Search Results (615)

Atrial fibrillation (AF) and heart failure (HF) frequently coexist, but the clinical relevance of AF may differ according to whether it appears to be a potentially reversible contributor, an aggravating factor in established HF, or a marker of advanced substrate. The driver–modifier–marker lens used in this review is a provisional, nonvalidated aid to clinical reasoning and should not be interpreted as a treatment score. This narrative review was informed by dated searches of PubMed/MEDLINE, the Cochrane Library, and OpenAlex through 29 July 2026, followed by a targeted update on 30 July 2026. It considers HF with reduced, mildly reduced, and preserved ejection fraction together with AF timing, burden, ventricular-rate exposure, myocardial substrate, and reversibility. Early rhythm control may be particularly relevant when AF is recent or temporally associated with ventricular dysfunction, symptoms, decompensation, or inadequate cardiac resynchronization therapy delivery. Evidence supporting catheter ablation is most direct in suspected AF-mediated cardiomyopathy and selected HFrEF populations, whereas evidence in HFpEF more consistently supports symptom relief, improved exercise hemodynamics, and AF-burden reduction than mortality reduction. Pulmonary vein isolation remains the procedural foundation. Radiofrequency, cryoballoon, and pulsed-field ablation are effective in broad AF populations, but HF phenotype-specific prognostic superiority has not been established for any energy source. Clinical decisions should reflect the design and directness of the evidence together with expected benefit, rhythm durability, procedural risk, patient-reported outcomes, stroke prevention, guideline-directed HF therapy, risk-factor management, and patient preference. Full article

Infective endocarditis (IE) continues to represent a major challenge for global health systems. In 2019, its annual incidence was estimated at 13.8 cases per 100,000 individuals, contributing to approximately 66,300 deaths worldwide. Due to its high morbidity and mortality rates, enhancing preventive measures has become a priority in both clinical practice and ongoing research efforts. Since the publication of the 2015 ESC Guidelines for the management of IE, several pivotal studies have emerged, prompting a re-evaluation and potential update of the existing recommendations. One growing concern is the increasing antibiotic resistance among oral streptococci, particularly to macrolides such as azithromycin and clarithromycin, which now show higher resistance levels than penicillin. Changes in national antibiotic stewardship programs may have inadvertently contributed to a rise in IE incidence, in part due to altered prophylactic practices. At the same time, advances in diagnostic modalities—including more widespread and targeted use of echocardiography in patients with positive blood cultures for organisms like Enterococcus faecalis, Staphylococcus aureus, and various streptococci—have likely improved detection rates. Additionally, innovations in imaging, particularly computed tomography (CT) and nuclear medicine techniques, have enhanced the diagnosis of IE, especially among patients with prosthetic heart valves or implantable cardiac devices. This has allowed for better characterization of patient populations, aiding in the refinement of diagnostic criteria and therapeutic approaches. Furthermore, updated antibiotic treatment protocols, informed by EUCAST’s antimicrobial susceptibility data, have helped tailor antimicrobial regimens to current resistance trends. The combination of improved diagnostic sensitivity and evolving microbial resistance patterns has also led to an increased number of patients being considered for cardiac surgery as part of their treatment pathway. This review seeks to synthesize the latest findings and guideline revisions, offering an integrated overview of recent progress in the diagnosis, medical treatment, and surgical management of infective endocarditis. It will also explore current therapeutic strategies and operative indications in light of the most recent evidence. Full article

