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Background Aircrew members are required to attend hypoxia awareness training regularly to strengthen their memory of their personal hypoxia symptoms by undergoing training inside a hypobaric chamber. The aim of this study was to examine the association between hypoxia symptoms experienced during two training sessions that were 4 years apart. Methods This was a crossover study to compare hypoxia symptoms and self-reported physiological effects of trapped gas between a previous training session and a current training session in an altitude chamber. The subjects were military crew members who undertook a 25,000feet refresher training course in 2018. We used a structured questionnaire to obtain the target information before and during hypoxia exposure. Data were analyzed using SPSS software. Results A total of 341 trainees participated in this survey and completely filled out the questionnaire. Gastrointestinal tract discomfort caused by the expansion of trapped gas was the main physiological reaction during the previous and current training sessions. Frequently reported symptoms were poor concentration (30.5%), impaired cognitive function (20.5%), visual disturbances (16.4%), hot flashes (15.8%), and paresthesia (12.6%) during both exposures. However, the proportions of participants reporting poor concentration (P = 0.378) and visual disturbances (P = 0.594) were not significantly different between the recalled and current training sessions. The five most common symptoms among the subjects with less than 1,000 flight hours were poor concentration (29.8%), visual disturbance (27.3%), impaired

The exploitation of novel fused carbazole/carbonyl emitters is essential to broaden the application of thermally activated delayed fluorescence (TADF) materials for organic light‐emitting diodes (OLEDs). Here, with the aid of the addition and cyclization of the cyano group with the ortho‐carbazole, fused carbazole/carbonyl based TADF emitters are effectively synthesized via this new synthetic strategy. The attachment of ancillary donors including carbazole, diphenylamine, and phenolazine to the fused carbazole/carbonyl skeletons further tunes their emissions from blue to yellow‐green. Particularly, pure‐blue OLEDs incorporating the peripheral carbazole attached emitter exhibit a maximum external quantum efficiency (EQEmax) of 22.3%, with a small full width at half maximum (FWHM) of 48 nm. In addition, the peripheral phenolazine attached yellow‐green emitter shows extremely small singlet−triplet state energy gap (ΔEST) of 0.01 eV, high photoluminescence quantum efficiency of 82.5%, short delayed fluorescence lifetime of 6.2 µs and good OLED performances with an EQEmax of 21.7%, an FWHM of 68 nm and low efficiency roll‐off. These results demonstrate that the new synthetic strategy for fused carbazole/carbonyl molecules provide a valuable reference for the design of high‐efficient TADF emitters.

Real-world data have shown that clozapine and long-acting injectable antipsychotics (LAIA) are more effective than oral antipsychotics in preventing relapse in schizophrenia. 1 A treatment dilemma emerges when managing patients with treatment-resistant schizophrenia (TRS) who refuse oral antipsychotics, as the treatment of choice, long-acting injectable (LAI) clozapine, is not available. We report on two patients with TRS who were successfully managed with combined typical and atypical LAIA. Informed consents have been obtained from the families of both patients.Ms A was a 35-year-old woman with TRS for 10 years (nonresponse to amisulpride 800 mg/day, risperidone 6 mg/day, and olanzapine 20 mg/day). Flupentixol decanoate 40 mg once every 2 weeks was given, because she had refused oral antipsychotics 2 years previously. Her symptoms were partially relieved, while delusion, hostility, and affective lability were still severe. LAI aripiprazole 400 mg once every 4 weeks was added, and her symptoms had improved by 3 months later. When discontinuing flupentixol decanoate, her symptoms became worse. Thus, the dose of flupentixol decanoate was maintained. Over the following 6 months, LAI aripiprazole 400 mg once every 4 weeks and flupentixol decanoate 20 mg once every 4 weeks were coadministered (an A-F-A-F sequence), and her psychotic condition was stable.Mr T was a 46-year-old man with a 20-year history of TRS due to nonresponse to several antipsychotics, including quetiapine 800 mg/day, olanzapine 20 mg/day, and haloperidol 20 mg/day. He refused any drugs, and was treated with flupentixol decanoate 40 mg once every 2 weeks over 5 years recently. He still had prominent psychotic symptoms, and therefore paliperidone palmitate 150 mg once every 4 weeks was added, significantly improving the psychotic symptoms. In the following 2 years, he was stably managed with both LAIA (a P-F-P-F sequence). Moreover, he did not experience adverse effects and was able to do some casual work.Evidence recommends that a high dose of oral antipsychotics (above the officially approved dose range) may not provide benefits for TRS, and instead increases the risk of adverse effects. 2 We have successfully managed these two TRS patients with combined typical and atypical LAIA in an alternating administration sequence; however, the improvement in Mr T might be due to paliperidone LAI alone. From a pharmacological perspective, a combination of LAIA with different receptor-binding profiles may be considered in patients with TRS who partially respond to an initial LAIA trial. 2 We hypothesized that the alternating administration scheme of two LAIA with different receptor-binding profiles may offer pharmacological benefits and reduce the risk of adverse effects. Moreover, biweekly visits provide close clinical surveillance, rigorous monitoring of psychosocial stressors, and increasing interaction with clinic staff. LAIA may uncover 'pseudoresistance' due to nonadherence to oral antipsychotics. However, the potential risk of using multiple LAIA is th...

Gravity in the head-to-toe direction, known as +Gz (G force), forces blood to pool in the lower body. Fighter pilots experience decreases in blood pressure when exposed to hypergravity in flight. Human centrifuge has been used to examine the G tolerance and anti-G straining maneuver (AGSM) techniques of military pilots. Some factors that may affect G tolerance have been reported but are still debated. The aim of this study was to investigate the physiological responses and anthropometric factors correlated with G tolerance. We retrospectively reviewed the training records of student pilots who underwent high G training. Variables were collected to examine their correlations with the outcome of 7.5G sustained for 15 s (7.5G profile). There were 873 trainees who underwent 7.5G profile training, 44 trainees (5.04%) could not sustain the test for 15 s. The group with a small heart rate (HR) increase (less than 10%) during the first 1–5 s of the 7.5G profile had a nearly ten-fold higher failing chance compared with the large HR increase group (adjusted odds ratio: 9.91; 95% confidence interval: 4.11–23.88). The chances of failure were inversely related to the HR increase percentage (p for trend <0.001). Factors, including body mass index, relaxed and straining G tolerance, and AGSM, were found to be negatively correlated with the outcome.