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Background: Osteoarthritis (OA) can cause disability and reduce quality of life (QoL). Objectives: This study aimed to determine whether GreenShell mussel (GSM) powder (PERNAULTRA) consumption was more effective than placebo at improving physical performance and subjective measures of symptoms and function in adults with early signs of knee OA. Methods: The Researching Osteoarthritis and GSM study was a 6-mo randomized, double-blind, placebo-controlled trial in adults aged 55-80 y, screened for signs of OA (n = 120, 65.9 ± 6.43 y, 63% female). Participants consumed either 3 g of powdered whole GSM or placebo (pea protein) daily. Baseline and end data collection included 30-s chair stand, stair test, 40-m fast-paced walk test, Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire categorized into 5 subscales [pain (P), symptoms except pain (S), function in activities of daily living (ADL), function in sports/recreation (SP), and QoL], a measure of Intermittent and Constant Osteoarthritis Pain, and visual analog scale of pain and symptoms. Results: Visual analog scale symptoms showed a significantly greater reduction in percentage change for GSM than that for placebo [-28.1 (-59.2, 43.2) compared with 0.00 (-28.6, 100); P = 0.03]. Further, a trend for improvement in percentage change for GSM compared with placebo was seen in 40m fast-paced walk [2.51 (-3.55, 8.12) compared with 0.20 (-6.58, 4.92); P = 0.09], KOOS-SP [11.4 (-4.48, 27.0) compared with 0.00 (-11.1, 17.7); P = 0.09], and Intermittent and Constant Osteoarthritis Pain intermittent pain scale [-27.7 (-77.3, 0.00) compared with -14.6 (-50.0, 36.4); P = 0.08]. In those with body mass index (BMI; in kg/m²) <25, GSM consumption significantly improved KOOS-S compared with placebo [6.35 (3.49, 12.7) compared with 0.00 (-4.65, 4.49); P = 0.03] and showed a trend for improvement in KOOS-ADL [3.29 (1.01, 8.79) compared with 1.01 (-5.75, 4.30); P = 0.07]. Those with BMI of >25, consuming GSM showed a trend for improvement in KOOS-SP [13.6 (-4.76, 33.3) compared with 0.00 (-12.5, 20.0); P = 0.07]. Conclusions: This research suggests consumption of GSM has potential to alleviate symptoms and improve functionality in OA. [ABSTRACT FROM AUTHOR]

• A multidimensional construct of safety climate is proposed, considering the most salient factors from the literature, and including psychological capital as a new factor. • This research contributes to the literature by being the first empirical research, that incorporates the psychological capital factor as an element affecting safety climate, especially in the construction sector studies. • Accurate methodological description. Descriptive analyses and Partial least squares structural equation modelling (PLS-SEM) were used to assess the quality of the measurement instrument and the hypotheses of the proposed model. • This study proposes and validates a structural model to explain workers' mental and physical health as a function of safety climate, mediated by job satisfaction. • The sample of Spanish construction workers was composed by all random observations contained in the EWCS of all workers in the Spanish sector, totaling 232 workers. • Workers' mental and physical health are influenced by several factors, including, but not limited to, safety climate, work-life balance, and job rewards and compensations. • This study provides some recommendations for construction company managers providing a ranking of all the factors affecting the safety climate and the workers' health. Introduction: The number of physical and mental problems caused by occupational accidents and diseases increases every year. To control them, the safety climate at work is a recognized critical factor. However, a widely applicable model to capture the safety climate for various industries and organizations is lacking. Method: This study proposes a theoretical model to measure the direct and indirect effects of safety climate on workers' physical and mental health, mediated by job satisfaction, in the construction sector. We propose a multidimensional construct of safety climate, considering the most salient factors from the literature, and including psychological capital as a new factor. Using data from the last wave of the European Working Conditions Survey (2015) in Spain, the proposed model was validated using structural equation modeling. Results: Our findings suggest that to further improve the mental health of construction workers, work-life balance and job rewards and compensation must be prioritized along with safety climate. As for physical health, safety climate and work-life balance are crucial. Finally, we provide some recommendations for construction company managers based on a ranking of all the factors affecting the safety climate and the workers' health. [ABSTRACT FROM AUTHOR]