Background/Objectives: Cardiac comorbidities are increasingly common among liver transplant candidates, particularly those with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis. Although the Liver Transplant Comorbidity Index identifies coronary artery disease (CAD) as a predictor of post-transplant mortality, the impact of overall cardiac comorbidity burden on early outcomes after liver transplantation remains unclear. We evaluated the association between pre-transplant cardiac comorbidities and early post-transplant outcomes, with emphasis on MASH-related cirrhosis. Methods: We performed a retrospective cohort study using the TriNetX US Collaborative Research Network. Adults undergoing first-time isolated liver transplantation through May 2026 were included. Pre-transplant CAD, heart failure (HF), and atrial fibrillation (AF) documented within 12 months before transplantation were identified using ICD-10-CM codes. Patients were categorized by cardiac comorbidity burden (0–3 conditions). Recipients with any cardiac comorbidity underwent 1:1 propensity score matching to those without cardiac disease using 16 baseline demographic, clinical, and laboratory variables, including MELD-Na. The estimand was the average treatment effect in the treated patients. Primary outcomes comprised 30- and 90-day all-cause mortality. Secondary outcomes included a prespecified restricted major adverse cardiac event (MACE) composite, limited to hard endpoints (death, myocardial infarction, cardiac arrest, ischemic stroke), and a broader composite, i.e., acute kidney injury, prolonged mechanical ventilation, vasopressor requirement, renal replacement therapy, ICU and hospital length of stay, and 90-day readmission. Results: Among 5124 recipients, 986 (19.2%) exhibited at least one cardiac comorbidity. After matching, 974 patients remained in each group. Pre-transplant cardiac comorbidity was associated with higher 30- and 90-day mortality and increased risks of all secondary outcomes. The association with MACE persisted but was attenuated when restricted to hard endpoints (90-day RR 1.55; 95% CI 1.19–2.03) when compared with the broad composite (RR 1.75; 95% CI 1.40–2.18). MASH recipients with cardiac comorbidities experienced numerically higher event rates than did non-MASH recipients, but interaction estimates were imprecise and non-significant. In separate matched analyses, AF was most strongly associated with MACE, whereas CAD showed the strongest association with mortality. Conclusions: Pre-transplant cardiac comorbidity burden is associated with worse early post-transplant outcomes. Although MASH-cirrhosis recipients experienced numerically higher event rates, exploratory subgroup analyses did not demonstrate statistically significant differences from the non-MASH recipients. These findings may help refine cardiac risk prediction and perioperative planning, but they do not establish that intensified cardiac risk stratification or perioperative optimization improve outcomes. Prospective studies incorporating detailed cardiac, donor, operative, frailty, and medication data are needed to validate these associations and determine whether targeted risk-stratification and perioperative strategies can improve post-transplant outcomes. Full article

Heat stress represents one of the most economically and biologically consequential environmental challenges facing modern dairy production, with projected intensification under ongoing climate change. Intraruminal bolus sensors have emerged as a uniquely capable platform for heat stress surveillance in lactating dairy cows: once administered, they provide continuous, lifetime access to reticuloruminal temperature—a reliable indicator of core body thermal status—alongside behavioral parameters, in a configuration entirely shielded from external environmental interference. This review examines the scientific basis and practical capabilities of bolus-based heat stress monitoring and its potential to optimize dairy production systems. We describe the physiological rationale for reticuloruminal temperature as a heat stress indicator, the principal confounding factors including drinking-water effects and diurnal variation, and the evidence base for interpreting temperature signals in the context of breed, parity, milk yield, and the temperature–humidity index. We review controlled studies characterizing the determinants of reticuloruminal temperature across breeds and seasons, and a four-level machine-learning processing architecture for bolus data integration. Individual baseline calibration—rather than fixed population thresholds—is identified as a prerequisite for reliable detection, enabling targeted cooling interventions, improved reproductive management, and enhanced disease surveillance. We further review bolus developments extending sensing to heart-rate monitoring and low-power wide area network communication, and discuss machine-learning methodologies suited to bolus-derived time-series data. Methodological challenges—including drinking-water effects, sensor precision, communication reliability, and the absence of standardized crossbreed validation protocols—are critically appraised, and future research priorities are identified. Full article

Background/Objectives: Ammonia inhalants, commonly known as smelling salts, are widely used in sport as an acute arousal strategy, yet their ergogenic value remains uncertain. This systematic review and three-level meta-analysis examined the acute effects of ammonia inhalation on physical performance and selected psychophysiological outcomes. Methods: Controlled human studies involving healthy adults, physically active individuals, or athletes were included when they compared ammonia inhalation with placebo, sham, or no-inhalation control conditions. Physical performance was the primary outcome, with heart rate and selected subjective responses analyzed as exploratory secondary outcomes. Results: Ten studies were included. The primary analysis showed no statistically significant effect of ammonia inhalation on overall physical performance (k = 47, g = 0.11, 95% CI [−0.06, 0.28]). Heart rate and subjective exertion/fatigue were also not significantly affected. In contrast, subjective activation/arousal increased significantly (k = 9, g = 0.73, 95% CI [0.43, 1.04]), although this finding was based on only two studies. Moderator analyses did not show consistent subgroup differences for performance type, training status, or comparator type, whereas sex-based differences were exploratory and based on limited evidence. Sensitivity analyses suggested that physical performance became significantly improved after removal of influential effects, and power/explosive performance showed a possible benefit; however, these findings should be considered preliminary rather than confirmatory. Conclusions: Overall, ammonia inhalation appears to act primarily as a brief arousal stimulus rather than a consistent ergogenic aid. Potential benefits may depend on task demands, with explosive or repeated high-intensity tasks appearing more plausible targets than maximal strength or precision-based skills. Current evidence remains limited by small samples, heterogeneous protocols, and low certainty. Full article

