Impact of music performance anxiety on cardiovascular blood pressure responses, autonomic tone and baroreceptor sensitivity to a western classical music piano-concert.

Introduction: Music Performance Anxiety (MPA) is a prevalent condition among musicians that can manifest both psychologically and physiologically, leading to impaired musical performance. Physiologically, MPA is characterized by excessive muscular and/or autonomic tone. This study focuses on the cardiovascular blood pressure responses, autonomic tone and baroreceptor sensitivity changes that occur during musical performance due to MPA. Methods: Six professional pianists perform a piece for piano written only for the left hand by Alexander Scriabin. The following parameters have been studied during the performance: ECG, non-invasive beat to beat continuous arterial blood pressure and skin conductance. Sympathetic and parasympathetic autonomic flow was studied with Wigner-Ville analysis (W-V) from R-R ECG variability, and baroreceptor sensitivity with the Continuous Wavelet Transform (CWT). Results: During the concert a significant increase of heart rate, systolic, mean and diastolic arterial pressure were observed. No significant differences were found in skin conductance. The W-V analysis, which studies frequency changes in the time domain, shows a significant increase of sympathetic flow and a decrease of parasympathetic flow during the concert which is associated with a significant decrease in sympathetic and vagal baroreceptor sensitivity. Discussion: The study of cardiac variability using the Wigner-Ville analysis may be a suitable method to assess the autonomic response in the context of MPA, and could be used as biofeedback in personalized multimodal treatments.

Towards the declaration of the strait of Gibraltar as an environmental controlled area.

The emissions from maritime transportation, both greenhouse gases and traditional pollutants, are harmful to the ecosystem and human health. The large quantities of these pollutants emitted by shipping in the Strait of Gibraltar could be reduced if the Strait was declared an Emission Control Area (ECA). Using the SENEM1 emissions model, this study aims to compare the current situation and a possible future situation as an ECA. Unlike other models, SENEM1 includes all the variables - both ship and external conditions - that influence the calculation of emissions. Comparing only the 2017 emissions from ships sailing in the Strait of Gibraltar with the designated ECA simulation, reductions of up to 75.8 % in NOx, 73.4 % in PM2.5 and 94 % in SOx were collected. It would be a wakeup call for the International Maritime Organization (IMO) and the governments responsible to recommend that the Strait of Gibraltar be designated an ECA zone.

Management of Suprachoroidal Hemorrhage during Phacoemulsification: A Comprehensive Review.

Suprachoroidal hemorrhage (SCH) is a rare and sight-threatening complication of various intraocular surgeries, including cataract surgery. Although the rate of SCH complicating cataract surgery has decreased in the era of phacoemulsification, most likely due to smaller self-sealing incisions and modern equipment, it remains a challenging complication to manage. The aim of this review is to summarize the current evidence of the pathophysiology and management of SCH complicating phaco surgery. A literature review was performed using the PubMed database searching for diagnosis, therapy, and management of SCH during phacoemulsification. The evidence available on the optimal management of this condition is low, and there is no consensus so far. An early diagnosis is thought to be essential to avoid progression to the devastating stage of expulsion of intraocular contents (expulsive hemorrhage). Sudden intraoperative anterior chamber shallowing, red reflex loss, and a significant increase in intraocular pressure are highly suspicious for this severe complication. A fundus examination and ocular ultrasound are crucial to confirm the diagnosis and, if it is confirmed, stabilize the globe immediately. The initial therapeutic approach includes aggressive topical and systemic medication focused on controlling ocular inflammation and intraocular pressure, whereas the timing and the indications of surgical intervention remain controversial.

Henle fiber layer hemorrhage as the first manifestation of factor V Leiden homozygous mutation.

PURPOSE: To report a case of a Henle fiber layer hemorrhage as the initial manifestation of Factor V Leiden disease. METHODS: Case report and literature review. RESULTS: A healthy 19-year-old patient presented with a spontaneous Henle fiber layer (HFL) hemorrhage. The genetic analysis showed a previously unknown homozygous Factor V Leiden Mutation. No specific treatment was given due to the patient's good visual acuity and favorable prognosis, but the diagnosis of a Factor V Leiden mutation enabled a correct therapeutic management to be followed by the patient. CONCLUSION: Advances in eye imaging allow to detect ocular findings that may lead to an early diagnosis and treatment. To the best of our knowledge, this is the first case of a HFL hemorrhage as the initial manifestation of Factor V Leiden disease. Further research is needed to identify the pathways linking these findings.

Estimating the health and economic burden of shipping related air pollution in the Iberian Peninsula.

