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Study design: Systematic review with meta-analysis and meta-regression.
Background and objectives: We systematically reviewed and delineated the existing evidence on sustainability effects of motor control exercises on pain intensity and disability in chronic low back pain patients when compared with an inactive or passive control group or with other exercises. Secondary aims were to reveal whether moderating factors like the time after intervention completion, the study quality, and the training characteristics affect the potential sustainability effects.
Methods: Relevant scientific databases (Medline, Web of Knowledge, Cochrane) were screened. Eligibility criteria for selecting studies: All RCTs und CTs on chronic (≥ 12/13 weeks) nonspecific low back pain, written in English or German and adopting a longitudinal core-specific/stabilizing sensorimotor control exercise intervention with at least one pain intensity and disability outcome assessment at a follow-up (sustainability) timepoint of ≥ 4 weeks after exercise intervention completion.
Results and conclusions: From the 3,415 studies that were initially retrieved, 10 (2 CTs & 8 RCTs) on N = 1081 patients were included in the review and analyses. Low to moderate quality evidence shows a sustainable positive effect of motor control exercise on pain (SMD = -.46, Z = 2.9, p < .001) and disability (SMD = -.44, Z = 2.5, p < .001) in low back pain patients when compared to any control. The subgroups’ effects are less conclusive and no clear direction of the sustainability effect at short versus mid versus long-term, of the type of the comparator, or of the dose of the training is given. Low quality studies overestimated the effect of motor control exercises.
Vibroarthrography measures joint sounds caused by sliding of the joint surfaces over each other. and can be affected by joint health, load and type of movement. Since both warm-up and muscle fatigue lead to local changes in the knee joint (e.g., temperature increase, lubrication of the joint, muscle activation), these may impact knee joint sounds. Therefore, this study investigates the effects of warm-up and muscle fatiguing exercise on knee joint sounds during an activity of daily living. Seventeen healthy, physically active volunteers (25.7 ± 2 years, 7 males) performed a control and an intervention session with a wash-out phase of one week. The control session consisted of sitting on a chair, while the intervention session contained a warm-up (walking on a treadmill) followed by a fatiguing exercise (modified sit-to-stand) protocol. Knee sounds were recorded by vibroarthrography (at the medial tibia plateau and at the patella) at three time points in each session during a sit-to-stand movement. The primary outcome was the mean signal amplitude (MSA, dB). Differences between sessions were determined by repeated measures ANOVA with intra-individual pre-post differences for the warm-up and for the muscle fatigue effect. We found a significant difference for MSA at the medial tibia plateau (intervention: mean 1.51 dB, standard deviation 2.51 dB; control: mean -1.28 dB, SD 2.61 dB; F = 9.5; p = .007; η2 = .37) during extension (from sit to stand) after the warm-up. There was no significant difference for any parameter after the muscle fatiguing exercise (p > .05). The increase in MSA may mostly be explained by an increase in internal knee load and joint friction. However, neuromuscular changes may also have played a role. It appears that the muscle fatiguing exercise has no impact on knee joint sounds in young, active, symptom-free participants during sit to stand.
Background: High numbers of consumable medical materials (eg, sterile needles and swabs) are used during the daily routine of intensive care units (ICUs) worldwide. Although medical consumables largely contribute to total ICU hospital expenditure, many hospitals do not track the individual use of materials. Current tracking solutions meeting the specific requirements of the medical environment, like barcodes or radio frequency identification, require specialized material preparation and high infrastructure investment. This impedes the accurate prediction of consumption, leads to high storage maintenance costs caused by large inventories, and hinders scientific work due to inaccurate documentation. Thus, new cost-effective and contactless methods for object detection are urgently needed.
Objective: The goal of this work was to develop and evaluate a contactless visual recognition system for tracking medical consumable materials in ICUs using a deep learning approach on a distributed client-server architecture.
Methods: We developed Consumabot, a novel client-server optical recognition system for medical consumables, based on the convolutional neural network model MobileNet implemented in Tensorflow. The software was designed to run on single-board computer platforms as a detection unit. The system was trained to recognize 20 different materials in the ICU, while 100 sample images of each consumable material were provided. We assessed the top-1 recognition rates in the context of different real-world ICU settings: materials presented to the system without visual obstruction, 50% covered materials, and scenarios of multiple items. We further performed an analysis of variance with repeated measures to quantify the effect of adverse real-world circumstances.