Cross-sectional studies on diffuse idiopathic skeletal hyperostosis have focused on its incidence and related factors. However, the long-term changes caused by the disease remain unclear. This longitudinal cohort study aimed to elucidate the progression of diffuse idiopathic skeletal hyperostosis and its effects on physical function, health-related quality of life, and spinal alignment. We recruited 255 older adults (87 men and 168 women; average age, 71.3 years in 2014) who attended local health checkups in 2014 and 2020. Height, body weight, body mass index, blood pressure, grip strength, functional reach, and bone mineral density were measured. The prevalence, location, number of ossified contiguous vertebrae, and spinopelvic parameters were estimated using whole-spine standing radiographs. For health-related quality of life assessment, the Oswestry disability index and EuroQuol-5D were obtained. We performed a 1:1 case-control study with age and sex-matched patients with and without diffuse idiopathic skeletal hyperostosis and analyzed progression over a 6-year period. In 2014, 39 (15.3%) of 255 patients were diagnosed with diffuse idiopathic skeletal hyperostosis (24 males and 15 females), which occurred more frequently in the elderly and males. In 2020, 12 (4.3%) patients were newly diagnosed with diffuse idiopathic skeletal hyperostosis, and 28 (71.7%) of 39 patients diagnosed in 2014 showed varying degrees of progression. Compared with age- and sex-matched patients without diffuse idiopathic skeletal hyperostosis, patients with the condition had higher body mass index and lumbar bone mineral density, larger sagittal vertical axis, and greater T1-pelvic angle. Changes in physical function and spinal-pelvic parameters during the 6-year period did not differ between the groups. Over a 6-year period, the prevalence of diffuse idiopathic skeletal hyperostosis increased by 4.3%, and it progressed in 71.7% of patients. However, it had little effect on longitudinal physical function, health-related quality of life, and spinopelvic parameters in older adults. [ABSTRACT FROM AUTHOR]

Background: We investigated intramuscular fat (IMF) in quadriceps femoris (QF) and hamstring muscles in the middle-aged women with knee osteoarthritis (KOA). We also examined the relationship between muscular infiltration of QF and hamstring muscles and muscle architecture and physical performance of the women with KOA.Methods: In this cross-sectional study, 72 women were included. Body muscle and fat mass were measured by BIA, isometric muscle strength was evaluated by hand-held dynamometer. IMF and muscle architecture were calculated from rectus femoris (RF), vastus intermedius (VIM), vastus lateralis (VL), vastus medialis (VM), biceps femoris (BF), semitendinosus (ST) and semimembranosus (SM) using B-mode ultrasonography. KOA-related symptoms and functions were assessed with KOOS. The functional performance assessments were evaluated with Stair Climbing Test, 20-Meter Walking Test.Results: Women with KOA had more IMF in RF, VIM, VL, VM and BF, ST, SM muscles compared to the healthy women. Pennation angles decreased as the IMF in the RF, VM, BF and ST decreased. As the IMF of the RF and VM increased isometric knee extensor strength decreased and KOOS symptom score, pain score and ADL score increased in women with KOA. Walking and stair climbing speed deteriorated as the IMF in RF, VIM, VM, BF increased in the middle-aged women. As the IMF in BF increased isometric knee flexor strength decreased and KOOS scores increased. Physical performance scores deteriorated as the IMF in BF increased in middle-aged women with KOA.Conclusion: IMF in QF and hamstring muscles were higher in the middle-aged women with KOA group compared with that in the healthy group. Weakness of the QF and hamstring muscles may due to the changes in architectural properties of muscle depending on muscular infiltration. IMF in knee muscles is an important determining factor in performance and physical function of middle-aged women with KOA. [ABSTRACT FROM AUTHOR]

In this work, we present a modification of the phase-field tumor growth model given in [1] that leads to bounded, more physically meaningful, volume fraction variables. In addition, we develop an upwind discontinuous Galerkin (DG) scheme preserving the mass conservation, pointwise bounds and energy stability of the continuous model. Finally, some computational tests in accordance with the theoretical results are introduced. In the first test, we compare our DG scheme with the finite element (FE) scheme related to the same time approximation. The DG scheme shows a well-behavior even for strong cross-diffusion effects in contrast with FE where numerical spurious oscillations appear. Moreover, the second test exhibits the behavior of the tumor-growth model under different choices of parameters and also of mobility and proliferation functions. • Extension of phase-field tumor model to be pointwise bounded and energy-dissipative. • Development of DG scheme that preserves the pointwise bounds and is energy-stable. • Numerical experiments contrasting the DG approximation with a FE counterpart. • Simulations showing the effects of different mobility and proliferation functions. [ABSTRACT FROM AUTHOR]

