Physiological Features of Stress Resilience.

In this paper, we investigate the potential of generic physiological features of stress resilience in predicting air traffic control (ATC) candidates' performance in a highly-stressful low-fidelity ATC simulator scenario. Stress resilience is highlighted as an important occupational factor that influences the performance and well-being of air traffic control officers (ATCO). Poor stress management, besides the lack of skills, can be a direct cause of poor performance under stress, both in the selection process of ATCOs and later in the workplace. 40 ATC candidates, within the final stages of their selection process, underwent a stimulation paradigm for elicitation and assessment of various generic task-unrelated physiological features, related to resting heart rate variability (HRV) and respiratory sinus arrhythmia (RSA), acoustic startle response (ASR) and the physiological allostatic response, which are all recognized as relevant psychophysiological markers of stress resilience. The multimodal approach included analysis of electrocardiography, electromyography, electrodermal activity and respiration. We make advances in computational methodology for assessment of physiological features of stress resilience, and investigate the predictive power of the obtained feature space in a binary classification problem: prediction of high- vs. low-performance on the developed ATC simulator. Our novel approach yields a relatively high 78.16% classification accuracy. These results are discussed in the context of prior work, while considering study limitations and proposing directions for future work.

Performance on the Robotics On-Board Trainer (ROBoT-r) Spaceflight Simulation During Acute Sleep Deprivation.

Exploration of deep space poses many challenges. Mission support personnel will not be immediately available to assist crewmembers performing complex operations on future long-duration exploration operations. Consequently, it is imperative that crewmembers have objective, reliable, and non-invasive metrics available to aid them in determining their fitness for duty prior to engaging in potentially dangerous tasks. The Robotics On-Board Trainer (ROBoT) task is NASA's platform for training astronauts to perform docking and grappling maneuvers. It is regularly used by crewmembers during spaceflight for refresher training. The operational ROBoT system, however, does not record data. Thus, a research version of ROBoT, called ROBoT-r, was developed so that operationally relevant data could be mined to provide feedback to crewmembers. We investigated whether ROBoT-r metrics would change according to sleep loss and circadian phase in a 28-h laboratory-based sleep deprivation study. Overall, participants showed improvement over time despite sleep loss, indicating continued learning. Performance on the psychomotor vigilance task (PVT) followed an expected profile, with reduced performance across the night. These findings suggest that individuals may be able to temporarily compensate for sleep loss to maintain performance on complex, novel tasks. It is possible that some ROBoT-r metrics may be sensitive to sleep loss after longer bouts of wakefulness or after individuals have habituated to the task. Studies with additional participants and extended pre-training on the ROBoT-r task should be conducted to disentangle how brain activity may change as individuals learn and habituate to complex tasks during sleep loss.

Operationally Relevant Behavior Assessment Using the Robotic On-Board Trainer for Research (ROBoT-r).

INTRODUCTION: Spaceflight can strain astronaut physical, physiological, and mental well-being, whereas maintaining astronaut operational performance remains an essential goal. Although various cognitive tests have been used for spaceflight assessment, these have been challenged on their lack of operational relevance.METHODS: To address this gap, we developed and characterized the Robotic On-Board Trainer for Research (ROBoT-r) system, based on the Robotic On-Board Trainer (ROBoT) currently used for astronaut training on Canadarm2 track-and-capture activities. The task requires use of dual hand-controllers (6 degrees of freedom) to grapple an incoming vehicle in free-drift in a time-limited setting. After developing a platform for conducting research studies, characterization testing of ROBoT-r was completed by 14 astronaut-like volunteers (35 ± 11 yr; N = 5 women) over 16 sessions each.RESULTS: We describe the design and capabilities of the ROBoT-r system for conducting operationally relevant research on human performance. Version 6.2 of the system supports H-II Transfer Vehicle track-and-capture operations within a multimillion component, physics-enabled 3D model using NASA's DOUG graphics platform. It has configurable task initialization and auto-run capabilities, saves 38 variables continuously at 20 Hz throughout each run, provides the user quantitative feedback after each run, and provides summaries after each session. Detailed performance characterization data is reported for future experimental planning purposes.DISCUSSION: ROBoT-r's range of performance variables enables detailed and quantitative performance assessment. Its use in spaceflight will help provide insight into operational performance, as well as allowing investigators to compare these results with more traditional cognitive tests to help better understand the interaction between individual cognitive abilities and operational performance.Ivkovic V, Sommers B, Cefaratti DA, Newman G, Thomas DW, Alexander DG, Strangman GE. Operationally relevant behavior assessment using the Robotic On-Board Trainer for Research (ROBoT-r). Aerosp Med Hum Perform. 2019; 90(9):819-825.