Results: Consumabot reached a >99% reliability of recognition after about 60 steps of training and 150 steps of validation. A desirable low cross entropy of <0.03 was reached for the training set after about 100 iteration steps and after 170 steps for the validation set. The system showed a high top-1 mean recognition accuracy in a real-world scenario of 0.85 (SD 0.11) for objects presented to the system without visual obstruction. Recognition accuracy was lower, but still acceptable, in scenarios where the objects were 50% covered (P<.001; mean recognition accuracy 0.71; SD 0.13) or multiple objects of the target group were present (P=.01; mean recognition accuracy 0.78; SD 0.11), compared to a nonobstructed view. The approach met the criteria of absence of explicit labeling (eg, barcodes, radio frequency labeling) while maintaining a high standard for quality and hygiene with minimal consumption of resources (eg, cost, time, training, and computational power).
Conclusions: Using a convolutional neural network architecture, Consumabot consistently achieved good results in the classification of consumables and thus is a feasible way to recognize and register medical consumables directly to a hospital’s electronic health record. The system shows limitations when the materials are partially covered, therefore identifying characteristics of the consumables are not presented to the system. Further development of the assessment in different medical circumstances is needed.
Fuzzy system based on two-step cascade genetic optimization strategy for tobacco tar prediction
(2019)
There are many challenges in accurately measuring cigarette tar constituents. These include the need for standardized smoke generation methods related to unstable mixtures. In this research were developed algorithms using fusion of artificial intelligence methods to predict tar concentration. Outputs of development are three fuzzy structures optimized with genetic algorithms resulting in genetic algorithm (GA)-FUZZY, GA-adaptive neuro fuzzy inference system (ANFIS), GA-GA-FUZZY algorithms. Proposed algorithms are used for the tar prediction in the cigarette production process. The results of prediction are compared with gas chromatograph (high-performance liquid chromatography (HPLC)) readings.
Understanding and modulating CNS function in physiological as well as pathophysiological contexts remains a significant ambition in research and clinical applications. The investigation of the multifaceted CNS cell types including their interactions and contributions to neural function requires a combination of the state-of-the-art in vivo electrophysiology and imaging techniques. We developed a novel type of liquid crystal polymer (LCP) surface micro-electrode manufactured in three customized designs with up to 16 channels for recording and stimulation of brain activity. All designs include spare central spaces for simultaneous 2P-imaging. Nanoporous platinum-plated contact sites ensure a low impedance and high current transfer. The epidural implantation of the LCP micro-electrodes could be combined with standard cranial window surgery. The epidurally positioned electrodes did not only display long-term biocompatibility, but we also observed an additional stabilization of the underlying CNS tissue. We demonstrate the electrode’s versatility in combination with in vivo 2P-imaging by monitoring anesthesia-awake cycles of transgenic mice with GCaMP3 expression in neurons or astrocytes. Cortical stimulation and simultaneous 2P Ca2+ imaging in neurons or astrocytes highlighted the astrocytes’ integrative character in neuronal activity processing. Furthermore, we confirmed that spontaneous astroglial Ca2+ signals are dampened under anesthesia, while evoked signals in neurons and astrocytes showed stronger dependency on stimulation intensity rather than on various levels of anesthesia. Finally, we show that the electrodes provide recordings of the electrocorticogram (ECoG) with a high signal-to noise ratio and spatial signal differences which help to decipher brain activity states during experimental procedures. Summarizing, the novel LCP surface micro-electrode is a versatile, convenient, and reliable tool to investigate brain function in vivo.
Aim: The aim of the study was to identify common orthopedic sports injury profiles in adolescent elite athletes with respect to age, sex, and anthropometrics.
Methods: A retrospective data analysis of 718 orthopedic presentations among 381 adolescent elite athletes from 16 different sports to a sports medical department was performed. Recorded data of history and clinical examination included area, cause and structure of acute and overuse injuries. Injury-events were analyzed in the whole cohort and stratified by age (11–14/15–17 years) and sex. Group differences were tested by chi-squared-tests. Logistic regression analysis was applied examining the influence of factors age, sex, and body mass index (BMI) on the outcome variables area and structure (α = 0.05).