La artritis reumatoide (AR) cursa generalmente con una afectación mayor en el miembro superior, pudiendo ocasionar dificultades en el desempeño de actividades en el día a día. El objetivo principal de este estudio fue establecer la relación entre la autoeficacia, la intensidad del dolor y la duración de los síntomas en pacientes con AR, y analizar cómo y en qué medida cada uno de ellos influye en la discapacidad funcional, así como, conocer el valor predictivo de la autoeficacia sobre las demás variables. Estudio transversal con una muestra de 117 mujeres con AR. Las variables de evaluación empleadas fueron la escala visual analógica (EVA), el cuestionario QuickDASH y la escala española de autoeficacia en enfermedades reumáticas. Los resultados muestran que el modelo más significativo para la función (R2 = 0,35) incluye la variable función y dolor, por lo que, sí hay relación existente entre la autoeficacia, la intensidad del dolor y la funcionalidad del miembro superior, así como la asociación de las puntuaciones obtenidas en la EVA, QuickDASH y la escala española de autoeficacia en enfermedades reumáticas para su evaluación. Nuestros resultados, concuerdan con estudios previos donde se establece la posible relación entre la autoeficacia y la discapacidad funcional, así como la autoeficacia y su relación con funciones físicas, demostrando que un bajo nivel de autoeficacia implica una disminución de la funcionalidad, pero sin que ninguna variable sea más predictora que otra. Rheumatoid arthritis (RA) primarily affects the upper limbs and can cause disturbances in the performance of daily activities. The main objective of this study was to establish the relationship between self-efficacy, pain intensity, and duration of symptoms in patients with RA and analyse how each influences functional disability, and to determine the predictive value of self-efficacy over the other variables. Cross-sectional study with a sample of 117 women diagnosed with RA. The endpoints were the visual analogue scale (VAS), Quick-DASH questionnaire and the Spanish scale of self-efficacy in rheumatic diseases. The most significant model for function (R2 = 0.35) includes function and pain, therefore, there is a relationship between self-efficacy, pain intensity, and upper limb functionality. Our results agree with previous studies where a relationship between self-efficacy and functional disability is established, as well as self-efficacy and its relationship with physical functions, demonstrating that a low level of self-efficacy implies a decrease in functionality; however, no variable is more predictive than another. [ABSTRACT FROM AUTHOR]

• A new adaptive polynomial chaos expansion technique for surrogate modelling. • Novel basis selection strategy comprising basis expansion, pruning, and refinement. • Automatic and simultaneous selection of training samples and truncation degree. • Sparse representation along with sequential sampling and adaptive basis selection. • Validation using benchmarks and physical model and comparison with existing methods. In this paper, a novel adaptive modelling framework for sparse polynomial chaos expansion is proposed, which can automatically determine adequate truncation degree and training sample set simultaneously. Moreover, the curse of dimensionality issue in polynomial chaos expansion, which generally arises in dealing with high input dimension or large truncation degree, can be alleviated to a large extent. In this framework, a new basis selection strategy, which leverages basis expansion, pruning and refinement, is pursued to adaptively select the polynomial terms of proper degree during the modelling process. Besides, an outstanding sequential sampling strategy is adopted to collect samples of high quality and in relatively small quantity for training polynomial chaos expansion model, and a sparse representation method, Bayesian compressive sensing, is employed for regression calculation. To reconcile the sequential sampling and adaptive basis selection in a consistent framework, a stability evaluation process which works in parallel with the sequential sampling process is performed. The performance of the proposed adaptive modelling framework is evaluated on two benchmark functions and a physical model through comparison with an existing adaptive polynomial chaos expansion modelling technique, a sequential sampling-only approach, and several basis adaptivity strategies. Results demonstrate that the proposed method has high adaptiveness in building surrogate models for various problems. It outperforms the existing adaptive polynomial chaos expansion modelling technique in terms of modelling precision and convergence rate, and it has similar performance with the sequential sampling-only method while lessening the burden in regression calculation and enabling adaptive determination of the truncation degree. Limitations of the proposed method are also summarized after comparing it with various basis adaptivity strategies. [ABSTRACT FROM AUTHOR]

