In this study, a motion control problem for the vessels towed by tugboats or towing ships on the sea is considered. The towed vessels including barge ships are need to have assistance of tugboats. Combining two vessels, some work purposes in the sea or harbor area can be completed. In this study, the authors give newly developed mathematical model and control system strategy. Especially, the system model fully presenting the physical characteristics of two vessels are derived. For controlling the system effectively, it is considered that the towed vessel has no power propulsion system but the rudder is activated to improve the maneuverability. Considering the strong nonlinearities included in the vessel dynamics, the modelled system is presented by nonlinear system without linearization of nonlinear parameters. Thus, the control system for the towed vessel is designed based on the nonlinear control scheme. Exactly, the back-stepping control method is applied to its motion control. Also, the PID control method is applied for comparing with the proposed control strategy.

This paper focuses on the integrated guidance and autopilot design with control input saturation in the end-game phase of hypersonic flight. Firstly, uncertain nonlinear integrated guidance and autopilot model is developed with third actuator dynamics, where the control surface deflection has magnitude constraint. Secondly, neural network is implemented in extended state observer (ESO) design, which is used to estimate the complex model uncertainty, nonlinearity and state coupling. Thirdly, a command filtered back-stepping controller is designed with hybrid sliding surfaces to improve the terminal performance. In the process, different command filters are implemented to avoid the influences of disturbances and repetitive derivation, meanwhile solve the problem of unknown control direction caused by saturation. The stability of closed-loop system is proved by Lyapunov theory, and the principles abided by the controller parameters are concluded through the proof. Finally, series of 6-DOF numerical simulations are presented to show the feasibility and validity of the proposed controller.

In airborne sensor networks (ASNs), the media access control (MAC) protocol is facing with serious unfairness problem due to the traditional protection mechanism of air-to-air communications among aircrafts. Actually by using the binary exponential back-off algorithm at high traffic loads to minimize collisions among users, the latest successful node can always benefit from this kind of MAC to obtain channel resources. Moreover, when taking the existence of the hidden nodes in ASNs into account, the inaccurate traffic load information will further aggravate the system’s unfairness. In this paper, a neighbor-channel-aware (NCA) protocol is proposed to improve the fairness of MAC protocol in ASNs. In the proposal, the NCA frame is firstly added and exchanged between neighbor nodes periodically, which helps to resolve the inaccurate traffic load information, so as to avoid reducing the probability of successful message transmission. Then a traffic-loading based back-off algorithm is involved to make the neighbor nodes cooperatively adjust the inter-frame space (IFS) interval to further reduce the unfairness. The simulation results show that, the proposed MAC protocol can guarantee the satisfied fairness, simultaneously avoiding heavy network overloads to protect key messages’ successful transmissions in ASNs.

Simulator training for image-guided surgical interventions may benefit from artificial intelligence systems that control the evolution of task skills in terms of time and precision of a trainee's performance on the basis of fully automatic feed-back systems. At the earliest stages of training, novice trainees frequently focus on getting faster at the task, and may thereby compromise the optimal evolution of the precision of their performance. For automatically guiding them towards attaining an optimal speed-accuracy trade-off, an effective control system for the reinforcement/correction of strategies must be able to exploit the right individual performance criteria in the right way, reliably detect individual performance trends at any given moment in time, and alert the trainee, as early as necessary, when to slow down and focus on precision, or when to focus on getting faster. This article addresses several aspects of this challenge for speed-accuracy controlled simulator training before any training on specific surgical tasks or clinical models should be envisaged. Analyses of individual learning curves from the simulator training sessions of novices and benchmark performance data of one expert surgeon, who had no specific training in the simulator task, validate the suggested approach.

Today’s intruders usually send attacking commands to a target system through several stepping-stone hosts, in order to reduce the chance of being detected. With stepping-stone intrusion (SSI), the intruder’s identity is hidden behind a long interactive chain of hosts and very hard to detect. An effective approach for SSI detection (SSID) is to estimate the length of the chain. This type of method is called network-based SSID. Most existing network-based SSID worked effectively only when intruders’ session manipulation was not present. These known SSID algorithms are either weak to resist intruders’ chaff-perturbation manipulation or having very limited capability in resisting attacker’s session manipulation. This paper develops a novel network-based SSID algorithm resistant to intruders’ chaff-perturbation by using packet crossover. Our proposed SSID algorithm is simple and easy to implement as the number of packet crossovers can be easily computed. We conduct rigorous technical proofs to verify the correctness of our proposed algorithm. The experimental results show that our proposed SSID algorithm works effectively and perfectly in resisting intruders’ chaff-perturbation up to 50% chaff rate.

It is well known that low back pain (LBP) prevalence is high during the course of school age children’s lives. However, literature concerning the initial onset of back pain between ages of 3 and 11 years remains scarce. The present study aimed to analyze the prevalence of LBP in kindergarten and primary school students. 278 (9.9±2.1 years old; 52.2% girls) students from two public kindergarten and primary schools in Valencia, Spain participated in this cross-sectional study. The Nordic questionnaire on LBP was used to ask questions related to the duration of LBP symptoms over time. The lifetime prevalence of LBP was 47.5% (n = 132), a last year prevalence of 44.2% (n = 123), and a last week prevalence of 18.8% (n = 50) was reported. Boys and girls reached lifetime prevalence of 52.3% (n = 64) and 47.7% (n = 82) (χ2 = 1.978, p = .099), respectively. By age group, lifetime episodes of LBP also showed a higher prevalence with increasing age (χ2 = 32.637; p < .001). In summary, our findings suggest that LBP increases with age. In addition, our results further strengthen the evidence that LBP onset could start as young as 10-years-old.

Background: The thoracolumbar fascia (TLF) is thought to play a role in the development of LBP, but it is not yet clear which factor of TLF changes is a cause and which is an effect. Therefore, some studies used the cross-correlation function (CCR) to reveal time-dependent relationships between biomechanical and neuromotor factors. Methods: Ten patients with acute low back pain (aLBP) were matched to healthy controls. Simultaneous recording of surface electromyography (sEMG) of the erector spinae muscle (ES) and dynamic ultrasound (US) images of TLF deformation were performed during trunk extension. CCR functions and Granger causality were used to describe the relationship between the two measures. Results: CCR time lags were significant higher in the aLBP group (p = 0.04). Granger causality (GC) showed a direct effect of TLF deformation on ES activation only in the aLBP group (p < 0.03). Conclusions: The results suggest that in aLBP, ES activity is significantly affected by TLF, whereas this relation-ship is completely random in healthy subjects studied with CCR and GC comparisons of dynamic US imaging and sEMG data signals. Fascia-related disturbances in neuromotor control, particularly due to altered muscle spindle functions, are suspected as a possible mechanism behind this.

We present a simplified computational rule for the back-propagation formulas for artificial neural networks. In this work, we provide a generic two-step rule for the back-propagation algorithm in matrix notation. Moreover, this rule incorporates both the forward and backward phases of the computations involved in the learning process. Specifically, this recursively computing rule permits the propagation of the changes to all synaptic weights in the network, layer by layer, efficiently. In particular, we use this rule to compute both the up and down partial derivatives of the cost function of all the connections feeding into the output layer.

Back pain is a common symptom that affects all age groups across the globe, when left untreated may eventually lead to disability. A convenient sample selection method was used in this study due to the global Covid-19 pandemic lockdown which was effective in Turkey during the investigation period. Thus, virtual data collection and health education including some health risks were employed. A total population of two hundred adult women was involved in the study but one hundred and twenty-one responses were collected. Findings show that, for socio-demographic characteristics, the pain was found highest in women between the ages of 41-50 and obese/overweight individuals. Although, there was no significant difference recorded in the marital status category. Moreover, statistical mean differences were detected between the scales for ODI (4.18) and BPFS (6.09). Also, p<0.05, paired sample t-test was 0.001 ODI and 0.001 BPFS after the training exercise. This suggests that exercise training is inversely correlated with pain severity which implies that training has a significant influence on pain intensity. Thus, it could be concluded that there is a relationship between the training exercise and ODI/BPFS.

Low back pain is a common problem in the active population, and the second reason for visiting a physician. In patients with lumbar disc protrusion, the nucleus pulposus bulges against the disc and the latter protrudes into the spinal column, but the annulus fibrosus remains intact. The purpose of this study was to prove that starting an early complex rehabilitation treatment results into pain and disability reduction, and increased muscle strength and mobility in patients with lumbar disc protrusions. We performed a prospective cohort study, enrolling 60 patients (25 men and 35 women) aged between 26 to 76 years, diagnosed with lumbar disc protrusion. Patients in the experimental group registered significant improvements in all studied variables (pain, mobility, muscle strength, disability) after 6 months of treatment. The results of our study suggest that, in the lumbar disc disease, a combined rehabilitation program may be more effective in terms of pain and disability reduction, if it starts early after diagnosis. The current study proves the importance of combining electrotherapy with hydrotherapy and physical therapy. Patients who received this treatment combination showed an extremely significant improvement in pain relief, and reduction of functional disability after 6 months of treatment.