Results: Higher proportions of injury-events were reported for females (60%) and athletes of the older age group (66%) than males and younger athletes. The most frequently injured area was the lower extremity (47%) followed by the spine (30.5%) and the upper extremity (12.5%). Acute injuries were mainly located at the lower extremity (74.5%), while overuse injuries were predominantly observed at the lower extremity (41%) as well as the spine (36.5%). Joints (34%), muscles (22%), and tendons (21.5%) were found to be the most often affected structures. The injured structures were different between the age groups (p = 0.022), with the older age group presenting three times more frequent with ligament pathology events (5.5%/2%) and less frequent with bony problems (11%/20.5%) than athletes of the younger age group. The injured area differed between the sexes (p = 0.005), with males having fewer spine injury-events (25.5%/34%) but more upper extremity injuries (18%/9%) than females. Regression analysis showed statistically significant influence for BMI (p = 0.002) and age (p = 0.015) on structure, whereas the area was significantly influenced by sex (p = 0.005).
Conclusion: Events of soft-tissue overuse injuries are the most common reasons resulting in orthopedic presentations of adolescent elite athletes. Mostly, the lower extremity and the spine are affected, while sex and age characteristics on affected area and structure must be considered. Therefore, prevention strategies addressing the injury-event profiles should already be implemented in early adolescence taking age, sex as well as injury entity into account.
Water is crucial for socio-economic development and healthy ecosystems. With the actual population growth and in view of future water scarcity, development calls for improved sectorial allocation of groundwater and surface water for domestic, agricultural and industrial use. Instead of intensifying the pressure on water resources, leading to conflicts among users and excessive pressure on the environment, sewage effluents, after pre-treatment, provide an alternative nutrient-rich water source for agriculture in the vicinity of cities. Water scarcity often occurs in arid and semiarid regions affected by droughts and large climate variability and where the choice of crop to be grown is limited by the environmental factors. Jatropha has been introduced as a potential renewable energy resource since it is claimed to be drought resistant and can be grown on marginal sites. Sewage effluents provide a source for water and nutrients for cultivating jatropha, a combined plant production/effluent treatment system. Nevertheless, use of sewage effluents for irrigation in arid climates carries the risk of salinization. Thus, potential irrigation with sewage effluents needs to consider both the water requirement of the crop and those needed for controlling salinity build-up in the top soil. Using data from a case study in Southern Morocco, irrigation requirements were calculated using CROPWAT 8.0. We present here crop evapotranspiration during the growing period, required irrigation, the resulting nutrient input and the related risk of salinization from the irrigation of jatropha with sewage effluent.
Concerning human and environmental health, safe alternatives to synthetic pesticides are urgently needed. Many of the currently used synthetic pesticides are not authorized for application in organic agriculture. In addition, the developed resistances of various pests against classical pesticides necessitate the urgent demand for efficient and safe products with novel modes of action. Botanical pesticides are assumed to be effective against various crop pests, and they are easily biodegradable and available in high quantities and at a reasonable cost. Many of them may act by diverse yet unexplored mechanisms of action. It is therefore surprising that only few plant species have been developed for commercial usage as biopesticides. This article reviews the status of botanical pesticides, especially in Europe and Mediterranean countries, deepening their active principles and mechanisms of action. Moreover, some constraints and challenges in the development of novel biopesticides are highlighted.
Driven by falling photovoltaic (PV) installation costs and potential support policies, rooftop PV is expected to expand rapidly in Thailand. As a result, the relevant stakeholders, especially utilities, have concerns about the net economic impacts of high PV adoption. Using a cost–benefit analysis, this study quantifies the net economic impacts of rooftop PV systems on three utilities and on ratepayers in Thailand by applying nine different PV adoption scenarios with various buyback rates and annual percentages of PV cost reduction. Under Thailand’s current electricity tariff structure, Thai utilities are well-protected and able to pass all costs due to PV onto the ratepayers in terms of changes in retail rates. We find that when PV adoption is low, the net economic impacts on both the utilities and retail rates are small and the impacts on each utility depend on its specific characteristics. On the other hand, when PV adoption ranges from 9–14% in energy basis, five-year retail rate impacts become noticeable and are between 6% and 11% as compared to the projected retail rates in 2036 depending on the PV adoption level. Thus, it is necessary for Thailand to make tradeoffs among the stakeholders and maximize the benefits of rooftop PV adoption.