Modeling attacks such as machine learning attacks are pretty efficient in breaking hardware security primitives like silicon strong physical unclonable functions (PUFs). As compared to regular strong PUFs such as arbiter PUFs and lightweight (LW)-PUFs, subthreshold current array (SCA)-PUFs exhibit a better resilience against modeling attacks since they utilize the non-linear relationship between the subthreshold current and gate voltage of transistors to obfuscate the corresponding relationship between input challenge and output response. Unfortunately, the degree of non-linearity (DoNL) within SCA-PUFs is still not sufficiently high to resist against state-of-the-art modeling attacks. Therefore, to further enhance DoNL for resisting against modeling attacks, a new strong PUF architecture is proposed in this paper by embedding reconfigurable neural networks (RNNs) into SCA-PUFs. Mathematical foundations are established for finding appropriate RNNs that are able to maximize the DoNL of an SCA-PUF. As shown in the result, when state-of-the-art modeling attacks like Lagrange multiplier attacks (LMAs) are selected, the robustness of the proposed RNN-embedded SCA-PUF is enhanced over 20 times with less than 18.5% power and area overhead as compared to a regular SCA-PUF. • SCA-PUF utilizes the non-linear sunthreshold current of transistors. • SCA-PUF is quite vulnerable to advanced modeling attacks such as LMAs. • RNN-embedded SCA PUF resists LMAs by masking power side-channel information. [ABSTRACT FROM AUTHOR]

Patient-Reported Outcomes Measurement Information System (PROMIS) enables the use of computer adaptive testing (CAT). The aim of this prospective cohort study was to compare the most commonly used disease-specific instruments with PROMIS CAT questionnaires in patients with trauma. All patients with trauma (ages 18-75) who underwent an operative intervention for an extremity fracture between June 1, 2018, and June 30, 2019, were included. The disease-specific instruments were the Quick Disabilities of the Arm, Shoulder, and Hand for upper extremity fractures and the Lower Extremity Functional Scale (LEFS) for lower extremity fractures. Pearson's correlation (r) between the disease-specific instruments and the PROMIS CAT questionnaires (PROMIS Physical Function, PROMIS Pain Interference, and PROMIS Ability to Participate in Social Roles and Activities) was calculated at week 2, week 6, month 3, and month 6. Construct validity and responsiveness were calculated. A total of 151 patients with an upper extremity fracture and 109 patients with a lower extremity fracture were included. At month 3 and month 6, the correlation was strong between the LEFS and PROMIS Physical Function (r = 0.88 and r = 0.90, respectively), and at month 3, the correlation was strong between the LEFS and PROMIS Social Roles and Activities (r = 0.72). At week 6, month 3, and month 6, there was a strong correlation between the Quick Disabilities of the Arm, Shoulder, and Hand and PROMIS Physical Function (r = 0.74, r = 0.70, and r = 0.76, respectively). The PROMIS CAT measures are acceptably related to existing non-CAT instruments and may be a useful tool during follow-up after operative interventions for extremity fractures. • Patient-Reported Outcomes Measurement Information System computer adaptive testing (CAT) questionnaires could be used as a supplement to outpatient visits to provide insight into perceived health and the domain of experienced limitations. Knowledge about the results and the clinical consequences has yet to grow, but using these questionnaires could enhance communication between clinicians and patients. • Patient-Reported Outcomes Measurement Information System CAT measures are acceptably related to existing non-CAT instruments, resulting in a lower response burden than that with injury-specific instruments. [ABSTRACT FROM AUTHOR]