Background/Objectives: Benchmark performance does not establish that a wrist-wearable stress measure is valid in healthcare workflows. We tested whether binary stress-versus-non-stress performance reflects stress-specific physiology rather than heart-rate (HR) arousal, as well as whether models generalize from wellness-like corpora to a clinical workforce context. Methods: We analyzed three public wrist Empatica E4 corpora: Wearable Stress and Affect Detection (WESAD), Stress-Predict, and a real-world Nurse dataset. An iso-heart-rate (iso-HR) evaluation balanced the HR within subjects before measuring non-cardiac discriminability. We compared a continuous skin conductance response (SCR) count with logistic regression, gradient boosting, four unsupervised domain-adaptation methods, and an accelerometer context-aware variant, under leave-one-subject-out and leave-one-dataset-out evaluation with subject-cluster bootstrap intervals. Results: The single SCR score was statistically indistinguishable from logistic regression in paired cross-corpus tests, and no adaptation method moved a weak corpus into a usable range: across all evaluated models, the transfer area under the receiver operating characteristic curve (AUROC) was approximately 0.90 with WESAD as the target but 0.52–0.57 with Stress-Predict or Nurse. Adding activity context raised the within-corpus AUROC yet lowered cross-corpus transfer, because the movement–stress association reverses across protocols. On Nurse, source-trained models reached AUROC 0.541–0.559 against prevalence 0.796 with poor calibration, and conditioning on movement or on distance to the source distribution removed the residual discrimination. Iso-HR evidence was diagnostic mainly in WESAD. Conclusions: Neither shallow unsupervised adaptation nor wrist activity context established reliable transfer to Nurse, and sparse retrospective labels prevent attributing this solely to physiological non-transfer. Cross-corpus and iso-HR controls, not model complexity, determine what can be concluded for healthcare workflows. Full article

Chronic heart failure (CHF) is characterized by heightened cardiac sympathetic activity and neuroinflammation within the stellate ganglia (SG), contributing to cardiac arrhythmogenesis. However, the upstream mediators of this neuroimmune interaction remain incompletely defined. This study investigated whether systemic neutralization of granulocyte–macrophage colony-stimulating factor (GM-CSF, an inflammatory cytokine) attenuates SG inflammation and cardiac sympathetic overactivation in a rat model of coronary artery ligation-induced CHF. Male Sprague–Dawley rats underwent myocardial infarction or sham surgery and were treated with a GM-CSF neutralizing antibody or vehicle. Cardiac sympathetic nerve activity (CSNA), heart rate variability (HRV), cytokine expression, and the electrophysiological properties of cardiac sympathetic post-ganglionic (CSP) neurons were assessed. CHF increased the levels of GM-CSF, ionized calcium-binding adaptor molecule 1 (IBA1, an activated macrophage marker) and pro-inflammatory markers (TNF-α, pro IL-1β) in the SG, enhanced neuronal Ca²⁺ currents, cell excitability, and CSNA, and impaired HRV. The GM-CSF neutralizing antibody significantly attenuated SG inflammation, partially normalized Ca²⁺ currents and neuronal firing, decreased CSNA, and improved cardiac autonomic balance. These findings identify GM-CSF as a key regulator of SG neuroinflammation and sympathetic dysregulation in CHF. Targeting this GM-CSF protein may represent a novel therapeutic strategy to mitigate autonomic imbalance and arrhythmic risk. Full article