As productive biofilms are increasingly gaining interest in research, the quantitative monitoring of biofilm formation on- or offline for the process remains a challenge. Optical coherence tomography (OCT) is a fast and often used method for scanning biofilms, but it has difficulty scanning through more dense optical materials. X-ray microtomography (μCT) can measure biofilms in most geometries but is very time-consuming. By combining both methods for the first time, the weaknesses of both methods could be compensated. The phototrophic cyanobacterium Tolypothrix distorta was cultured in a moving bed photobioreactor inside a biocarrier with a semi-enclosed geometry. An automated workflow was developed to process µCT scans of the biocarriers. This allowed quantification of biomass volume and biofilm-coverage on the biocarrier, both globally and spatially resolved. At the beginning of the cultivation, a growth limitation was detected in the outer region of the carrier, presumably due to shear stress. In the later phase, light limitations could be found inside the biocarrier. µCT data and biofilm thicknesses measured by OCT displayed good correlation. The latter could therefore be used to rapidly measure the biofilm formation in a process. The methods presented here can help gain a deeper understanding of biofilms inside a process and detect any limitations.
Background: To facilitate access to evidence-based care for back pain, a German private medical insurance offered a health program proactively to their members. Feasibility and long-term efficacy of this approach were evaluated.
Methods: Using Zelen’s design, adult members of the health insurance with chronic back pain according to billing data were randomized to the intervention (IG) or the control group (CG). Participants allocated to the IG were invited to participate in the comprehensive health program comprising medical exercise therapy and life style coaching, and those allocated to the CG to a longitudinal back pain survey. Primary outcomes were back pain severity (Korff’s Chronic Pain Grade Questionnaire) as well as health-related quality of life (SF-12) assessed by identical online questionnaires at baseline and 2-year follow-up in both study arms. In addition to analyses of covariance, a subgroup analysis explored the heterogeneity of treatment effects among different risks of back pain chronification (STarT Back Tool).
Results: Out of 3462 persons selected, randomized and thereafter contacted, 552 agreed to participate. At the 24-month follow-up, data on 189 of 258 (73.3%) of the IG were available, in the CG on 255 of 294 (86.7%). Significant, small beneficial effects were seen in primary outcomes: Compared to the CG, the IG reported less disability (1.6 vs 2.0; p = 0.025; d = 0.24) and scored better at the SF-12 physical health scale (43.3 vs 41.0; p < 0.007; d = 0.26). No effect was seen in back pain intensity and in the SF-12 mental health scale. Persons with medium or high risk of back pain chronification at baseline responded better to the health program in all primary outcomes than the subgroup with low risk at baseline.
Conclusions: After 2 years, the proactive health program resulted in small positive long-term improvements. Using risk screening prior to inclusion in the health program might increase the percentage of participants deriving benefits from it.
Background: The Musculoskeletal Health Questionnaire (MSK-HQ) has been developed to measure musculoskeletal health status across musculoskeletal conditions and settings. However, the MSK-HQ needs to be further evaluated across settings and different languages.
Objective: The objective of the study was to evaluate and compare measurement properties of the MSK-HQ across Danish (DK) and English (UK) cohorts of patients from primary care physiotherapy services with musculoskeletal pain.
Methods: MSK-HQ was translated into Danish according to international guidelines. Measurement invariance was assessed by differential item functioning (DIF) analyses. Test-retest reliability, measurement error, responsiveness and minimal clinically important change (MCIC) were evaluated and compared between DK (n = 153) and UK (n = 166) cohorts.