Surgical treatment of spinal metastases has been associated with high morbidity and mortality in patients with sarcopenia based on low skeletal muscle mass. We assessed physical performance using the Eastern Cooperative Oncology Group performance status scale and the Barthel Index on the 30th day after palliative surgery for spinal metastases and investigated the effectiveness of surgery according to sarcopenia assessed by skeletal muscle mass. We retrospectively analyzed 78 consecutive patients with thoracic and lumbar spinal metastases who underwent palliative surgery. The value of the area of the psoas major muscle at the L3 level normalized by the vertebral area was divided into first, middle, and third tertiles. Clinical variables were compared by tertile. Variables affecting the 30-day good performance status were investigated with univariate and multivariate analyses. The 30-day morbidity rates were 50%, 38.5%, and 15.4% by tertile. The 30-day mortality rate was 2%; all were in the first tertile. Good preoperative performance status scores were seen in 15.4% of first and 50% of third tertile patients. Postoperatively, the performance status improved in all groups, with 30.8%, 65.4%, and 92.3% by tertile. Multivariate regression analysis revealed that a good preoperative performance status (OR: 15.50, 95% CI: 1.610–149.00, P < 0.05) and the value of the area of the psoas major muscle at the L3 level normalized by the vertebral area not in the first tertile (OR: 0.22, 95% CI: 0.06–0.82, P < 0.05) were significant predictors of a good postoperative 30-day performance status. A good preoperative performance status and exclusion from the first tertile were clinical factors predicting a good postoperative 30-day performance status. In patients with large psoas muscle mass (third tertile), a good 30-day performance status can be expected after surgery, suggesting that surgery in this population should be pursued aggressively. [ABSTRACT FROM AUTHOR]

We propose a stochastic memristor utilizing ultrathin native-SiO x films (∼2.7 nm) and dynamic Ag nanoclusters for constructing physical unclonable function (PUF) hardware. The atomically thin solid electrolyte allows for quantum-mechanical tunneling current at high resistance states, which exponentially increases the entropy between separated devices. This results in good uniformity (54.4%), uniqueness (53.7%), and reliability (98.75%) for the prototype native-SiO x mem-PUF array. Furthermore, the proposed device demonstrates reconfigurability for key refreshing and passes all 15 National Institute of Science and Technology (NIST) tests, verifying the high randomness of the generated bits. Overall, this work highlights the potential of the ultrathin native-SiO x memristor for PUF applications. [ABSTRACT FROM AUTHOR]

The Japanese Orthopaedic Association (JOA) introduced the concept of locomotive syndrome (LS), which indicates a decline in mobility function by musculoskeletal disorders with new 3-staged category. Additionally, sarcopenia indicates a decline in the quantity and/or quality of skeletal muscle. However, the relationship between low back pain (LBP) and LS or sarcopenia in older people has not been sufficiently understood. This study aimed to investigate the association between them through a cross-sectional locomotorium survey. A total of 302 participants were drawn from the aquatic exercise participants in a rural area of Japan. The body mass index, body fat percentage, skeletal muscle mass index (SMI), spinal inclination angle (SIA), grip strength, timed up-and-go test (TUG), and maximum stride of the participants were measured. LBP and LBP-related quality of life (QOL) were evaluated using the Oswestry Disability Index (ODI), visual analogue scale (VAS) of LBP, and the Short-Form 8 (SF-8). Associations between the investigating parameters and sarcopenia or LS were analyzed. There were no significant differences in the findings except grip strength between the non-sarcopenia and sarcopenia groups. However, the LS group showed significantly larger SIA, higher ODI, higher VAS of LBP, lower physical component score (PCS) of the SF-8, longer time in TUG, and lower value in maximum stride than the non-LS group. In addition, the ODI and PCS of the SF-8 significantly deteriorated as the LS stage progressed, and the GLFS-25 score was significantly correlated with ODI (r = 0.706, p < 0.001) and PCS (r = −0.643, p < 0.001) scores. LBP, LBP-related QOL, and physical performance were found to be significantly associated with LS, not sarcopenia, with LBP-related QOL and physical function being closely correlated with 3-stage categories of LS. Thus, these results suggested that LBP is a key factor for LS prevalence. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) limits survival and negatively affects health-related quality of life (HRQOL). Cost-effectiveness analysis (CEA) may be used to make reimbursement decisions for new CF treatments; nevertheless, generic utility measures used in CEA, such as EQ-5D, are insensitive to meaningful changes in lung function and HRQOL in CF. Here we develop a new, CF disease–specific, preference-based utility measure based on the adolescent/adult version of the Cystic Fibrosis Questionnaire-Revised (CFQ-R), a widely used, CF-specific, patient-reported measure of HRQOL. Blinded CFQ-R data from 4 clinical trials (NCT02347657, NCT02392234, NCT01807923, and NCT01807949) were used to identify discriminating items for a classification system using psychometric (eg, factor and Rasch) analyses. Thirty-two health states were selected for a time trade-off (TTO) exercise with a representative sample of the UK general population. TTO utilities were used to estimate a preference-based scoring algorithm by regression analysis (tobit models with robust standard errors clustered on participants with censoring at −1). A classification system with 8 dimensions (CFQ-R-8 dimensions; physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image) was generated. TTO was completed by 400 participants (mean age, 47.3 years; 49.8% female). Among the regression models evaluated, the tobit heteroscedastic–ordered model was preferred, with a predicted utility range from 0.236 to 1, no logical inconsistencies, and a mean absolute error of 0.032. The CFQ-R-8 dimensions is the first disease-specific, preference-based scoring algorithm for CF, enabling estimation of disease-specific utilities for CEA based on the well-validated and widely used CFQ-R. • Cost-effectiveness analysis (CEA) may guide reimbursement decisions for cystic fibrosis (CF) treatments; nevertheless, standard measures of utility used in CEA are insensitive to changes in lung function and health-related quality of life in CF. • We used blinded Cystic Fibrosis Questionnaire-Revised (CFQ-R) data from 4 clinical trials to develop the CFQ-R-8 dimensions (CFQ-R-8D), a new, CF disease–specific, preference-based utility measure with 8 dimensions (physical functioning, vitality, emotion, role functioning, breathing difficulty, cough, abdominal pain, and body image). • The CFQ-R-8D enables disease-specific utilities for use in CEA to be generated from the CFQ-R, a measure that is widely used in CF trials. [ABSTRACT FROM AUTHOR]