Air pollution is the leading cause of the global burden of disease from the environment, entailing substantial economic consequences. International shipping is a significant source of NOx, SO2, CO and PM, which can cause known negative health impacts. Thus, this study aimed to estimate the health impacts and the associated external costs of ship-related air pollution in the Iberian Peninsula for 2015. Moreover, the impact of CAP2020 regulations on 2015 emissions was studied. Log-linear functions based on WHO-HRAPIE relative risks for PM2.5 and NO2 all-cause mortality and morbidity health end-points, and integrated exposure-response functions for PM2.5 cause-specific mortality, were used to calculate the excess burden of disease. The number of deaths and years of life lost (YLL) due to NO2 ship-related emissions was similar to those of PM2.5 ship-related emissions. Estimated all-cause premature deaths attributable to PM2.5 ship-related emissions represented an average increase of 7.7% for the Iberian Peninsula when compared to the scenario without shipping contribution. Costs of around 9 100 million € yr-1 (for value of statistical life approach - VSL) and 1 825 million € yr-1 (for value of life year approach - VOLY) were estimated for PM and NO2 all-cause burden of disease. For PM2.5 cause-specific mortality, a cost of around 3 475 million € yr-1 (for VSL approach) and 851 million € yr-1 (for VOLY approach) were estimated. Costs due to PM and NO2 all-cause burden represented around 0.72% and 0.15% of the Iberian Peninsula gross domestic product in 2015, respectively for VSL and VOLY approaches. For PM2.5 cause-specific mortality, costs represented around 0.28% and 0.06%, respectively, for VSL and VOLY approaches. If CAP2020 regulations had been applied in 2015, around 50% and 30% respectively of PM2.5 and NO2 ship-related mortality would been avoided. These results show that air pollution from ships has a considerable impact on health and associated costs affecting the Iberian Peninsula.

Calculating ships' real emissions of pollutants and greenhouse gases: Towards zero uncertainties.

The energy output and emissions from maritime transport have increased considerably over the last two decades. Countries in Europe, North America and Asia use different methodologies to calculate these important variables; two of the main methods used are known as the Ship Traffic Emission Assessment Model (STEAM) and the Ship Traffic, Energy and Environmental Model (STEEM). Furthermore, the International Maritime Organization has recently required additional parameters to be included in the calculation, but the procedure for calculating these is not defined. In this paper, a model named SENEM (Ship's ENergy Efficiency Model) is proposed to calculate the power delivered in real time by the main engine taking into account all the equations required for defining and calculating all these parameters together with the efficiency of both the shaft and propulsion system. This model has been tested and validated on board four Ro-Pax ships operating across the Strait of Gibraltar - three vessels powered by waterjet and the fourth by propeller. The results show differences of up to 40% compared with other models.

Comparative analysis between different methods for calculating on-board ship's emissions and energy consumption based on operational data.

With the aim of more reliably measuring ships' fuel consumption and emissions several different estimation methods have been put forward and are in use but there is ongoing debate still on the best way to measure maritime emissions. Fuel and emissions monitoring are already a common practice in the shipping industry. But there are currently neither harmonised guidelines nor legal requirements that clearly define the method and the rules to follow to monitor on-board fuel consumption for each situation during navigation. In this context, this article describes and compares four existing methods (EPA, IMO, Jalkanen and MAN) for calculating energy consumption and emissions, and presents a more realistic method, based on a case study. The purpose is to examine the differences between all of these methods, in order to propose the most suitable method of obtaining the data needed for better energy management, and a method that can be applied to any type of ship. The case study was carried out on Ro-Pax ships, comparing these four different methods through the application of a bottom-up integrated system approach. The study describes in detail and applies the most complete methodology for calculating energy consumption and emissions during cruising, operating in a Speed Reduction Zone (SRZ), manoeuvring and berthing. Application of the new improved method proposed in this paper could be the first step in implementing operational measures for detecting both abnormal high emissions and abnormal fuel consumption. The application of this method does not, in itself, reduce fuel use or improve efficiency, but it should be the necessary first step to establish uniform operational measures that will improve the management of energy on board ship and monitor accurately the performance of the fleet.

The influence of the waterjet propulsion system on the ships' energy consumption and emissions inventories.

In this study we consider the problems associated with calculating ships' energy and emission inventories. Various related uncertainties are described in many similar studies published in the last decade, and applying to Europe, the USA and Canada. However, none of them have taken into account the performance of ships' propulsion systems. On the one hand, when a ship uses its propellers, there is no unanimous agreement on the equations used to calculate the main engines load factor and, on the other, the performance of waterjet propulsion systems (for which this variable depends on the speed of the ship) has not been taken into account in any previous studies. This paper proposes that the efficiency of the propulsion system should be included as a new parameter in the equation that defines the actual power delivered by a ship's main engines, as applied to calculate energy consumption and emissions in maritime transport. To highlight the influence of the propulsion system on calculated energy consumption and emissions, the bottom-up method has been applied using data from eight fast ferries operating across the Strait of Gibraltar over the course of one year. This study shows that the uncertainty about the efficiency of the propulsion system should be added as one more uncertainty in the energy and emission inventories for maritime transport as currently prepared. After comparing four methods for this calculation, the authors propose a new method for eight cases. For the calculation of the Main Engine's fuel oil consumption, differences up to 22% between some methods were obtained at low loads.