Results: The Danish version demonstrated acceptable face and construct validity. Out of the 14 MSK-HQ items, three items showed DIF for language (pain/stiffness at night, understanding condition and confidence in managing symptoms) and three items showed DIF for pain location (walking, washing/dressing and physical activity levels). Intraclass Correlation Coefficients for test-retest were 0.86 (95% CI 0.81 to 0.91) for DK cohort and 0.77 (95% CI 0.49 to 0.90) for the UK cohort. The systematic measurement error was 1.6 and 3.9 points for the DK and UK cohorts respectively, with random measurement error being 8.6 and 9.9 points. Receiver operating characteristic (ROC) curves of the change scores against patients’ own judgment at 12 weeks exceeded 0.70 in both cohorts. Absolute and relative MCIC estimates were 8–10 points and 26% for the DK cohort and 6–8 points and 29% for the UK cohort.
Conclusions: The measurement properties of MSK-HQ were acceptable across countries, but seem more suited for group than individual level evaluation. Researchers and clinicians should be aware that some discrepancy exits and should take the observed measurement error into account when evaluating change in scores over time.
Since operational managers often monitor large numbers of wind turbines (WTs), they depend on a toolset to provide them with highly condensed information to identify and prioritize low performing WTs or schedule preventive maintenance measures. Power curves are a frequently used tool to assess the performance of WTs. The power curve health value (HV) used in this work is supposed to detect power curve anomalies since small deviations in the power curve are not easy to identify. It evaluates deviations in the linear region of power curves by performing a principal component analysis. To calculate the HV, the standard deviation in direction of the second principal component of a reference data set is compared to the standard deviation of a combined data set consisting of the reference data and data of the evaluated period. This article examines the applicability of this HV for different purposes as well as its sensitivities and provides a modified HV approach to make it more robust and suitable for heterogeneous data sets. The modified HV was tested based on ENGIE's open data wind farm and data of on- and offshore WTs from the WInD-Pool. It proved to detect anomalies in the linear region of the power curve in a reliable and sensitive manner and was also eligible to detect long term power curve degradation. Also, about 7 % of all corrective maintenance measures were preceded by high HVs with a median alarm horizon of three days. Overall, the HV proved to be a promising tool for various applications.
Thailand’s power system has been facing an energy transition due to the increasing amount of Renewable Energy (RE) integration, prosumers with self-consumption, and digitalization-based business models in a Local Energy Market (LEM). This paper introduces a decentralized business model and a possible trading platform for electricity trading in Thailand’s Micro-Grid to deal with the power system transformation. This approach is Hybrid P2P, a market structure in which sellers and buyers negotiate on energy exchanging by themselves called Fully P2P trading or through the algorithm on the market platform called Community-based trading. A combination of Auction Mechanism (AM), Bill Sharing (BS), and Traditional Mechanism (TM) is the decentralized price mechanism proposed for the Community-based trading. The approach is validated through a test case in which, during the daytime, the energy import and export of the community are significantly reduced when 75 consumers and 25 PV rooftop prosumers participate in this decentralized trading model. Furthermore, a comparison analysis confirms that the decentralized business model outperforms a centralized approach on community and individual levels.
This study introduced an automated long-term fermentation process for fungals grown in pellet form. The goal was to reduce the overgrowth of bioreactor internals and sensors while better rheological properties in the fermentation broth, such as oxygen transfer and mixing time, can be achieved. Because this could not be accomplished with continuous culture and fed-batch fermentation, repeated-batch fermentation was implemented with the help of additional bioreactor internals (“sporulation supports”). This should capture some biomass during fermentation. After harvesting the suspended biomass, intermediate cleaning was performed using a cleaning device. The biomass retained on the sporulation support went through the sporulation phase. The spores were subsequently used as inocula for the next batch. The reason for this approach was that the retained pellets could otherwise cause problems (e.g., overgrowth on sensors) in subsequent batches because the fungus would then show undesirable hyphal growth. Various sporulation supports were tested for sufficient biomass fixation to start the next batch. A reproducible spore concentration within the range of the requirements could be achieved by adjusting the sporulation support (design and construction material), and an intermediate cleaning adapted to this.