With the Integrated Circuits becoming pervasive in all key industries and applications, PUF's has gained immense popularity for securing the IC's by providing unique identification code to each chip. Designing a highly efficient PUF with optimal values of uniqueness and reliability is a significant challenge. Uniqueness depends on process variations during chip fabrication, and reliability depends on the chip's ability to resist changes to supply voltage and temperature variations. Multiple PUF designs that employ reliability enhancement circuits and security algorithms achieve these design characteristics. Nonetheless, these techniques are design overheads. This paper presents a novel Physical Unclonable Function (PUF) based on the ProHys switch. It deals with hysteresis and proteresis mode of operation, which are complementary to each other. The Prohys PUF befittingly satisfies both uniqueness and reliability criteria, without any additional circuitry or security algorithms. It is the first attempt to design a PUF based on the ProHys switch to the best of our knowledge. The proposed ProHys PUF is designed in TSMC 180 nm CMOS technology, generating an inter-chip variation of 49.85% with 99.7% uniqueness. The minimum reliability of the circuit is 96.9% for a temperature range of -40 °C to 100 °C at a supply voltage range of 1.7V–1.9V. • A novel Physical Unclonable Function (PUF) based on ProHys switch is presented. • It satisfies uniqueness and reliability criteria without any additional circuitry. • This is the first attempt to design a ProHys based PUF, to the best of our knowledge. • Proposed PUF generates an inter-chip variation of 49.85% and uniqueness of 99.7%. • The minimum circuit reliability is 96.9% at a supply voltage range of 1.7 V–1.9 V. [ABSTRACT FROM AUTHOR]

Various security measures for IoT devices have been introduced in recent years. One of the improvements is through the addition of cryptographic hardware along with the central core processor. As IoT devices are resource-constrained, area and power-efficient solutions are needed. Every cryptographic algorithm has a key generator that provides proper keys to encrypt and decrypt the data. This paper focuses on improving the key generators using Physical Unclonable Functions (PUFs). Execution of NIST-STS randomness test and evaluation of crucial performance parameters is done for the generated bit-stream by proposed PUF design. The proposed design is also compared with three designs from the literature based on area and power consumption which are essential parameters for resource-constrained IoT devices. For proposed design number of LUTs, FFs and power consumption are decreased up to 80%, 76% and 67%, respectively, when implemented on Xilinx Artix-7 FPGAs. • PUF based approach to be used for key generation. • A comparative study is done with RO, TERO, and Arbiter PUF. • The output bitstream of the proposed design also checked for randomness, entropy, uniqueness, steadiness, uniformity, and bit-aliasing. • Efficient key generator design for the cryptographic algorithm in terms of area and power consumption is identified as PDL-PUF based design. [ABSTRACT FROM AUTHOR]