Background and objective. Globally, disposing of unused medicines has become a source of concern, as pharmaceutical waste enters the ecosystem, posing a threat to human health and the environment. This study aimed to assess the disposal practice of unused medication among pharmacists in Libya. This study also seeks to determine if pharmacists plan to have their pharmacies serve as assembly points for potential take-back initiatives. Methods. A random sample of 150 pharmacists from various government and private pharmacies in Tripoli participated in a self-administered questionnaire about their disposal practices, and knowledge on pharmacies serving as collection points for ideal disposal of unused medicines. Descriptive statistics were used to interpret the data. Results. A total of 128 pharmacists completed the survey. The majority of respondents said that throwing discarded drugs in the trash bin was their preferred method of disposal (53.1%), followed by discarding via burn and drug wholesalers (17.2%, 14.8%, respectively). Only 2.1% of the respondents disposed unused medicines according to the WHO guidelines of drug disposal. Moreover, about 65.6% had poor knowledge about Take-Back program. Conclusion. Failure to follow the WHO guidelines for drug disposal raises the risk of contamination of our environment and the likelihood of humans and animals ingesting harmful pharmaceutical wastes.

(1) Background: Although manual therapy for pain relief has been used as an adjunct in treatments for chronic low back pain (CLBP), there is still the belief that a single session of myofascial release would be effective. This study aimed to investigate whether a single session of a specific technique reduces pain and disability. (2) Methods: This was a crossover clinical trial in which 41 participants over 18 years old with CLBP were randomly enrolled into 3 situations - experimental, placebo, control, in a balanced and cross-over manner. The subjects underwent a single session of myofascial release on thoracolumbar fascia and compare it with the control and placebo. Outcome were pain and functionality, evaluated using the numerical pain rating scale (NPRS), pressure pain threshold (PPT) and Oswestry (ODI). (3) Results: There was no effects between-, within-tests, and interaction for all the outcomes, i.e., NPRS (η 2 = 0.32, F = 0.48, p = 0.61), PPT (η2 = 0.73, F = 2.80, p = 0.06), ODI (η 2 = 0.02, F = 0.02, p = 0.97). (4) Conclusion: A single trial of thoracolumbar myofascial release technique was not enough to reduce pain and disability in subjects with CLBP.

South America has become the new epicenter of the coronavirus, especially in Brazil where the disease continues to spread exponentially across the country. This text aims to analyze the psychosocial factors of Covid-19 on back to school strategies in Brazil from a bioecological perspective. At the microsystem level, the population is experiencing different levels of stress and fear; at the mesosystem level, changes in routines, separation from family and friends, and closure of schools; and at the macrosystem level, national guidelines to control the pandemic, institutional standards on a national and international scale. Therefore, the main focus for the success of school return must be in the prevention of contagion and with physical and psychological health, and should not only consider the demands of curricula, financial or administrative management. For this reason, it is paramount that greater female representativeness is increased in decision-making levels of the meso and macrosystem, regarding the resumption of school and academic activities in the pandemic period, since the number of female leaders in decision-making, is still insufficient.

Development of rovers and development of infrastructure which enables them to probe other planets (such as Mars) have sparked a lot of interest recently specially with increasing public attention in Moon and Mars program by National Aeronautics and Space Administration. This is designed to be achieved by various means such as advanced spectroscopy and artificial intelligent techniques such as deep learning and transfer learning to enable the rover to not only map the surface of planet but to get a detailed information about its chemical makeup in layers beneath (deep learning) and in areas around point of observation (transfer learning). In this work, which is part of a proposal, later approach is explored. A systematic strategy is presented which make use of aforementioned techniques developed for metallic glass matrix composites as benchmark and helps develop algorithms for chemistry mapping of actual Martian surface on Perseverance Rover launching shortly.

Monochromatic documents claim for much less computer bandwidth for network transmission and storage space than their color or even grayscale equivalent. The binarization of historical documents is far more complex than recent ones as paper aging, color, texture, translucidity, stains, back-to-front interference, kind and color of ink used in handwritting, printing process, digitalization process, etc. are some of the factors that affect binarization. This article presents a new binarization algorithm for historical documents. The new global filter proposed is performed in four steps: filtering the image using a bilateral filter, splitting image into the RGB components, decision-making for each RGB channel based on an adaptive binarization method inspired by Otsu's method with a choice of the threshold level, and classification of the binarized images to decide which of the RGB components best preserved the document information in the foreground. The quantitative and qualitative assessment made with 21 binarization algorithms in three sets of “real world” documents showed very good results.

Background. The purpose of the study was to evaluate the intensity and frequency of low back pain (LBP) in people with multiple sclerosis (PwMS) and the patient's knowledge of physiotherapeutic methods of combating. Methods. In this study, patients with confirmed multiple sclerosis were selected. The study was carried out using an original survey questionnaire and a numerical pain intensity scale (Visual Analogue Scale). PwMS were divided into 3 age groups: 18-30 years, 31-50 years, and over 50 years. Results. Ninety PwMS (68 women and 22 men) aged 18 to 60 years were included in the study. The mean duration of the disease was 9.5±4.9 years, and the mean EDSS was 3.5±1.6. Most of the patients had a relapse-remitting form. 68.9% of PwMS felt lower back pain (n = 62). The relationship tested was statistically significant (p=0.0000012), and the strength of the relationship was high (rc=0.695). The average level of low back pain among PwMS was 4.7 out of 10 on the VAS scale. The prevalence of LBP was higher in female patients (p<0.001), with a secondary progressive form (p<0.001) and with a longer duration of the disease (p=0.023). The most widely used methods of LBP therapy were kinesitherapy and manual therapy. Conclusions. LBP is common in multiple sclerosis. A female sex, a secondary progressive form of MS, and a longer duration of the disease increased the risk of LBP. It is important to implement properly planned physiotherapy activities and educate patients on how to combat LBP.

The texture properties of cooked rice are a dominant property which can indicate the eating quality. Evaluation of back extrusion (BE) test precision and sensitivity for cooked germinated brown rice (GBR) texture in production process was investigated in this study. BE test on texture properties of cooked GBR rice show high precision of measurement of hardness, toughness and stickiness tests which indicated by the repeatability and reproductivity test but the sensitivity indicated by coefficient of variation of the texture properties. The findings of the study of the effect of different soaking and aging duration in the production of Khao Dawk Mali 105 (KDML 105) GBR on cooked GBR texture measured by BE test confirmed the developed protocol for evaluation of high precision and sensitivity of the texture measurement method. Repeatability and reproducibility of reliable measurements have a low standard deviation of the farthest different between replicates, which is considered high precision. High coefficient of variation where the relative wide variation of the absolute value of the property can be detected indicate high sensitivity which even small resolution can be detected or vice versa. But the correlation coefficient among the texture properties by BE were not related to the precision or sensitivity of the test. By these results, the original protocol for determination of precision and sensitivity of food texture measurement was successfully verified as the usable evaluation protocol for GBR texture measurement.

Low back pain (LBP) is a health problem that affects 70-80% of the population in Western countries. Because of the biomechanical relationship between the lumbar region and the hip, it is thought that strengthening the muscles of this joint could improve the symptoms of people with LBP. The objective of the study is to evaluate the current evidence on the efficacy of hip strengthening exercises to reduce pain and disability in people with LBP. Clinical trials were collected from PubMed, PEDro, and Scopus databases published up to September 2022. Based on Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and using CASpe and PEDro tools for methodological quality assessment, we selected studies that included hip strengthening exercises as part of LBP treatment and measured pain and/or disability parameters. Among the 966 records identified in the search, a total of 7 studies met the established selection criteria. Overall, participants who performed hip strengthening exercises had significantly improved in pain and disability. The methodological quality of the included studies was assessed as “good”. In conclusion, the addition of hip muscle strengthening exercises iterating LBP effectively improving pain and disability.