Background: Motorsport competition imposes significant psychophysiological demands on athletes, characterized by prolonged cardiovascular strain, high cognitive workloads, and extreme thermal environments. However, scientific literature focusing specifically on the category of single-seater race cars remains lacking. Therefore, the objective of this review was to identify possible physiological demands in Formula drivers to suggest training recommendations and to examine gaps in the literature for future studies. Methods: A narrative literature search was conducted including the following search engines: PubMed/MEDLINE, ScienceDirect, and Google Scholar. All studies until October 2025 were included. Results: A total of eight studies were selected. The limited physiological demands of Formula drivers suggest that professional drivers exhibit specialized physical adaptations. These findings describe high aerobic capacity, elevated sustained heart rates during competition, and targeted musculoskeletal development, particularly regarding neck and upper body strength required to withstand gravitational loads. Conclusions: Although the currently available data provide valuable preliminary insights into the physiological impact of auto racing, the extremely limited and heterogeneous nature of the existing samples prevents definitive conclusions from being drawn. There is an urgent need for future longitudinal research using high-fidelity, category-specific monitoring to establish robust and standardized psychophysiological profiles and provide training recommendations applicable throughout an entire single-seater racing career. Full article

In Internet-of-Things (IoT)-based rehabilitation, patient data from wearable sensors (IMU, EMG, heart rate), clinical assessments, and surveys differ in format and granularity, complicating unified patient-state construction. Existing AI-based systems often omit fatigue level or rehabilitation stage, or they place large language models (LLMs) in the clinical decision-making role, exposing patients to hallucination risk. We propose an IoT-ready framework comprising three components: an input-source-independent context abstraction pipeline, a digital twin that simulates clinical-score trajectories, and an LLM Agent that interprets the outputs of a deterministic algorithm and a digital twin as (subject, predicate, object) Triplets to produce a retrieval-augmented clinical report. The algorithm—not the LLM—selects the 13-exercise sequence from Shoulder Pain and Disability Index (SPADI) item-level responses. Explicit per-layer schemas let IoT-sensor branches be added without changing the downstream interface. Here we evaluate the framework on the clinical-score path (three patient-reported outcome measures and six range-of-motion measures); the multi-modal IoT branches maintain deployment-target functionality. On 48 IRB-approved shoulder rehabilitation patients (144 longitudinal records; augmented to 7200 only to train the trajectory generator), real-only leave-one-subject-out evaluation gave VAS RMSE 0.658 (0–10) and SPADI RMSE 6.499 (0–100). Ablation across four surface forms revealed a fidelity–accuracy trade-off—Narrative highest on template fidelity (BERTScore F1 0.250), raw JSON highest on judge-rated accuracy—and the framework adopts the balanced-midpoint Triplet form. A claim-level audit of the Triplet-form reports left 22–31% of atomic claims unsupported (Claude Sonnet and GPT-4o judges) regardless of guideline retrieval. A raw-LLM control never reproduced the algorithm-defined sequence exactly (0 of 48), supporting deterministic, auditable sequence selection and the need for clinician review before clinical use. Full article

Background/Objectives: Cardiac implantable electronic device (CIED) infections are infrequent but clinically significant, and Latin American—particularly Chilean—data remain scarce. We aimed to describe the clinical and microbiological profile, complications, mortality, and local infection burden of CIED infections at a tertiary center in southern Chile. Methods: This was a retrospective descriptive cohort study of all patients treated for CIED infection at Hospital Dr. Hernán Henríquez Aravena between January 2015 and December 2021. Crude per-procedure infection proportions were calculated using locally implanted devices (primary implants, generator replacements, and upgrades) as the denominator; because annual implant volumes and individual follow-up times were not retrievable, only exploratory approximate rates per 100 patient-years were derived under strong assumptions and were not used for formal comparison. Results: Fifty-four patients were included (77.8% men; mean age 69 ± 14 years). Predominant comorbidities were arterial hypertension (79.6%), heart failure (40.7%), atrial fibrillation (27.8%), and type 2 diabetes mellitus (24.1%). Pacemakers accounted for 59.3% of infections, and late-onset cases predominated (48.2%). The overall per-procedure infection proportion was 1.4% (95% confidence interval [CI] 1.1–1.9%) and was numerically higher for implantable cardioverter-defibrillators (ICDs; 5.5%) and cardiac resynchronization therapy (CRT) devices (4.3%) than for pacemakers (1.1%). Coagulase-negative Staphylococcus (43.2%) and Staphylococcus aureus (24.3%) were the leading isolates, although microbiological sampling was incomplete (available in 68.5%). Complete system extraction was attempted in all patients and achieved in all but one case; recurrence occurred in 9.3% and in-hospital mortality in 1.9%. Conclusions: The clinical and microbiological profile of CIED infections in this single-center southern Chilean cohort was broadly consistent with international series. Per-procedure proportions for ICDs and CRT devices were numerically higher than those for pacemakers, but the retrospective design, a procedure-based denominator including replacements and upgrades, and incomplete echocardiographic and microbiological workup preclude formal comparison with time-to-event registries; these device-specific findings should be regarded as exploratory and hypothesis-generating. The findings identify concrete, locally actionable targets: more systematic microbiological sampling, broader pre-procedural and diagnostic echocardiography (including transesophageal studies), and strengthened long-term follow-up of CIED carriers. Full article