La espondiloartritis axial (EspAax) es una enfermedad musculoesquelética con manifestaciones diversas. En la práctica clínica se ha observado variabilidad y limitaciones en la recogida de las variables necesarias para su seguimiento. El objetivo del proyecto CREA fue consensuar estrategias de mejora para la valoración inicial y el seguimiento de los pacientes con EspAax en España. Se realizó una encuesta con 33 preguntas a una muestra representativa de reumatólogos expertos del territorio español sobre la práctica clínica, los recursos y las limitaciones actuales en el seguimiento de los pacientes con EspAax. En 10 reuniones regionales se discutieron los resultados de la encuesta y se propusieron 107 estrategias que fueron valoradas mediante un consenso Delphi en el que participaron 85 expertos. La falta de tiempo en consulta, de personal de enfermería y/o de apoyo, y el retraso en la realización de pruebas de imagen fueron las limitaciones más destacadas en el seguimiento de los pacientes con EspAax. Se propusieron 202 estrategias relacionadas con la evaluación de los índices de calidad de vida e impacto de la enfermedad; las comorbilidades y manifestaciones extraarticulares; las pruebas de laboratorio; las pruebas de imagen; la exploración física y metrología; y los índices de actividad y función. De todas, 54 se consideraron altamente aconsejables. No se encontraron diferencias regionales en los valores de consenso. Las propuestas consensuadas como altamente aconsejables en el estudio actual son aplicables a todo el territorio nacional, permiten realizar un seguimiento y control más estrecho y homogéneo de los pacientes con EspAax, facilitar un manejo integral y responden a las necesidades no cubiertas detectadas en la encuesta inicial. Axial spondyloarthritis (axSpA) are musculoskeletal diseases with different manifestations. In clinical practice, variability, and limitations in the collection of the outcomes required for follow-up have been observed. The objective of the CREA project was to agree on improvement strategies for the initial assessment and follow-up of patients with axSpA in Spain. A survey with 33 questions was conducted by a representative sample of rheumatologists on clinical practice, resources, and present limitations in the follow-up of patients with axSpA. The results of the survey were discussed in 10 regional meetings, and 105 strategies were proposed and evaluated through a Delphi consensus in which 85 experts participated. The lack of time for clinical visits, the lack of nurses and/or support staff and the delay in performing the imaging tests were the most prominent limitations in the follow-up of patients with axSpA. One hundred and five strategies were proposed related to the evaluation of disease activity, physical function, quality of life and disease impact, to the evaluation of comorbidities and extra-articular manifestations, laboratory tests; imaging tests, physical examination and metrology. Of the total, 85 were considered highly advisable. No regional differences were found. The proposals agreed upon as highly advisable in the present study are applicable to the entire national territory, allow tighter and more homogeneous monitoring of the patients with axSpA, facilitate more comprehensive management of the disease, and respond to the unmet needs detected in the initial survey. [ABSTRACT FROM AUTHOR]

Ascites is the most common complication of decompensated cirrhosis of liver requiring paracentesis for diagnostic and therapeutic purposes. The ascitic fluid leak can develop after paracentesis in patients with cirrhosis leading to significant morbidity if persistent. We aimed to study the incidence and predictors of post-paracentesis leak in patients with ascites. In this prospective study, patients with cirrhosis undergoing therapeutic paracentesis were followed up, and those patients who developed persistent leak were included as cases. Controls were randomly selected in a 2:1 ratio from the group of patients who did not develop leak. Clinical and laboratory parameters were compared between the two groups. A total of 256 patients underwent 1126 sessions of therapeutic abdominal paracentesis over a period of 14 months. Post-paracentesis leak was seen in 55 (4.8%) patients while only 20 (1.7%) patients had persistent leak. The management of leak was in a stepwise manner initially with tincture benzoin with tight dressing followed by topical cyanoacrylate adhesive and followed by autologous blood patch in those not responding. The persistent leak group had higher proportion of patients with parietal edema, higher PT-INR and Child-Pugh score, lower mid-upper arm circumference, short physical performance battery score, and handgrip strength. On multivariate analysis, only the presence of parietal edema was an independent predictor of post-paracentesis persistent leak (odds ratio 10.35, 95% confidence interval 1.61–66.54, P = 0.014). Persistent leak after paracentesis develops in a minority of patients with cirrhosis. The presence of parietal edema is a risk factor for persistent leak. The majority of these patients can be managed in a stepwise approach. [ABSTRACT FROM AUTHOR]