Bounce Back Loan is amongst a number of UK business financial support schemes launched by UK Government in 2020 amidst pandemic lockdown. Through these schemes, struggling businesses are provided financial support to weather economic slowdown from pandemic lockdown. £43.5bn loan value has been provided as of 17^th Dec2020. However, with no major checks for granting these loans and looming prospect of loan losses from write-offs from failed businesses and fraud, this paper theorizes prospect of applying spatiotemporal modelling technique to explore if geospatial patterns and temporal analysis could aid design of loan grant criteria for schemes. Application of Clustering and Visual Analytics framework to business demographics, survival rate and Sector concentration shows Inner and Outer London spatial patterns which historic business failures and reversal of the patterns under COVID-19 implying sector influence on spatial clusters. Combination of unsupervised clustering technique with multinomial logistic regression modelling on research datasets complimented by additional datasets on other support schemes, business structure and financial crime, is recommended for modelling business vulnerability to certain types of financial market or economic condition. The limitations of clustering technique for high dimensional is discussed along with relevance of an applicable model for continuing the research through next steps

The aim of this study was to analyze the level of specific back-health-related physical activity and exercise knowledge. This is a cross-sectional study. A representative sample of 1500 students were recruited with a confidence level of 95% and an accepted standard error of ±2.53%. Individuals were aged between 13 and 18 years old (mean age= 15.18; SD = ±1.446). Self-reported questionnaires were used to record back-health-related physical activity and exercise knowledge concerning back care in adolescents. The level of specific knowledge of back health education related to physical activity and exercise in adolescents was low (X = 2.05, SD = ±2.264). Only 10.9% of the students passed the specific knowledge test, achieving a grade equal or superior to 5. The boys average score was higher (X = 2.17, SD = ±2.312) than the girls (X = 1.94, SD = ±2.212) with statistically significant differences (p = .048). The level of specific knowledge increased with age (F = 11.531; p &lt; .001). High school students have a low level of specific knowledge. Physical Education teachers should apply the conceptual content properly. Knowledge is the first step towards changing behavioral habits. Back care education in the school curriculum is recommended.

The purpose of the present study was to examine the relationships between bat swing speed (BSS) and muscle thickness and lateral asymmetry of the trunk and limbs in collegiate baseball players. Twenty-four collegiate baseball players participated in this study. The maximum BSS in hitting a teed ball was measured using a motion capture system. The muscle thicknesses of the trunk (upper abdominal rectus, central abdominal rectus, lower abdominal rectus, abdominal wall, and multifidus lumborum), upper limb, and lower limb were measured using a B-mode ultrasonography. Lateral asymmetry between each pair of muscles was determined as the ratio of the thickness of the dominant side to that of the non-dominant side. Significant positive correlations were observed between BSS and muscle thicknesses of the abdominal wall and multifidus lumborum on the dominant side (r = 0.426 and 0.431, respectively; p < 0.05), while nearly significant positive correlations were observed between BSS and muscle thicknesses on the non-dominant side. No significant correlations were found between BSS and lateral asymmetry of all muscles. These findings indicate the importance of the trunk muscles for bat swing, and the lack of association between BSS and lateral asymmetry of muscle size.

In this paper, the active front-end (AFE) converter topology for the total harmonic distortion (THD) reduction in a wind energy system (WES) is used. A higher THD results in serious pulsations in the wind turbine (WT) output power and in several power losses at the WES. The AFE converter topology improves capability, efficiency and reliability in the energy conversion devices; by modifying a conventional back-to-back converter, from using a single voltage source converter (VSC) to use pVSC connected in parallel the AFE converter is generated. The THD reduction is done by applying a different phase shift angle at the carrier of digital sinusoidal pulse width modulation (DSPWM) switching signals of each VSC. To verify the functionality of the proposed methodology, the WES simulation in Matlab-Simulink® is analyzed, and the experimental laboratory tests using the concept of rapid control prototyping and the real-time simulator Opal-RT® Technologies is achieved. The obtained results show a type-4 WT with total output power of 6MVA, generating a THD reduction up to 5.5 times at the WES.

Background: Spinal pain is highly prevalent and in Spain it produces a very high economic cost and the scientific evidence supporting treatments shows low to moderate evidence for exercise. Therefore, the aim of this study was to assess the effectiveness of a therapeutic group exercise protocol in reducing pain intensity and disability in patients with spinal pain in primary health care setting. Methods: A total sample of 149 patients who suffered from chronic non-specific spinal pain. Patients received a therapeutic exercise protocol, including exercises of auto-mobilization of the neck and lumbar regions, as well as core stabilization exercises. Pain intensity and disability were evaluated before and after the therapeutic exercise protocol. Results: Statistically significant differences (P&lt;0.05) were shown for pain intensity and disability of patients with neck and low back pain with an effect size from moderate to large. Conclusions: A therapeutic exercise protocol may provide beneficial effects on disability and pain intensity in patients with chronic non-specific spinal pain, including neck and low back pain conditions. Clinicians should consider the use of self-administered exercise protocols, demonstrate great effectiveness, and be less costly.

Background and Objectives: The relevance of red flags in serious spinal pathology (SSP) evolved throughout the last years. Recently, new considerations have been proposed to expand the consideration of red flags. The purpose of this study was to determine, approve and test a model for the triage and manage-ment process of SSP based on the latest data available in the literature. Materials and Methods: The SSP model was initially built on the basis of a literature re-view. The model was further determined and approved by an expert panel us-ing a Delphi process. Finally, clinical scenario were used to test the applicabil-ity of the model. Results: After three rounds of Delphi process, panellists reached a consensus on a final version of the model. The use of clinical scenari-os by experts bring about reflexive elements both on the determined model and on the evocative SSP of the clinical cases. Conclusions: The validation of the model and its implementation in the clinical field could help assess the skills of first-line practitioners managing spinal painful patients. To this end, the devel-opment of additional clinical scenarios fitting with the determined model should be further considered.

A multicenter, prospective cohort study conducted in 5 physiotherapy clinics in the UAE from January 2021 to March 2023 to assess coronal lumbar spine radiographic parameters as a predictor of conservative therapy outcomes in patients suffering from low back and leg pain due to lumbar disc herniation (HNP). Ninety patients (mean age 44 yrs., 54% male) with lumbar HNP underwent conservative therapy. All participants received lumbar spine MRI and radiography to assess spine alignment. Interventions included specific exercises, diathermy, traction, education, a home-based exercise pro-gram, and medications. Detailed demographic data was collected. Follow-up was 6-months after discharge. A successful outcome was based on a minimum of the following four outcomes: (1) reduction of pain by 17.5 points (0–100 NRS); (2) fatigue reduction by 7.5 points; (3) distress reduction by 5 points; and (4) interference reduction by 9.5 points. At 6-month follow-up it was found that patient age, education, and radio-graphic determined lumbosacral angle measures significantly affected the odds of a successful outcome. Increasing age 1-year significantly decreased the odds of success of improving pain, fatigue (OR = 0.85, p = 0.016) and interference scores (OR = 0.89, p = 0.042) by 15%, 15%, and 11% respectively. Lower education significantly increased the odds of success for improving pain, fatigue, and interference by 26.18, 26.18, and 7.5 (p = 0.006, = 0.006, and = 0.029 respectively). Increasing (worsening) the radiographic lumbosacral angle by each 1° significantly reduced the odds of success for improving pain, fatigue, distress, and interference by 3.52, 3.52, 27.99, and 2.55, respectively (p < 0.001, < 0.001, = 0.003, = 0.001). Our findings indicate that younger age, less education, and better coronal radiological lumbar spine alignment all had a substantial impact on the likelihood of success of 6-month outcomes in patients suffering from chronic lower back pain and radiculopathy due to HNP.

Low back pain (LBP) is a common musculoskeletal complaint that can impede physical function and mobility. Current management often involves pain medication, but there is a need for non-pharmacological and non-invasive interventions. Soft tissue manipulation (STM) such as massage has been shown to be effective in human subjects, but the molecular mechanisms underlying these findings are not well understood. In this paper, we evaluated potential changes in soft tissue levels of more than thirty pro- or anti-inflammatory cytokines following instrument-assisted STM (IASTM) in rats with chronic, induced LBP using Complete Freund’s Adjuvant. Our results indicate that IASTM is associated with reduced soft tissue levels of RANTES/CCL5 and increased soft tissue levels of IL-4, which are pro-inflammatory and anti-inflammatory factors, respectively, by 120 minutes post-treatment. IASTM was not associated with tissue-level changes in CXCL5/LIX (the murine homologue of IL-8), CXCL7, GM-CSF ICAM-1, IL1-ra, IL-6, IP-10/CXCL10, L-selectin, TNF-α, or VEGF at either 30- or 120 minutes post-treatment. Combined, our findings suggest that IASTM exerts tissue-level effects that are associated with improved clinical outcomes and potentially beneficial changes in pro/anti-inflammatory cytokines in circulation and at the tissue level.