[Alterations in cerebral perfusion in patients with systemic sclerosis and cognitive impairment]. / Alteraciones en la perfusión cerebral en pacientes con esclerosis sistémica y deterioro cognitivo.

INTRODUCTION: Systemic sclerosis (SSc) is a systemic autoimmune disease characterized by fibrosis, immunological and vascular abnormalities. Cerebral hypoperfusion can be caused by cerebral ischemia. Cognitive impairment (CI) are a major cause of morbidity in SSc The aim of this study is to estimate the frequency of alterations in cerebral perfusion (CP) in SSc patients with CI. METHODS: We studied 88 patients with SSc. The Montreal Test (MT) was given to all patients to evaluate CI. To 15 patients with CI and without systemic hypertension, diabetes mellitus, cerebrovascular disease, vasculitis, hypothyroidism, depression, and drugs that interfere with the cognitive assessment, the PC was measured by cerebral gammagram (CG). RESULTS: Of the 88 patients with ES, 58 had CI by MT. A decrease in CP was observed in following lobes: frontal in 9 of 15 patients, temporal in 7 of 15, and parietal in 3 of 15. Concordance between MT and CG was 60% for the frontal, 46% for the temporal and parietal 13%. CONCLUSIONS: The CI is common in SSc. A decrease in CP was more frequent in the frontal lobe, predominating in older patients and with longer duration of SSc.

Introducción: la esclerosis sistémica (ES) es una enfermedad autoinmune, sistémica, caracterizada por fibrosis, alteraciones inmunológicas y vasculares. La hipoperfusión cerebral puede ser causada por isquemia. Los trastornos cognitivos son causa importante de morbilidad. El objetivo de este estudio fue determinar la frecuencia de alteraciones en la perfusión cerebral (PC) en pacientes con ES y deterioro cognitivo (DC). Métodos: se estudiaron 88 pacientes con ES. A todos se les aplicó el Test de Montreal (TM) para evaluar el DC. A 15 pacientes con DC que cumplieron con los criterios (sin hipertensión arterial sistémica, diabetes mellitus, evento vascular cerebral, vasculitis, hipotiroidismo, depresión, sin ingesta de fármacos que interfieran con la evaluación cognitiva), se les midió la PC mediante Gamagrama Cerebral Perfusorio (GCP).Resultados: de los 88 pacientes con ES, 58 tuvieron DC con el TM. La PC se encontró disminuida en 12/15. La disminución de la PC se observó en los siguientes lóbulos (frontal en 9/15; temporal en 7/15, y parietal en 3/15. La concordancia entre el TM y GC fue 60 % para el lóbulo frontal, 46 % para el lóbulo temporal y 13 % parietal.Conclusiones: el DC es frecuente en la ES, la disminución de la PC fue más común en el lóbulo frontal, predominado en los pacientes de mayor edad y tiempo de evolución de la ES.

Towards an integrated environmental risk assessment of emissions from ships' propulsion systems.

Large ships, particularly container ships, tankers, bulk carriers and cruise ships are significant individual contributors to air pollution. The European Environment Agency recognizes that air pollution in Europe is a local, regional and transborder problem caused by the emission of specific pollutants, which either directly or through chemical reactions lead to negative impacts, such as damage to human health and ecosystems. In the Marine Strategy Framework Directive 2008/56/EC of the European Parliament emissions from ships are mentioned explicitly in the list of pressures and impacts that should be reduced or minimized to maintain or obtain a good ecological status. While SOx and NOx contribute mainly to ocean and soil acidification and climate change, PM (particularly ultrafine particles in the range of nanoparticles) has the potential to act more directly on human and ecosystem health. Thus, in terms of risk assessment, one of the most dangerous atmospheric aerosols for environmental and human health is in the size range of nanoparticles. To our knowledge, no study has been carried out on the effects of the fraction that ends up in the water column and to which aquatic and sediment-dwelling organisms are exposed. Therefore, an integrated environmental risk assessment of the effects of emissions from oceangoing ships including the aquatic compartment is necessary. Research should focus on the quantitative and qualitative determination of pollutant emissions from ships and their distribution and fate. This will include the in situ measurement of emissions in ships in order to derive realistic emission factors, and the application of atmospheric and oceanographic transportation and chemistry models.