Should the dilated ascending aorta be repaired at the time of bicuspid aortic valve replacement?

OBJECTIVES: Bicuspid aortic valve (BAV) is the most common congenital valvular abnormality and frequently presents with accelerated calcific aortic valve disease, requiring aortic valve replacement (AVR) and thoracic aortic aneurysm and dissection. Supporting evidence for Association Guidelines of aortic dimensions for aortic resection is sparse. We sought to determine whether concurrent repair of dilated or aneurysmal aortic disease during AVR in patients with BAV substantially improves morbidity and mortality outcomes. METHODS: Mortality and reoperation outcomes of 1301 adults with BAV and dilated aorta undergoing AVR-only surgery were compared to patients undergoing AVR with aortic resection (AVR-AR) using Cox proportional hazards modelling and patient matching. RESULTS: Clinically important differences in patient characteristics, aortic valve function and aortic dimensions were identified between cohorts. Event rates were low, with rates of reoperation and death within 1 year of only 1.8% and 5.4%, respectively, and no aortic dissection observed during follow-up. There were no significant differences in reoperation or mortality outcomes between the AVR-only and AVR-AR cohorts. Age, aortic dimension or a combination thereof was not associated with better or worse outcomes after each AVR-AR compared with AVR. CONCLUSIONS: We conclude AVR-only and AVR-AR surgery have low morbidity and mortality and have utility over a wide range of age and aortic sizes. Our results do not provide support for the 45-mm aortic dimension recommended in the current guidelines for aortic resection while performing AVR or any other specific dimension.

Wearable brain imaging with multimodal physiological monitoring.

The brain is a central component of cognitive and physical human performance. Measures, including functional brain activation, cerebral perfusion, cerebral oxygenation, evoked electrical responses, and resting hemodynamic and electrical activity are all related to, or can predict, health status or performance decrements. However, measuring brain physiology typically requires large, stationary machines that are not suitable for mobile or self-monitoring. Moreover, when individuals are ambulatory, systemic physiological fluctuations-e.g., in heart rate, blood pressure, skin perfusion, and more-can interfere with noninvasive brain measurements. In efforts to address the physiological monitoring and performance assessment needs for astronauts during spaceflight, we have developed easy-to-use, wearable prototypes, such as NINscan, for near-infrared scanning, which can collect synchronized multimodal physiology data, including hemodynamic deep-tissue imaging (including brain and muscles), electroencephalography, electrocardiography, electromyography, electrooculography, accelerometry, gyroscopy, pressure, respiration, and temperature measurements. Given their self-contained and portable nature, these devices can be deployed in a much broader range of settings-including austere environments-thereby, enabling a wider range of novel medical and research physiology applications. We review these, including high-altitude assessments, self-deployable multimodal e.g., (polysomnographic) recordings in remote or low-resource environments, fluid shifts in variable-gravity, or spaceflight analog environments, intracranial brain motion during high-impact sports, and long-duration monitoring for clinical symptom-capture in various clinical conditions. In addition to further enhancing sensitivity and miniaturization, advanced computational algorithms could help support real-time feedback and alerts regarding performance and health.

Dose- and time-dependent effects of clodronate on orthodontic tooth movement.