As traditional supply chains face increasingly severe environmental issues and countries promote green development and sustainable development policy concepts, cultivating green supply chain operation models is gradually being highly valued by current governments and enterprises. Generally speaking, the production of green products incurs higher additional costs and thus their total production costs also increase. In this work, the product green level is related to the random demand. Under the green supply chain buy-back contract with the green product R&amp;D cost sharing between the manufacturer and the retailer, both the product green level and the order quantity need to be decided to maximize the channel profit. In order to coordinate the green supply chain, the manufacturer needs to share both the risk of good salvage and the green product R&amp;D cost with the retailer. We find that both the wholesale price and buy-back price increase in the manufacturer’s proposition of the green product R&amp;D cost, but decrease in emission reduction efficiency coefficient or carbon trading price. In addition, the product green level, the optimal order quantity and the channel profit increase in emission reduction efficiency coefficient, but decrease in the R&amp;D cost coefficient of the product green level. Interestingly, we find that if the carbon trading price is low, the manufacturer will set a low product green level and the product carbon emission trading is a cost for the supply chain. The increment of the carbon trading price leads to a higher cost such that the channel profit is decreased. However, if the carbon trading price is high, the manufacturer will set a high product green level and the product carbon emission trading is a revenue for the supply chain. The increment of the carbon trading price leads to a higher revenue such that the channel profit is increased.

Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient’s quality of life, limits their daily living activities, and reduces work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of heat therapy in the management of LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LB)P, and finally review the published evidence regarding the impact of heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is still relevant in modern clinical practice.

The prevalence of back pain (BP) among children and adolescents has increased over recent years. Some authors advocate promoting back-health education in the school setting. It is therefore important to adopt a uniform suite of assessment instruments to measure the various constructs. The present study aimed to perform a cultural adaptation of a validated measurement instrument (BackPEI), beginning with a translation and cultural adaptation phase, followed by a second phase to test reliability using a test-retest design. The translation and cross-cultural adaptation were performed based on the guidelines. Reliability was tested by applying the questionnaire to 224 secondary school students, at two different times with a 7-day interval between the tests. In general, the Spanish version presented adequate agreement for questions 1–20, with only question 9 achieving a low Kappa range of .312 [-.152- .189]. The question about pain intensity did not show differences between the averages for the test (4.72 ± 2.33) and re-test (4.58 ± 2.37) (p = .333), and the responses for these two tests were highly correlated (ICC= .951 [.928- .966]; p= .0001). Psychometric testing indicated that the Spanish version of the BackPEI is well-adapted and reliable, based on the test-retest design, providing similar results to the original Brazilian version.

Lower Back Pain (LBP) is a disease that needs immediate attention. Person with back pain shall go immediately to doctor for treatment. Injury, excessive works and some medical conditions are result of back pain. Back pain is common to any age of human for different reasons. Due to factors such as previous occupation and degenerative disk disease the chance of developing lower back pain increases for older people. It hampers the working condition of people common reason for seeking medical treatment. The result is absence from work and is unable to normal due to pain. It creates uncomfortable and debilitating situations. Hence, detecting this disease at an early stage will assist the medical field experts to suggest counter measures to the patients. Detection of lower back pain is implemented in this paper by applying ensemble machine learning technique. This paper proposes Stacking ensemble classifier as an automated tool that will predict lower back pain tendency of a patient. Experimental result implies that the proposed method reaches an accuracy of 76.34%, f1-score of 0.76 and MSE of 0.34.

Lower back musculoskeletal disorders (MSD) are an important public health problem and the leading cause of disability worldwide, but with prevalence yet unknown among shellfish gatherers. To investigate the prevalence and work-related factors associated with lower back MSD in a population of female shellfish gatherers, an epidemiological cross-sectional study was carried out in Saubara, Bahia – Brazil, in 2013. The Brazilian version of the Job Content Questionnaire (JCQ) and the Nordic Musculoskeletal Questionnaire (NMQ), in addition to a questionnaire containing the physical demands adapted to the artisanal work, were applied to a random sample of 209 female shellfish gatherers. The prevalence of lower back MSD was 72.7%. Using multivariate logistic regression, the shellfish gatherers who had worked for more than 26 years in the activity showed a prevalence of 1.22 (95% CI: 1.04-1.44) times higher compared to those unexposed. Lower back MSD was 1.24 (95%CI: 1.08-1.42) times higher among those more exposed to work sitting with trunk flexion. Those performed manual handling and muscle force with the arms had a prevalence ratio of 1.18 (95%CI: 1.01-1.39). These results show the need for greater awareness of health and social welfare factors impacting workers in small-scale fisheries and will promote the elaboration of health care policies for this occupational class.

Low Back Pain (LBP) is one of the most common problems among adults. The usual physiotherapy treatment is to perform physical exercises. However, some LBP patients have false beliefs regarding their pain and they tend to avoid physical movements which might increase their pain and disability. Virtual Reality (VR) has shown to be an effective intervention in improving motor functions and reducing pain perception. Existing VR interventions for LBP rehabilitation were based on a non-immersive VR, whereas to effectively reduce the pain intensity, we need an immersive VR. In this paper, we introduce the development and evaluation of a serious game called RabbitRun with an immersive experience to engage the patients in a virtual environment and distract them from the pain while performing LBP exercises. The initial usability evaluation results suggest that RabbitRun game is enjoyable and acceptable. The game is easy to play and learn and most of the participants are willing to play the game at home. This solution will enhance the rehabilitation outcome since the patients who are suffering from LBP can use the system at their home and train more for long period of time using a smartphone and low-cost virtual reality device such as Google Cardboard.

In this work, we present some results related with the issue of the Loop Quantum Black Holes (LQBH) thermodynamics by the use of the tunneling radiation formalism. The information loss paradox is also discussed in this context, where we have considered the influence of back reaction effects.

Road intersections are made of asphalt pavement, a popular road surface material used worldwide. The pavement may suffer deformities and deterioration, resulting in higher maintenance expenses and an elevated likelihood of road accidents, due to factors such as heavy vehicles and environmental variables like temperature and rainfall. To tackle these obstacles, researchers have devised several machine-learning algorithms and optimization techniques. These tools aim to forecast and scrutinize pavement deformation, with the goal of refining pavement design and maintenance approaches, as well as obtaining a more comprehensive comprehension of the factors that impact pavement effectiveness. This paper shows that heavy vehicles contribute significantly more to road erosion, and the retention and braking of vehicles greatly impact roadways. We also emphasize the statistical errors computed on the actual data range and demonstrate the results of the multilayer perceptron (MLP) model. The MLP model used the lath erosion standard to simulate future impact. Even though the model given is based on a small sample of data from one intersection, its estimates for road erosion in a year were found to be accurate when contrasted to real data. Controlling traffic flow can significantly improve road conditions, reducing erosion decay by reducing the time spent at intersections and other parameters. We conclude that machine learning can help control traffic flow, which can significantly improve road conditions, reducing vehicle time stretches at intersections.

The core of eLoran ground-based timing navigation system is the accurate measurement of groundwave propagation delay. However, meteorological changes will disturb the conductive characteristic factors along the groundwave propagation path, especially for complex terrestrial propagation environment, and may even lead to microsecond-level propagation delay fluctuation, seriously affecting the timing accuracy of the system. Aiming at this problem, this paper proposes a propagation delay prediction model based on Back-Propagation neural network (BPNN) for complex meteorological environment, which realizes the function of directly mapping propaga-tion delay fluctuation through meteorological factors. Firstly, the theoretical influence of meteoro-logical factors on each component of propagation delay is analyzed based on calculation parame-ters. Then, through the correlation analysis of the measured data, the complex relationship be-tween the seven main meteorological factors and the propagation delay, as well as their regional differences are demonstrated. Finally, a BPNN prediction model considering regional changes of multiple meteorological factors is proposed, and the validity of the model is verified by long-term collected data. Experimental results show that the proposed model can effectively predict the propagation delay fluctuation in the next few days, and its overall performance is significantly improved compared with the existing linear model and simple neural network model. eLoran; meteorological factor; propagation delay prediction model; Back-Propagation neural network;

Central nervous system (CNS) uses vision, vestibular, and somatosensory information to maintain body stability. Research has shown that there is more lumbar proprioception error among low back pain (LBP) individuals as compared to healthy people. In this study, two groups of 20 healthy people and 20 non-specific low back pain participants (LBP) took part in this investigation. This investigation focused on somatosensory sensors and in order to alter proprioception, a vibrator (frequency of 70Hz, amplitude of 0.5 mm) was placed on the soleus muscle area of each leg and two vibrators were placed bilaterally across the lower back muscles. Individuals, whose vision was occluded, were placed on two surfaces (foam and rigid) on force plate, and trunk angles were recorded simultaneously. Tests were performed in 8 separate trials; the independent variables were vibration (4 levels) and surface (2 levels) for within subjects and 2 groups (healthy and LBP) for between subjects (4×2×2). MANOVA and multi-factor ANOVA tests were done. Linear parameters for center of pressure (COP) (deviation of amplitude, deviation of velocity, phase plane portrait (PPP), and overall mean velocity) and nonlinear parameters for COP and trunk angle ((recurrence quantification analysis) RQA and Lyapunov exponents) were chosen as dependent variables. Results indicated that NSLBP individuals relied more on ankle proprioception for postural stability. Similarly, RQA parameters for the COP on both sides and for the trunk sagittal angle indicated more repeated patterns of movement among the LBP cohort. Analysis of short and long Lyapunov exponents showed that people with LBP caused no use of all joints in their bodies (non-flexible), are less stable than healthy subjects.