Hypertensive heart disease (HHD) is a major global cause of cardiovascular mortality and disability-adjusted life years (DALYs). We used an age–period–cohort model to assess mortality and DALY trends (1992–2021) across sociodemographic regions and their association with healthcare quality. Using Global Burden of Disease (GBD) data (1992–2021), we applied an age–period–cohort model to HHD mortality and DALYs in adults aged 20–54 across SDI regions and examined associations with healthcare quality. HHD mortality and DALYs declined across most SDI regions over 29 years, with high-middle SDI females showing the greatest reductions (ASMR: −3.2% annually; ASDR: −2.9%). Conversely, high-SDI regions exhibited rises of ~1.7% and ~1.2% in males and females, respectively. Low-SDI regions maintained the highest absolute burden, with 2021 mortality rates 10-fold higher in males and 13.7-fold higher in females versus high-SDI regions, despite the steepest declines. The male-to-female mortality ratio ranged from 1.74× (high-middle SDI) to 1.14× (low SDI). Age-related patterns diverged markedly: high-SDI females showed a 46.7% risk decline for ages 20–54, while males experienced a 92–111% lifespan risk increase. Period effects showed pre-2002 peak risk in lower-SDI versus post-2002 increases in high-SDI regions (males: +36%; females: +24%). The 1997–2001 birth cohort in high-SDI regions showed the highest risk (males: RR 1.75–1.85; females: RR 1.45–1.50). No significant correlation was found between HHD burden and HAQI (ASMR: r = 0.40; ASDR: r = 0.42; p > 0.05). HHD remains a major global health concern, with rising burden in high-SDI regions and persistent male predominance. Healthcare quality alone is insufficient, highlighting the need for targeted prevention focused on modifiable risk factors in working-age adults. Full article

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening form of heart failure that occurs toward the end of pregnancy or in the months following delivery. Biomarkers that may support the recognition and characterization of PPCM remain limited. We investigated whether targeted serum organic-acid profiling could identify candidate metabolites associated with PPCM. In this case–control study, serum samples from women with PPCM (n = 40) and healthy controls (n = 40) were analyzed using a targeted organic-acid panel. Log₂-transformed metabolite abundances were compared using Welch’s t-test, with Benjamini–Hochberg false discovery rate (FDR) correction correction and Hedges’ g effect sizes. Distributional assumptions were assessed using group-specific Shapiro–Wilk tests, and Mann–Whitney U tests were performed as a non-parametric sensitivity analysis. Homogentisic acid was increased in PPCM (log₂fold change (log₂FC) = 0.696; FDR q = 9.8 × 10⁻⁶), whereas lactic acid was decreased (log₂FC = −0.701; FDR q = 0.00773). Both findings remained significant in the Mann–Whitney U sensitivity analysis (BH-FDR q = 5.63 × 10⁻⁵ and q = 0.0114, respectively). The best-performing single metabolite showed an area under the receiver operating characteristic curve(AUC) of 0.818 (95% CI, 0.723–0.899). The multivariable model achieved a cross-validated AUC of 0.708 (95% CI, 0.590–0.813), with a sensitivity of 0.800 and a specificity of 0.550. Targeted organic-acid profiling revealed a distinct metabolic signal in PPCM, highlighted by higher homogentisic acid and lower lactic acid levels. These exploratory findings warrant confirmation in larger prospective studies with external validation. Full article