Orthodontic tooth movement is the result of bone remodeling that occurs in periodontal ligament and alveolar bone tissue as a response to mechanical loading of the tooth. The aim of this study is to investigate the time- and dose-response effects of locally administered clodronate on tooth movement. Sixty Wistar rats were randomly assigned to 4 groups of 15 specimens: E1 - application of 10 mMol of clodronate in 3-day intervals; E2 - application of 2.5 mMol of clodronate in 3-day intervals; E3 - application of 10 mMol of clodronate in 7-day intervals; E4 - application of 2.5 mMol of clodronate in 7-day intervals. A 50 µL clodronate solution was injected into a subperiosteal area to the right maxillary incisor. The left maxillary incisor served as a control, with an injection of saline solution. In 3-day interval application regime, there was no effect of clodronate dosing on tooth movement. In 7-day interval application regime, decreased tooth movement was observed with 10 mMol compared with 2.5 mMol clodronate concentration. However, decreased tooth movement was also observed when 2.5 mMol of clodronate was applied in 7-versus 3-day intervals. Conversely, no difference was observed when 10 mMol concentration was applied in 3- versus 7-day intervals. When clodronate is applied subperiosteally in the root area, it decreases the tooth movement. Tooth movement is impeded by the higher clodronate dosing, as well as by shorter application interval even with lower dosing. The purpose of future trials should, therefore, be to determine a safe therapeutic dose/interval application of clodronate in humans and their potential side effects.

Should Moderate-to-Severe Tricuspid Regurgitation be Repaired During Reoperative Left-Sided Valve Procedures?

The risks vs benefits of tricuspid valve (TV) surgery in reoperative patients requiring left-sided valve surgery and moderate-to-severe tricuspid regurgitation is unclear. We compared patients with and without concomitant TV surgery. A total of 200 patients with moderate-to-severe TV regurgitation had reoperative left-sided valve procedures from January 2002 to April 2014; 75 with TV intervention (TVI) and 125 with no tricuspid intervention (TVN). Propensity-matched cohorts of 60 TVI and 60 TVN patients were compared. Outcomes included New York Heart Association class, TV regurgitation and survival. TVI patients were younger (66 ± 15 vs 72 ± 13 years, P < 0.001), had more cardiogenic shock (6 of 75, vs 0 of 125, P < 0.001) and mitral valve surgery (60 of 75 vs 69 of 125, P < 0.001). Propensity matching yielded 60 pairs of TVI cases and TVN controls. Matched groups were comparable in age (TVI = 67 ± 13 vs TVN 68 ± 14 years, P = 0.67), cardiogenic shock (2 vs 0, P = 0.50), and mitral valve surgery (15 each, P = 1.0). Operative mortality was 2 of 60 in TVI vs 10 of 60 TVN (P = 0.27). Median follow-up was 4.4 years. Follow-up rates of New York Heart Association class III-IV were similar (12 of 60 for TVI vs 16 of 60 TVN, P = 0.52). Kaplan-Meier analysis indicated improved event-free survival for TVI patients (6 years, 95% CI: 4.8-7.2 years vs 8 years, 95% CI: 6.7-9.3 years for TVN, P = 0.030). There was a trend towards increased TR at follow-up in patients with valve repair alone vs annuloplasty (P = 0.15). TV surgery was performed more often in higher-risk patients. Matched case-control analyses showed TVI was associated with improved midterm outcomes. Our data suggest that annuloplasty was preferable to TV repair alone.

Ambulatory diffuse optical tomography and multimodality physiological monitoring system for muscle and exercise applications.

Ambulatory diffuse optical tomography (aDOT) is based on near-infrared spectroscopy (NIRS) and enables three-dimensional imaging of regional hemodynamics and oxygen consumption during a person's normal activities. Although NIRS has been previously used for muscle assessment, it has been notably limited in terms of the number of channels measured, the extent to which subjects can be ambulatory, and/or the ability to simultaneously acquire synchronized auxiliary data such as electromyography (EMG) or electrocardiography (ECG). We describe the development of a prototype aDOT system, called NINscan-M, capable of ambulatory tomographic imaging as well as simultaneous auxiliary multimodal physiological monitoring. Powered by four AA size batteries and weighing 577 g, the NINscan-M prototype can synchronously record 64-channel NIRS imaging data, eight channels of EMG, ECG, or other analog signals, plus force, acceleration, rotation, and temperature for 24+ h at up to 250 Hz. We describe the system's design, characterization, and performance characteristics. We also describe examples of isometric, cycle ergometer, and free-running ambulatory exercise to demonstrate tomographic imaging at 25 Hz. NINscan-M represents a multiuse tool for muscle physiology studies as well as clinical muscle assessment.