Consideration of climate change in Environmental Impact Assessment (EIA) is a rather novel topic, which became partly mandatory through the revised EU Directive on EIA. Through a mixed-methods approach involving key-actors from EIA practice, decision making and climate adaptation planning, this study presents a transdisciplinary point of view on barriers and opportunities to tackle climate change adaptation in environmental assessment of large-scale projects. It is based on both a retrospective ex-post evaluation of existing practices in Austria and Germany as well as prescriptive examination and development of outcomes for practice through the development of a climate-fit toolkit that supports the incorporation of climate change impacts into EIAs. The scenario analysis applied with a back casting approach provided the opportunity to look beyond limitations related to legal compliance and partly lack of data identified by previous research. Three scenario narratives were elaborated based on nine key impact factors based on literature review, content analysis of EIA documents and interviews with EIA actors. The groups of actors carried out a prioritization of actions towards consideration of climate change in EIA. Finally, the actors were involved in co-production of an online tool-kit for Austrian and German EIA practice.

Abstract: This study evaluates the effect of paravertebral spinal injection (PSI), utilizing both subjective and objective assessments in chronic low back pain (LBP) associated with facet joint arthrosis over a one-month duration. Subjective questionnaires included the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index, Health Survey SF-12, and the short Falls Efficacy Scale International (FES-I). Objective assessments included in-clinic gait and timed-up-and-go (TUG) tests using wearable sensors, as well as 48-hour daily physical activity (DPA) monitored using a chest-worn tri-axial accelerometer. Subjective and objective measures were performed prior to treatment, immediately after the treatment, and one-month afterthe treatment. Eight LBP patients were recruited for this study (mean age = 54±13 years, body mass index = 31.41±6.52 kg/m2, 50% males). Results show significant decrease in pain (~55%, p<0.05) and disability (Oswestry scores, ~21%, p<0.05). In-clinic gait and TUG were also significantly improved (~16% and ~18% faster walking and shorter TUG, p<0.05); however, DPA (including percentage of physical activities (walking and standing) and the number of steps) showed no significant change after PSI (p>0.25; effect size≤0.44). We hypothesize that DPA may continue to be truncated by conditioned fear-avoidance, a psychological state that may prevent increase in daily physical activity to avoid pain.

Chronic Low Back Pain (CLBP), defined as pain persisting for at least 12 weeks, is a significant public health issue, with prevalence intensifying due to an ageing global population, amassing approximately 619 million cases in 2020 and projected to escalate to 843 million by 2050. Given the multitude of therapeutic modalities available for CLBP, this research sought to ascertain their respective efficacies in ameliorating pain and disability. We specifically scrutinized Multidisciplinary Biopsychosocial Rehabilitation (MBR) among adults enduring non-specific low back pain for over 12 weeks, excluding acute pain conditions and pre-study surgical interventions. MBR is an approach encompassing various modalities, including exercise, behavioral therapies, educational programs, and work conditioning aspects, necessitating a comprehensive Network Meta-Analysis (NMA) to fully grasp the extensive scope of its impact. The constructed network comprised diverse MBR modalities (behavioral, educational, and work conditioning) alongside exercise therapy (ET), minimal intervention, and usual care, serving as controls with pain and disability as outcomes. Through the analysis of 4,619 initially identified studies, 93 were included, encompassing a total of 8,059 participants. The NMA conducted substantiated that both ET and MBR modalities were notably effective in alleviating CLBP, with education-oriented MBR emerging as the most efficacious for pain mitigation and behavior-focused MBR for disability reduction. Nevertheless, the discerned differences amongst the treatments were minimal and uncertain, highlighting that no modality was definitively superior to the others. The analysis revealed low global and local inconsistency within the network, underscoring the reliability of the observed outcomes. Given the intricate nature of CLBP, embodying various facets, our findings advocate for a combined therapeutic approach to optimize treatment efficacy. Nonetheless, the presence of high study heterogeneity and potential biases necessitates cautious interpretation of the results, prompting future research.

Blasting pattern optimization is an attempt to optimize blast design parameters aiming to achieve optimum fragmentation, reduce mining operating costs as well as environmental side consequences. The present study aims to propose a multi-objective optimization model, employing artificial intelligence and metaheuristics, to simultaneously minimize the mine-to-crusher operating costs and the impact of blasting consequences including fly-rock and back-break. To achieve the purpose of the study, a multi-variable regression model was developed to model total costs from drilling to crushing. In addition to the costs, multilayer perception neural networks were implemented to predict the blast-induced back-break and fly-rock as a function of collected variables such as number of holes, hole length, burden, spacing, hole slope, stemming, blasted rock per hole, powder factor, and charge per delay. High-precise estimations for both back-break and fly-rock were achieved with the average of 99% coefficient of determination for train, test and validation data sets. Then, the developed regression model and the neural networks were used in an optimization framework, employing Grasshopper algorithm, to find the optimum blast design satisfying practical constraints. The proposed model was tested on a lead-zinc open-pit mine, where 1032 blasting patterns were recorded and analyzed. The results of the optimization model provide a Pareto set of solutions, such that any of these solutions can be implemented according to the strategy of the mining operation management team. The blast pattern with the lowest cost, result in a relatively high fly-rock and back-break, while the pattern with low fly-rock and back-break raises the cost by 20.13 % compared the minimum cost blast design.

Circular RNAs (circRNAs) served as covalently closed single-stranded RNAs have been proposed to influence plant development and stress resistance. Grapevine is the most economically valuable fruit crops cultivated worldwide and threaten by various abiotic stresses. Herein, we reported that a circRNA (Vv-circPTCD1) processed from the second exon of a pentatricopeptide repeat family gene PTCD1 was preferentially expressed in leaves and responded to salt and drought but not heat stress in grapevine. Additionally, the second exon sequence of PTCD1 was highly conserved but the biogenesis of Vv-circPTCD1 is species-dependent in plants. It was further found that the overexpressed Vv-circPTCD1 can slightly decreased abundance of the cognate host gene and the neighboring genes were barely affected in grapevine callus. Furthermore, we also successfully overexpressed the Vv-circPTCD1, and found that the Vv-circPTCD1 deteriorated the growth during heat, salt, and drought stresses in Arabidopsis. However, the biological effects on grapevine callus were not always consistent with that of Arabidopsis. Interestingly, we found that the transgenic plants of linear counterpart sequence also conferred the same phenotypes as that of circRNA during the three stress conditions, no matter what species. Those results imply that although the sequences are conserved, the biogenesis and functions of Vv-circPTCD1 are species-dependent. Our results indicate that the plant circRNA function investigation should be conducted in homologous species, which support valuable reference for further plant circRNA studies.

Western Anatolia comprises a vast amount of various volcanic successions spanning from Eocene to Upper Miocene periods. These units mainly display southward younging in broad sense and display large amounts of chemical variation that spanned from basalt to rhyolite. The southward younging of magmatism and chemical variations have been largely attributed to the retreat and roll-back of the Hellenic slab and the western escape of the Anatolian microplate. However, there is still a lack of high precision data to pinpoint the exact nature of the magmatism and lithospheric tectonics. In this contribution we investigated a poorly known region along the Western Anatolia along Manisa district called Karakılıçlı volcanic field. We investigated two different volcanic sections (Kalpakkaya and Çamlık hill) that display the best volcano-sedimentary features in terms of geochronology and geochemistry. Samples acquired from the bottom, middle and upper portions of these sections display Early-Middle Miocene ages of 17.64±0.20, 17.22±0.15, 16.16±0.17 and 16.36±0.13, 15.79±0.71 and 13.61±0.20 Ma respectively. The results indicate that the volcanism in the region generated by the melting of the mantle and/or lithospheric mantle by slab retreat and roll-back of the Hellenic slab and evolved in the shallow magma chambers/mushes by fractional crystallization, magma mixing and crustal assimilation.

Field and numerical investigations at Happisburgh, East coast of England, UK, sought to characterize beach thickness and determine geologic framework controls on coastal change. After a major failure of coastal protection infrastructure, removal of about 1 km of coastal defense along the otherwise protected cliffed coastline of Happisburgh triggered a period of rapid erosion over 20 years of ca. 140 m. Previous sensitivity studies suggested that that beach thickness plays a major role in coastal recession. These studies were limited, however, by a lack of beach volume data. In this study, we have integrated the insights gained from our understanding of the Quaternary geology of the area, a novel non-intrusive passive seismic survey method, and a 3D novel representation of the subsurface source and transportable material into a coastal modelling environment to explore the role of beach thickness on the back wearing and down wearing of the cliffs and consolidated platform, respectively. Results show that beach thickness is non-homogeneous along the study site: we estimate that the contribution to nearshore sediment budget via platform down wearing is of a similar order of magnitude as sediment lost from the beach and therefore non-negligible. We have provided a range of evidence to support the idea that the Happisburgh beach is a relatively thin layer perched on a sediment rich platform of sand and gravel. This conceptualization differs from previous publications, which assumes that the platform was mostly till and fine material. This has direct implication on the regional sediment management of along this coastline. The present study contributes to our understanding of a poorly known aspect of coastal sediment budgeting and outlines a quantitative approach that allows for simple integration of geological understanding for coastline evolution assessments worldwide.