Irrigated paddy rice agriculture accounts for a major share of Asia Pacific’s total water withdrawal. Furthermore, climate change induced water scarcity in the Asia-Pacific region is projected to intensify in the near future. Therefore, methods to reduce water consumption through efficiency measures are needed to ensure the long-term (water) sustainability. The irrigation systems, subak of Karangasem, Indonesia, and the tameike of Kunisaki, Japan, are two examples of sustainable paddy rice irrigation. This research, through interviews and an extensive survey, comparatively assessed the socio-environmental sustainability of the two irrigation management systems with special reference to the intensity and nature of social capital, equity of water distribution, water demand, water footprint, and water quality, etc. The prevailing social capital paradigm of each system was also compared to its overall managerial outcomes to analyze how cooperative action contributes to sustainable irrigation management. Both systems show a comparable degree of sustainable irrigation management, ensuring an equitable use of water, and maintain relatively fair water quality due to the land-use practices adapted. However, the systems differ in water demand and water efficiency principally because of the differences in the irrigation management strategies: human and structural. These findings could help devise mechanisms for transitioning to sustainable irrigation management in the commercially-oriented paddy rice agricultural systems across the Asia-Pacific region.
Issues on climate change have been recognized as serious challenges for regional sustainable development both at a global and local level. Given the background that most of the artificial carbon emissions are resulted from the energy consumption sector and the energy is also the key element resource for economic development, this paper investigated the relationship between CO2 emission, fossil energy consumption, and economic growth in the period 1970–2008 of nine European countries, based on the approach of Granger Causality Test, followed by the risk analysis on impacts of CO2 reduction to local economic growth classified by the indicator of causality degree. The results show that there are various feedback causal relationships between carbon emission, energy consumption and economic growth, with both unidirectional and dual-directional Granger causality. The impact of reducing CO2 emission to economic growth varies between countries as well.
Integrated analysis on socio-economic metabolism could provide a basis for understanding and optimizing regional sustainability. The paper conducted socio-economic metabolism analysis by means of the emergy accounting method coupled with data envelopment analysis and decomposition analysis techniques to assess the sustainability of Qingyang city and its eight sub-region system, as well as to identify the major driving factors of performance change during 2000–2007, to serve as the basis for future policy scenarios. The results indicate that Qingyang greatly depended on non-renewable emergy flows and feedback (purchased) emergy flows, except the two sub-regions, named Huanxian and Huachi, which highly depended on renewable emergy flow. Zhenyuan, Huanxian and Qingcheng were identified as being relatively emergy efficient, and the other five sub-regions have potential to reduce natural resource inputs and waste output to achieve the goal of efficiency. The results of decomposition analysis show that the economic growth, as well as the increased emergy yield ratio and population not accompanied by a sufficient increase of resource utilization efficiency are the main drivers of the unsustainable economic model in Qingyang and call for polices to promote the efficiency of resource utilization and to optimize natural resource use.
This paper analyzed the characteristic of the tourism destination ecosystem from perspective of entropy in Dunhuang City. Given these circumstances, an evaluation index system that considers the potential of sustainable development was formed based on dissipative structure and entropy change for the tourism destination ecosystem. The sustainable development potential evaluation model for tourism destination ecosystem was built up based on information entropy. Then, we analyzed each indicator impact for the sustainable development potential and proposed some measures for the tourism destination ecosystem. The conclusions include: (a) the requirements of Dunhuang tourism destination ecosystem on the natural ecosystem continuously grew between 2000 and 2012; (b) The sustainable development potential of the Dunhuang tourism destination ecosystem was on an oscillation upward trend during the study period, which is dependent on government attention, and pollution problems were improved.
With less than 6% of total global water resources but one fifth of the global population, China is facing serious challenges for its water resources management, particularly in rural areas due to the long-standing urban-rural dualistic structure and the economic-centralized developmental policies. This paper addresses the key water crises in rural China including potable water supply, wastewater treatment and disposal, water for agricultural purposes, and environmental concerns, and then analyzes the administrative system on water resources from the perspective of characteristics of the current administrative system and regulations; finally, synthetic approaches to solve water problems in rural China are proposed with regard to institutional reform, regulation revision, economic instruments, technology innovation and capacity-building. These recommendations provide valuable insights to water managers in rural China so that they can identify the most appropriate pathways for optimizing their water resources, reducing the total wastewater discharge and improving their water-related ecosystem.