Aortic Regurgitation With Markedly Reduced Left Ventricular Function Is Not a Contraindication for Aortic Valve Replacement.

BACKGROUND: The current study assesses outcomes and risk factors for aortic valve replacement (AVR) for aortic regurgitation (AR) in the setting of markedly reduced left ventricular (LV) function compared with moderately reduced LV function and preserved LV function. METHODS: Between January 2002 and June 2013, 485 consecutive patients underwent AVR for severe AR. Overall, 37 of 485 patients (8%) had an LV ejection fraction (EF) less than or equal to 35% (low EF) with median of 30%; 141 of 485 patients (27%) had an LVEF of 36% to 50% (moderate) with median of 45%, and 307 of 485 patients (65%) had an LVEF greater than 50% (preserved) with median of 60%. RESULTS: Preoperative characteristics were similar across groups, except patients with low EF were older (67.4 ± 12.1 years versus moderate [58.6 ± 15.0 years], p = 0.003 versus preserved [56.9 ± 14.3 years], p = 0.001), more often had reoperations (35.1% versus preserved 19.9%, p = 0.054), and had more concomitant coronary artery bypass grafts (37.6% versus preserved 14.3%, p = 0.001). Operative mortality for the entire cohort was 1.9% (9 or 485) and was similar across groups, 0% in the low EF group, 2.1% (3 of 141) in the moderate group, and 2.0% (6 of 307) in the preserved group (all p > 0.5). Cox proportional hazard modeling indicated that age (hazard ratio [HR] 1.061, p ≤ 0.001), preoperative creatinine (HR 1.478, p ≤ 0.014), history of atrial fibrillation (HR 1.920, p = 0.095), and New York Heart Association class III/IV (HR 2.127, p = 0.004) predicted survival. At median follow-up of 26 months, in the low EF group, the mean LVEF at follow-up was 49.5% ± 10.2% versus baseline 30% ± 4.6% (p ≤ 0.001). CONCLUSIONS: In this series, patients with markedly reduced LV function (LVEF ≤35%) had similar postoperative outcomes and survival as patients with moderate LV dysfunction or preserved LV function.

Smartphone-based tactile cueing improves motor performance in Parkinson's disease.

INTRODUCTION: Visual and auditory cueing improve functional performance in Parkinson's disease (PD) patients. However, audiovisual processing shares many cognitive resources used for attention-dependent tasks such as communication, spatial orientation, and balance. Conversely, tactile cues (TC) may be processed faster, with minimal attentional demand, and may be more efficient means for modulating motor-cognitive performance. In this study we aimed to investigate the efficacy and limitations of TC for modulating simple (heel tapping) and more complex (walking) motor tasks (1) over a range of cueing intervals, (2) with/without a secondary motor task (holding tray with cups of water). METHODS: Ten PD patients (71 ± 9 years) and 10 healthy controls (69 ± 7 years) participated in the study. TCs was delivered through a smart phone attached to subjects' dominant arm and were controlled by a custom-developed Android application. RESULTS: PD patients and healthy controls were able to use TC to modulate heel tapping (F(3.8,1866.1) = 1008.1, p < 0.001), and partially modulate walking (F(3.5,1448.7) = 187.5, p < 0.001) tasks. In the walking task, PD patients modulated performance over a narrower range of cueing intervals (R(2) = 0.56) than healthy controls (R(2) = 0.84; group difference F(3.5,1448.7) = 8.6, p < 0.001). TC diminished synchronization error associated with performance of secondary motor task during walking in PD patients and healthy controls (main effect of Task (F(1,494) = 0.4; p = 0.527), Task X Group interaction (F(1,494) = 0.5; p = 0.493)). CONCLUSION: This study expands modalities of TC usage for movement modulation and motor-cognitive integration in PD patients. The smartphone TC application was validated as a user-friendly movement modulation aid.

Long term outcomes of posterior leaflet folding valvuloplasty for mitral valve regurgitation.