To systematically assess the effect size of different methods for patients with low back pain. PubMed, Cochrane Library, Web of Science, and Google Scholar. databases were searched in January 2023. This study has been developed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. The key search terms were: “Low back pain”, “Back pain”, “SF-36”, “VAS”, “VASP”, “Roland-Morris”, “Oswestry Disability Index”, and “conservative treatment”. The risk of bias was determined for each randomized trial using the Cochrane Risk of Bias Tool, and the methodological index for non-randomized studies (MINORS). The outcomes included SF-36 Mental, SF-36 Physical, VAS, Roland-Morris, and Oswestry Disability Index. R 4.0.5 software was used, and standardized mean difference (SMD) and 95% confidence intervals (CI) were calculated for continuous outcomes, random model. Twenty-five studies were included. Depending on the outcome being measured, the effect size of different methods in treating low back pain varies from small to large as follows: SF-36 Mental (SMD = 0.39, p &lt; 0.0001), SF-36 Physical (SMD = 0.55, p &lt; 0.0001), VAS (SMD = -0.84, p &lt; 0.0001), Roland-Morris (SMD = -0.45, p &lt; 0.0001), and Oswestry Disability Index (SMD = -0.61, p &lt; 0.0001). Our meta-analysis indicates the positive effects of applying different methods in the treatment of low back pain. PROSPERO registration number: CRD42022371282

Background: Chronic non-specific low back pain (CNSLBP) is defined as back pain that lasts longer than 12 weeks. Objectives: To investigate the efficacy of manual therapy (MT) program combined with Capacitive and Resistive Electric Transfer (TECAR) therapy in individuals with CNSLBP. Method: Sixty adults with CNSLBP were randomly equally divided into three groups. The first group followed an MT protocol in the lumbar region (MT group), the second group followed the same MT protocol combined with TECAR therapy (MT + TECAR group) using a conventional capacitive electrode as well as a special resistive electrode bracelet and the third group (Control group) received no treatment. Both intervention programs included six treatments over two weeks. Pain in the last 24 hours with the Numeric Pain Rating Scale (NPRS), functional ability with the Roland-Morris Disability Questionnaire (RMDQ), Pressure Pain Threshold (PPT) in the lumbar region with pressure algometry, and mobility of the lumbo-pelvic region through fingertip-to-floor distance (FFD) test were evaluated before and after the intervention period with a one-month follow-up. Analysis of variance with repeated measures was applied. Results: In the NPRS score, both intervention groups showed statistically significant differences compared to the control group both in the second week as well as in the one-month follow-up (p < .001). Between-groups differences were also noticed between the two intervention groups in the second week (p < .05). Differences in the RMDQ score in the second week and on the one-month follow-up were detected between the intervention groups and the control group (p < .001), while differences between the two intervention groups were only detected in the one-month follow-up (p < .001). Regarding the PPT values, differences were found mainly between the MT + TECAR and the control group and between the MT + TECAR and the MT group (p < .05), with the MT + TECAR group in most cases showing the greatest improvement compared to the other two groups, which remained statistically significant in the one-month follow-up (p < .05). Finally, both intervention groups improved the mobility of the lumbo-pelvic region in both time points compared to the control group without, however, statistically significant differences between them (p> .05). Conclusion: The application of an MT protocol with TECAR therapy appeared more effective than conventional MT as well as compared to the control group in reducing pain and disability and improving PPT in individuals with CNSLBP. No further improvement was noted in mobility of the lumbo-pelvic region by adding TECAR to the MT intervention.

This study presents three forms of interdisciplinary expertise in the healthcare design context to approach a particular multifaceted problem around the current healthcare for older adult patients with chronic low-back pain (LBP). Using an interdisciplinary co-design framework, first, our design approach performs the role of an initiator to define the problem by exploring the current context of healthcare. Second, it facilitates the experiences of experts and patients to reach the roots of the problem by functioning as a mediator. Third, our approach fulfills the primary role of healthcare design in producing new meanings considering the principles of patient-centeredness. These roles significantly contributed to the design of healthcare innovations. Our framework transformed the distributed disciplinary knowledge developed while tackling the multifaceted problem into new forms of expertise for collaboration in healthcare innovation.

Utilization of Bidirectional Reflectance Distribution Function (BRDF) model parameters obtained from the multi-angular remote sensing is one of the approaches for the retrieval of vegetation structural information. In this research, the potential of multi-angular vegetation indices, formulated by the combination of multi-spectral reflectance from different view angles, for the retrieval of forest above ground biomass was assessed. This research was implemented in the New England region with the availability of a high quality forest inventory database. The multi-angular vegetation indices were generated by the simulation of the Moderate Resolution Imaging Spectroradiometer (MODIS) BRDF/Albedo Model Parameters Product (MCD43A1 Version 6) based BRDF parameters. The effects of seasonal (spring, summer, autumn, and winter) composites of the multi-angular vegetation indices on above ground biomass, angular relationship of the spectral reflectance with above ground biomass, and the interrelationships between the multi-angular vegetation indices were analyzed. Among the existing multi-angular vegetation indices, only the Nadir BRDF-adjusted NDVI ( and Hot-spot incorporated NDVI ( showed significant relationship (more than 50%) with the above ground biomass. This research proposed two more sensitive vegetation structural indices, Fore-scattering Back-scattering NDVI and Vegetation Structure Index (VSI). The Fore-scattering Back-scattering NDVI showed higher sensitivity (R² = 0.62, RMSE = 52.46) towards the above ground biomass than existing multi-angular vegetation indices. Furthermore, the VSI performed in the most efficient way explaining 64% variation of the above ground biomass, suggesting that the right choice of the spectral channel and observation geometry should be considered for improving the estimates of the above ground biomass. In addition, the right choice of seasonal data (summer) was found to be important for estimating the forest biomass while other seasonal data were either insensitive or pointless. The promising results shown by the VSI suggest that it could be an appropriate candidate for monitoring vegetation structure from the multi-angular satellite remote sensing.

Artificial Intelligence is dominated by Artificial Neural Networks (ANNs). Currently, the Batch Gradient Descent (BGD) is the only solution to train ANN weights when dealing with large datasets. In this article, a modification to the BGD is proposed which significantly reduces the training time and improves the convergence. The modification, called Instance Eliminating Back Propagation (IEBP), eliminates correctly-predicted-instances from the Back Propagation. The speedup is due to the elimination of unnecessary matrix multiplication operations from the Back Propagation. The proposed modification does not add any training hyperparameter to the existing ones and reduces the memory consumption during the training.

This paper discusses a MEMS switch that can be fabricated using low temperature (<100^oC) deposition and patterning techniques suitable for the back-end-of-the-line integration with CMOS. The resulting cross-bar switches can be used for electrostatic discharge protection, FPGA implementation, chip security assessment and lock-down, and circuit block power management. We discuss platinum and iron switch with turn-on voltages of ~ 1.8 V. In the case of the iron switches, we also show that they can be magnetized to have “memory” and stay on when turned on. Platinum switch cycling of up to 1000 times did not show any changes in their turn-on voltage and their contact resistance was unchanged. The 10-100 nm switch airgaps were formed using low temperature sputtered sacrificial polysilicon and XeF₂ etching. XeF₂ does not attack any of the metals used in CMOS enabling fabrication of cross-bar switches with any of these metals. Once activated, it takes ∿ 6 to mechanically turn on the switch that can be decreased to ~1 ns by optimizing the device structure. Interestingly, the nm-scale gaps can be used as spark gap as a fast plasma switch to discharge first followed by the activation of the MEMS switch.

This paper proposes a single-stage asymmetrical half-bridge fly-back (AHBF) converter with resonant mode using dual-mode control. The presented converter has an integrated boost converter and asymmetrical half-bridge fly-back converter and operates in resonant mode. The boost-cell always operates in discontinuous conduction mode (DCM) to achieve high power factor. The presented converter operates simultaneously using a variable-frequency-controller (VFC) and pulse-width-modulation (PWM) controller. Unlike the conventional single-stage design, the intermediate bus voltage of this controller can be regulated depending on the main power switch duty ratio. The asymmetrical half-bridge fly-back converter utilizes a variable switching frequency controller to achieve the output voltage regulation. The asymmetrical half-bridge fly-back converter can achieve zero-voltage-switching (ZVS) operation and significantly reduce the switching losses. Detailed analysis and design of this single-stage asymmetrical half-bridge fly-back converter with resonant mode is described. A wide AC input voltage ranging from 90 to 264 Vrms and output 19 V/ 120 W prototype converter was built to verify the theoretical analysis and performance of the presented converter.