This paper proposes a lightweight vital-sign detection framework based on Frequency-Modulated Continuous Wave (FMCW) radar. By integrating time-domain complex differencing and adaptive trend reconstruction, the proposed framework mitigates distortions in chest micro-motion signals caused by multipath reflections, radar cross-section (RCS) variations, high-frequency impulsive noise, and body-motion artifacts in practical monitoring scenarios. The framework first employs a Time-Domain Complex Differencing and Sliding Accumulated Energy (TDCD-SAE) algorithm to precisely lock onto the target range-bin, followed by phase-difference extraction utilizing Complex Conjugate Multiplication (CCM). To eliminate non-physiological interference, an Adaptive Threshold-Based Bidirectional Trend Reconstruction (AT-BTR) algorithm is introduced to restore the corrupted phase profile. The optimized phase signal is converted into chest-wall displacement, followed by body motion detection to realize the joint estimation of the respiration rate and the heart rate. The experimental results demonstrate that the proposed system achieves a high precision, yielding low absolute errors of 1.24/1.71 BPM (supine) and 1.39/2.24 BPM (lateral), thereby validating its efficacy and robustness across diverse sleeping postures in resource-constrained environments. Full article

Background: Exercise testing is routinely performed before initiation of phase II cardiac rehabilitation to assess exercise capacity and determine safe training intensity. However, exercise tests may be terminated before reaching the target heart rate due to various cardiovascular and non-cardiovascular factors. The aim of this study was to analyze the reasons for terminating exercise tests performed on a treadmill and a cycle ergometer, with particular emphasis on the impact of the patient’s clinical profile and exercise capacity. Methods: A retrospective analysis was conducted on 336 patients after myocardial infarction (74 women and 262 men) referred to inpatient phase II cardiac rehabilitation between 2019 and 2022. Patients were divided into two matched groups according to the type of exercise test performed: treadmill and cycle ergometer. Reasons for test termination, exercise performance parameters, and demographic and clinical characteristics were analyzed. Results: The most common reasons for exercise test termination were fatigue (55.1%) and achievement of the target heart rate (37.2%), with no significant differences between testing modalities. Lower limb pain was significantly more frequent during cycle ergometer testing compared with treadmill testing (16.1% vs. 7.1%; p = 0.011). Patients tested on the treadmill achieved significantly higher exercise capacity (7.19 vs. 5.28 METs (metabolic equivalents); p < 0.001), higher peak heart rate, and higher rate-pressure product. Multiple regression analysis showed that the association between exercise modality and lower limb pain was not independent after adjustment for clinical and demographic variables, indicating that the observed differences were largely explained by patient clinical characteristics. Conclusions: The most common reasons for exercise test termination were patient fatigue and attainment of the target heart rate, confirming the safety of submaximal exercise testing in post-myocardial infarction patients. Lower limb pain was more frequently observed during cycle ergometer testing in unadjusted analysis; however, this association was not independent of clinical variables, indicating that it is primarily related to the patient’s clinical profile rather than the exercise modality. Exercise testing should therefore be individualized according to clinical status, functional capacity, and rehabilitation goals. Full article

At SAE Level 2 automation, the human driver retains full supervisory responsibility, making unobtrusive monitoring relevant for maintaining supervision under real-world driving conditions. Driver monitoring systems capable of operating robustly under such conditions are therefore essential, but wearable-based personalized approaches remain underexplored, particularly when the target labels are derived from experimental scenarios. This study presents a real-world SAE Level 2 on-road acquisition campaign and evaluates a target-driver intra-subject classification approach using non-intrusive wrist-derived signals. Physiological and motion data recorded with the Empatica E4 wristband, including blood volume pulse, electrodermal activity, heart rate, skin temperature, and triaxial wrist acceleration, were converted into image representations and processed with a frozen ResNet-50 feature extractor, principal component analysis, and a supervised classifier. The labels were scenario-derived operational driver-state classes defined from experimental phases and scenario groups. Personalization was assessed via a Leave-One-Experience-Out protocol on the target driver. Classification accuracy was 50% under external-user-only training, 54% under mixed target/external-user training, and 60% under target-driver-only training, with the target-driver-only configuration yielding the highest mean performance in the evaluated setting. For the low-demand baseline class, the one-vs.-rest classifier achieved 88.4% accuracy and an F1-score of 70%. These results provide initial evidence of the feasibility of personalized wrist-worn classification of scenario-derived operational driver-state classes under the real-world automated driving conditions evaluated in this study. Full article