BACKGROUND: Posterior mitral valve leaflet prolapse due to degenerative mitral valve disease has been treated with tissue sparing repair techniques since 2002. The simplified foldoplasty technique effectively lowers the height of the redundant posterior leaflet and creates an optimal coaptation line for the anterior leaflet that results in excellent long term durability, freedom from reoperation, and return of functional status. METHODS: Patient demographics and in-hospital outcome data were extracted from electronic medical records of 229 patients, aged 60.6±13.7 years who underwent the procedure for mitral valve repair (MVR) involving the posterior leaflet from myxomatous disease between 2002 and 2014. Parametric analyses were performed on outcomes data, while long-term survival was assessed by Kaplan-Meier analyses. RESULTS: Concomitant coronary bypass surgery was performed on 32/229 (14%) patients, the mean perfusion time was 119±40 min, and the mean cross clamp time was 86±31 min. Post-operative mortality was 2/229 (0.9%), reoperation for bleeding occurred in 4 (1.7%) and postoperative stroke in 4 (1.7%) patients. Long term follow up rate was 100% and the mean study follow-up duration was 6.8±2.3 years. Overall late mortality rate was 24/229 (14.9%), and mitral valve re-intervention was performed on 7 patients (4.3%). NYHA class III/IV and clinically significant MR at follow up were significantly lower compared to preoperative values (both P<0.001). CONCLUSIONS: Our results encourage further use of this simple and effective technique in patients with isolated posterior leaflet prolapse.

Twenty-four-hour ambulatory recording of cerebral hemodynamics, systemic hemodynamics, electrocardiography, and actigraphy during people's daily activities.

The feasibility and utility of wearable 24-h multimodality neuromonitoring during daily activities are demonstrated. We have developed a fourth-generation ambulatory near infrared spectroscopy device, namely NINscan 4. NINscan 4 enables recording of brain function (via cerebral hemodynamics), systemic hemodynamics, electrocardiography, and actigraphy simultaneously and continuously for up to 24 h at 250-Hz sampling rate, during (and with minor restriction to) daily activities. We present initial 24-h human subject test results, with example analysis including (1) comparison of cerebral perfusion and oxygenation changes during wakefulness and sleep over a 24-h period and (2) capturing of hemodynamic changes prior, during and after sudden waken up in the night during sleep. These results demonstrate the first ambulatory 24-h cerebral and systemic hemodynamics monitoring, and its unique advantages including long-term data collection and analysis capability, ability to catch unpredictable transient events during activities of daily living, as well as coregistered multimodality analysis capabilities. These results also demonstrate that NINscan 4's motion artifact at 1-g head movement is smaller than physiological hemodynamic fluctuations during motionless sleep. The broader potential of this technology is also discussed.

Parkinson's disease influences the structural variations present in the leg swing kinematics.

This study investigated the nature of the structural variations found in the motor output of individuals with Parkinson's disease (PD). Young (n = 21; 19.9 ± 1.3 yrs.), aged (n = 9; 74.8 ± 6.8 yrs.) and individuals with PD (n = 9; 73.4 ± 6.6 yrs.) swung their leg at a pendular frequency and frequencies that were 20% faster and slower. This study had three key findings. First, individuals with PD have greater variability in the leg swing angular kinematics and swing times. These variations appear to be related to the 0-15 Hz band of the of angular displacement power spectrum. Second, changes in the structural variations appear to not be derived from a stochastic source. Third, the magnitude of the variations and the structure of the variations are influenced by the frequency that the leg is swung. These results are consistent with the viewpoint that changes in the magnitude of the variations and the regularity of the structural variations are dependent upon health and adaptability to the task dynamics.

Empathy, communication, deception.

Empathy is understood as a mode of understanding operating on a subconscious level of mental processing. The cognitive element can only abstractly be distinguished from its affective expression. When recognizing a fellow creature we involuntarily sympathize with it. Recognition of covert motivations of overt behavior is the first step in formation of a communication channel between two (or more) empathizing agents. Yet, since communication evolved in variably complex social environments it was subject to pressure of conflicting individual interests. Deception thus evolved as an adaptive evolutionary strategy. Empathic understanding does not necessarily entail recognition of agent's real intentions. Deception may be achieved on both conscious and unconscious processing levels. A sufficient degree of biopsychosocial maturity must be reached for a child to be able to independently recognize verbal and non-verbal communication finesses. Once this level has been attained, the prevailing emotional orientation determines his/her degree of empathizing competence.