Objective: This systematic review and meta-analysis compared the patient-reported outcomes of intra-articular facet joint injections of normal saline and selected active substances to identify a more effective agent for treating subacute and chronic low back pain (LBP). Methods: The PubMed, Embase, Scopus, Web of Science, and CENTRAL databases were searched for randomized controlled trials and observational studies published in English. A research quality assessment was performed using ROB2 and ROBINS-I. A meta-analysis was conducted using a random-effects model, and the mean differences (MD) with 95% confidence intervals (CI) in efficacy outcomes, including pain, numbness, disability, and quality of life, were assessed. Results: Of the 2,467 potential studies, three were included (247 patients). The active substances and normal saline had similar therapeutic effects on pain within 1 h, after 1-1.5 months, and after 3-6 months, with MD and 95% CI of 2.43 and -11.61 to 16.50, -0.63 and -7.97 to 6.72, and 1.90 and -16.03 to 19.83, respectively, as well as the quality of life after 1 and 6 months. Conclusion: The short- and long-term clinical effects of intra-articular facet joint injections of normal saline are comparable to those of other active substances in patients with LBP.

Abstract: Sand-cement bound screed floor layers are at risk for work-related low back pain, lumbosacral radicular syndrome and knee osteoarthritis given their working technique of level-ling screed with their trunk bended and mainly supported by their hands and knees. To reduce the exposure of the physical demands of bending of the trunk and kneeling, a manually moved screed levelling machine was developed for floor layers in the Netherlands. The aim of this pa-per is to estimate the potential health gain of the manually moved screed levelling machine on the risk of low back pain (LBP), lumbosacral radicular syndrome (LRS) and knee osteoarthritis (KOA) compared to the traditional working technique. The potential health gain was assessed using the epidemiological population estimates of the Population Attributable Fraction (PAF) and the Potential Impact Fraction (PIF) combined with work-related risk estimates for these three disorders from systematic reviews. The percentage of workers exceeding these risk esti-mates was based on worksite observations among in total 28 floor layers. For LBP, 16/18 work-ers were at risk using the traditional working technique with PAF=38%, and for the manually moved screed levelling machine this was 6/10 with PIF=13%. For LRS, these data were 16/18 with PAF=55% and 14/18 with PIF=18% and for KOA, 8/10 with PAF=35% and 2/10 with PIF=26%. A manually moved screed levelling machine might have a significant impact on the prevention of LBP, LRS and KOA among floor layers in the Netherlands and a health impact assessment is a feasible approach to assess health gains in an efficient way.

Nociceptive innervation of the thoracolumbar fascia (TLF) has been investigated over decades, however these studies have not been compiled or collectively appraised. The purpose of this scoping review was to assess current knowledge regarding nociceptive innervation of the TLF to better inform future mechanistic and clinical TLF research targeting low back pain (LBP) treatment. PubMed, ScienceDirect, Cochrane and Embase databases were searched in January 2021 using relevant descriptors encompassing fascia and pain. Eligible studies were: (a) published in English; (b) preclinical and clinical (in vivo and ex vivo) studies; (c) original data; (d) included quantification of at least one TLF nociceptive component. Two-phase screening procedures were conducted by a pair of independent reviewers, data were extracted and summarized from eligible studies. The search resulted in 257 articles of which 10 met inclusion criteria. Studies showed histological evidence of nociceptive nerve fibers terminating in low back fascia, suggesting a TLF contribution to LBP. Noxious chemical injection or electrical stimulation into fascia resulted in longer pain duration and higher pain intensities than injections into subcutaneous tissue or muscle. Pre-clinical and clinical research provides histological and functional evidence of nociceptive innervation of TLF. Greater knowledge of fascial neurological components could impact LBP treatment.

Acute low back pain (LBP) stands as a leading cause of activity limitation and work absenteeism, and its associated healthcare expenditures are expected to become substantial when acute LBP develops into a chronic and even refractory condition. Therefore, early intervention is crucial to prevent progression to chronic pain whose management is particularly challenging and for which the most effective pharmacological therapy is still controversial. Current guideline treatment recommendations vary and are mostly driven by expertise with opinion differing across different interventions. Thus, it is difficult to formulate evidence-based guidance when relatively few randomized clinical trials did explore the diagnosis and management of LBP while employing different selection criteria, statistical analyses, and outcome measurements. This narrative review aims to provide a critical appraisal of current acute LBP management by discussing the unmet needs and areas of improvement from bench-to-bedside and proposes multimodal analgesia as the way forward to attain an effective and prolonged pain relief and functional recovery in patients with acute LBP.

Low back pain (LBP) is a pandemic and costly musculoskeletal condition in the United States. Patients with LBP may endure surgery, injections, and expensive visits to emergency departments. Some suggest that using physical therapy or chiropractic in the earlier stage of LBP reduces the utilization of expensive health services and lowers the treatment costs. Nevertheless, there is no consistent evidence to declare which one of these methods is a cost-effective treatment within a short (less than a year) period of time. The purpose of this study was to investigate the cost-effectiveness of chiropractic versus physical therapy in the United States. A decision tree analytic model was used for estimating the economic outcomes. The findings showed that in the chiropractic group, the total average cost was $48.56 lower than the physical therapy group, and daily adjusted life years (DALY) was 0.0043 higher than the physical therapy group. Chiropractic care was shown to be a cost-effective alternative compared with physical therapy for adults with at least three weeks of low back pain over six months.

Background: Low-level physical activity (PA) among Chronic Low Back Pain (cLBP) is associated with various biopsychosocial factors. This research aimed to study the predictors of PA behavior among cLBP patients. Methods: In the present study 300 eligible patients with cLBP who referred to comprehensive health service centers in the Shahid Beheshti University of Medical Sciences (SBUMS) in Tehran, Iran were random selected.To diagnose the predictors of PA behavior, all the Theory of Reasoned Action (TRA) constructs were examined as risk factors to see if they influence on the probability of PA behavior occurrence and were interpreted through odds ratio (OR). SPSS version 19 was used to analyze the data. Results: Totally 280 cLBP patients with mean age of 57.07 ±13.09 years old participated in the study. This study showed that motivation to comply significant predictor the cLBP patients for subjective norm OR (%95CI): 2.095(0.116-2.792), p-value<0.001), intention was significant predictor for perform the PA behavior OR (%95CI): 1.431(0.138-1.538), p-value <0.001), behavior beliefs could predictor for attitude OR (%95CI): 1.276(0.106-1.355), p-value= 0.002). attitude, normative beliefs, subjective norm ,and evaluation outcome behavior could predictors the cLBP patients for intention to perform the PA behavior OR (%95CI): 1.188(0.032-1.312), p-value<0.001)., OR (%95CI): 1.158(0.076-2.208), p-value=0.003) ., OR (%95CI): 1.104(0.076-1.128), p-value<0.001) ., OR (%95CI): 0.814(0.301-1.440), p-value=0.007). Conclusions: This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm). This study showed that the cLBP patients who were normative beliefs and evaluation regarding PA behavior could effect on the intention to engage in greater PA than those via other constructs (attitude and subjective norm).

This service improvement project was carried out at LEKMA Hospital, Ghana. Ghana has high levels of antimicrobial resistance (AMR). There is an urgent need to introduce models of care that optimize antibiotic prescribing. Methods Delayed / back-up prescribing is a strategy that could reduce antibiotic use in suspected upper respiratory tract infections. Four different models of delayed / back-up prescribing [no prescription; post-dated prescription (given to patient); post-dated prescription (forwarded to pharmacy); and follow-up appointment for reassessment after 3 days] were implemented in discussion between clinician and patient. Patients were contacted 10 days after their appointment to record compliance, check on their wellbeing, and rate their experience. Results Over a 3-month period (12/2019-02/2020), 142 patients were eligible for delayed / back-up prescribing. The most common clinical diagnoses were sore throat (102/140, 73%), common cold (22/140, 16%) and sinusitis (10/140, 7%). In total, 12 (9%) patients remained symptomatic at day 10, and only one individual in the entire cohort took antibiotics. Most patients (95%) rated their experience as good or very good. Conclusions Delayed / back-up prescribing models can lead to substantial reduction in antibiotic consumption amongst outpatient department patients with suspected upper respiratory tract infections. Delayed / back-up prescribing can be implemented safely in low and middle-income countries.

This scoping review investigated how consumers perceive and interpret serving size information on food packages. A search of seven databases (2010 to September 2017) was followed by title and abstract screening, with relevant articles assessed for eligibility in full-text. Fourteen studies met inclusion criteria, with relevant data extracted by one reviewer and checked for consistency by a second reviewer. Five studies reported poor understanding of nutrition facts labelling and portion size, with information to ‘benchmark’ serving size against reported as helpful in two studies. Consumer attitudes towards serving size labelling were measured in six studies and identified that serving size information was interpreted as indicative of nutrient intake regardless of portion size recommendations. Increased labelled serving sizes resulted in increased portion sizes in three studies, with three studies reporting the opposite or neutral effect for discretionary food portion sizes. The influence of labelled serving size on consumer attitudes and consumption is complex and sometimes counterintuitive. As labelled serving size can impact on consumption, any changes may result in unintended public health consequences. The effects of labelled serving size format changes should be tested carefully within experimental and ecological contexts and accompanied by tailored, comprehensive and serving size-specific food literacy initiatives.

In this work, the author employs the quantum hydrodynamic formalism to achieve the geometrization of spacetime for describing the gravitational interaction within the framework of quantum theory. This approach allows for the development of an equation of gravity that is mathematically connected to the fermion and boson fields. This achievement is accomplished by incorporating two fundamental principles: covariance of the quantum field equations and the principle of least action. By considering these principles, a theory is established that enables the calculation of gravitational corrections to Quantum Electrodynamics, and potentially, to the standard model of particle physics as well. The theory also provides an explanation for two phenomena: the existence of a cosmological pressure density similar to quintessence, that is compatible with the small value of the observed cosmological constant, and the breaking of matter-antimatter symmetry at high energies offering insights into why there is an imbalance between the two in the early universe. In the cosmological modeling of the theory, there exists a proposal to account for the formation of supermassive black holes that are accompanied by their own surrounding galaxies, without relying on the process of mass accretion. The model, in accordance with recent observations conducted by the James Webb Space Telescope, supports the notion that galactic configurations were established relatively early in the history of the universe, shortly after the occurrence of the Big Bang.

Historically, the evaluation and assessment of the clinical response to treatment for canine back pain is subjective and relies on owner and clinician assessment of pain. This study evaluated the use of sequential infrared thermal images as a measure of the response of canine patients with back pain to a prescribed series of photobiomodulation therapy (PBMT) treatments. Qualifying participants had histories of pain and dysfunction associated with spinal osteoarthritis or intervertebral disk disease, or of non-specific uni- or bilateral back pain along the paravertebral epaxial muscles. Each patient was initially thermally imaged prior to PBMT treatment and then received multiple PBMT treatments delivered to the appropriate spinal area on days 1, 2, 3, and 4. Participants were reimaged on day 7. Thermal images provided an objective measure of superficial temperature changes over the area of PBMT treatment of each patient after the PBMT regimen. The temperature correlated with statistically significant changes in Colorado State University Canine Chronic Pain Scale scoring (CPS) and owner assessment using the Canine Brief Pain Inventory (CBPI), which includes a Pain Severity Score (PSS) and Pain Interference Score (PIS). The correlation of objective thermal imaging data with more subjective outcome measures suggests thermal imaging may be a valuable additional tool in monitoring therapy outcome.

In the paper we show that the general relativity in recent Einstein-Palatini formulation is equivalent to a gauge field. We begin with a bit of information of the Einstein-Palatini formulation and derive Einstein field equations from it. In the next section, we consider general relativity with a positive cosmological constant in terms of the corrected curvature. We show that in terms of the corrected curvature general relativity takes the form typical for a gauge field. Finally, we give a geometrical interpretation of the corrected curvature.

Using coherent optical detection and digital signal processing, laser phase noise and equalization enhanced phase noise can be effectively mitigated using the feed-forward and feed-back carrier phase recovery approaches. In this paper, theoretical analyses of feed-back and feed-forward carrier phase recovery methods have been carried out in the long-haul high-speed n-level phase shift keying (n-PSK) optical fiber communication systems, involving a one-tap normalized least-mean-square (LMS) algorithm, a block-wise average algorithm, and a Viterbi-Viterbi algorithm. The analytical expressions for evaluating the estimated carrier phase and for predicting the bit-error-rate (BER) performance (such as the BER floors) have been presented and discussed in the n-PSK coherent optical transmission systems by considering both the laser phase noise and the equalization enhanced phase noise. The results indicate that the Viterbi-Viterbi carrier phase recovery algorithm outperforms the one-tap normalized LMS and the block-wise average algorithms for small phase noise variance (or effective phase noise variance), while the one-tap normalized LMS algorithm shows a better performance than the other two algorithms for large phase noise variance (or effective phase noise variance). In addition, the one-tap normalized LMS algorithm is more sensitive to the level of modulation formats.

The multidimensionality of chronic pain forces us to look beyond isolated pain assessment such as pain intensity, which does not consider multiple key parameters, particularly in patients suffering from post-operative Persistent Spinal Pain Syndrome (PSPS-T2). Our ambition was to provide a novel Multi-dimensional Clinical Response Index (MCRI), including not only pain intensity but also functional capacity, anxiety-depression, quality of life and objective quantitative pain mapping assessments, the objective being to capture patient condition instantaneously, using machine learning techniques. Two hundred PSPS-T2 patients were enrolled in a real-life observational prospective PREDIBACK study with 12-month follow-up and received various treatments. From a multitude of questionnaires/scores, specific items were combined using exploratory factor analyses to create an optimally accurate MCRI; as a single composite index, using pairwise correlations between measurements, it appeared to better represent all pain dimensions than any other classical score. It appeared to be the best compromise among all existing indexes, showing the highest sensitivity/specificity related to Patient Global Impression of Change (PGIC). Novel composite indexes could help to refine pain assessment by changing the physician’s perception of patient condition on the basis of objective and holistic metrics, and by providing new insights to therapy efficacy/patient outcome assessments, before ultimately being adapted to other pathologies.

With reference to Planck scale Hubble parameter, super luminal expansion speeds, super luminal rotation speeds, Mach’s principle and Holographic principle, we review the current cosmological observations with eight simple assumptions. By understanding Yuri N. Obukhov and V.A. Korotky proposed cosmic rotational effects of polarization of radiation due to massive bodies, to some extent cosmic rotation can be deep-rooted in an observational approach and the ratio of current angular velocity and Hubble parameter can be estimated. It is possible to show that, at H₀ =70 km/sec/Mpc, current cosmic temperature, age, radius, mass, mass density are 2.721 K, 4.41x10¹⁷ sec, 90 billion light years, 1.14654x10⁵⁴ kg, 0.0482 times the current critical density respectively. Clearly speaking, current universe seems to constitute 267 Hubble spheres. Important point to be noted is that, current rotational kinetic energy is 0.6667 times the current critical energy. Based on the estimated current mass density and current rotational kinetic energy, current cosmic dark matter density can be shown to be 0.2851 times the current critical density. These numerical coincidences cast serious doubt on the on the real existence of currently believed ‘dark energy’. Initial and current expansion speeds are 3x10⁸ m/sec and 3.56x10⁹ m/sec respectively. With increasing cosmic age and increasing cosmic expansion speed, current universe is expanding with a speed of 11.885c. By knowing the time to time future cosmic temperatures, future Hubble parameters and corresponding future cosmic expansion speeds can be estimated and thus future expansion speed can be understood. Starting from ‘speed of light’, our model assumes a continuous increase in expansion speed and attains a current radius of 90 billion light years (without inflationary concepts) and casts a serious doubt on the actuality of currently believed ‘inflation’.

While Spinal Cord Stimulation (SCS) provides satisfaction to almost 2/3 of Persistent Spinal Pain Syndrome-Type 2 (PSPS-T2) patients implanted for refractory chronic back and/or leg pain when not adequately addressed the back pain component, leaves patients in a therapeutic cul-de-sac. Peripheral Nerve field Stimulation (PNfS) has shown interesting results addressing back pain in the same population. Far from placing these two techniques in opposition, we suggest that these approaches could be combined to better treat PSPS-T2 patients. We designed a RCT (CUMPNS), with a 12-month follow-up, to assess the potential added value of PNfS, as a salvage therapy, in PSPS-T2 patients experiencing a “Failed SCS Syndrome” in the back pain component. Fourteen patients were included in this study and randomized into 2 groups (“SCS + PNfS” group/n=6 vs “SCS only” group/n=8). The primary objective of the study was to compare the percentage of back pain surface decrease after 3 months, using a computerized interface to obtain quantitative pain mappings, combined with multi-dimensional SCS outcomes. Back pain surface decreased significantly greater for the ”SCS+PNfS” group (80.2% ± 21.3%) compared to the “SCS only” group (13.2% ± 94.8%) (p=0.012), highlighting the clinical interest of SCS+PNfS, in cases where SCS fails to address back pain.