Melilite-spinel porous ceramics with high apparent porosity, sufficient strength and ultralow thermal conductivity were successfully prepared via a direct-thermal decomposition route using the solid waste of phosphorus tailings and coal gangue as raw materials. The micropores are derived from the in situ decomposition of dolomite and kaolinite, whose morphology, distribution form and quantity determine the thermal insulation performance and physical properties of porous ceramics. Melilite-spinel porous ceramics with an ultralow thermal conductivity of 0.036 W/(m·K) (tested at 200 °C), an apparent porosity of 61.3% and a compressive strength of 2.95 MPa, exhibited promising application prospects in thermal insulation materials used for high-temperature fields. [ABSTRACT FROM AUTHOR]

Background In animal studies, a meal containing Alaska pollack protein (APP) induces fast-twitch muscle hypertrophy. To our knowledge, no interventional studies have examined the benefits of APP intake on muscle mass and muscle weakness and the prevention of sarcopenia in older individuals. Objectives We evaluated the effects of APP intake on skeletal muscle mass, muscle strength, and physical performance among healthy community-dwelling older Japanese women. Methods In this double-blind randomized controlled trial, healthy women ≥ 65 y old were allocated to an APP or whey protein control (CON) group. Participants ingested test protein meals (5.0–5.1 g protein/serving) daily for 24 wk. Between-group differences in the change of skeletal muscle mass index (SMI) as the primary outcome and muscle strength as a secondary outcome were tested using multifrequency BIA and a handheld dynamometer, respectively, at baseline, and 4, 12, and 24 wk. The mean changes in the measured primary and secondary outcome variables from baseline to 4, 12, and 24 wk were compared using unpaired t tests. Results There were no between-group differences in nutritional status, food intake, or total energy and protein intakes at baseline, 12 wk, or 24 wk. The change in SMI was 0.12 kg/m2 (95% CI: 0.01, 0.23 kg/m2) and 0.11 kg/m2 (95% CI: 0.03, 0.19 kg/m2) greater in the APP group than in the CON group at 12 wk and 24 wk (P  ≤ 0.03) and knee extension strength was 0.07 Nm/kg BW (95% CI: 0.02, 0.12 Nm/kg BW) and 0.05 Nm/kg BW (95% CI: 0.00, 0.09 Nm/kg BW) higher in the APP group than in the CON group at these times (P  ≤ 0.015), respectively. The groups did not differ at 4 wk. Conclusions Daily intake of a meal containing APP compared with whey protein increases skeletal muscle mass and lower-extremity muscle strength in healthy older women, suggesting that an APP-containing meal may be useful in the prevention of sarcopenia in this group. This trial was registered at as UMIN000035718. [ABSTRACT FROM AUTHOR]

The coating of hydroxyapatite (HAP) on the surface of bio-inert metallic implants to augment their bioactivity is in use for the last two decades. Substitution of various materials in HAP further improves the functionality of these coatings. We demonstrate coating of Ti6Al4V alloy sheets with strontium and niobium reinforced HAP using microwave (MW) irradiation technique. Physical characterization revealed, uniform semicrystalline hydroxyapatite coating with enhanced surface roughness and microhardness. The increased surface roughness was accompanied by higher wettability and more protein adsorption. Electrochemical corrosion assessment showed a dramatic increase in corrosion potential and a noticeable decline in corrosion current density suggesting an enhanced anticorrosive behaviour. These implants also exhibited improved hemocompatibility and bacteriostatic properties. Cell viability and confocal microscopy studies of the coated samples showed enhanced cell attachment on the surface. We propose microwave irradiation as a fast and hassle-free alternative for one-pot synthesis and deposition of ionic substituted HAP on metallic implants. [ABSTRACT FROM AUTHOR]

A frequently used patient-reported outcome measure for assessing physical functioning in patients with hip problems is the 5-item Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS). Nevertheless, its content validity (whether this instrument adequately reflects the construct of physical functioning) is unknown. This study aimed to assess the content validity of the HOOS-PS. A quantitative and qualitative research approach was used. Physical functioning was defined as the ability to perform activities that require physical actions, ranging from self-care to more complex activities that require a combination of skills, often within a social context. Patients (n = 51) and experts (n = 25) completed questionnaires regarding the relevance, comprehensiveness, and comprehensibility of the HOOS-PS. Semistructured interviews (n = 5) explored issues identified in the quantitative data in more depth. Thematic content analysis was conducted using a coding frame. One of the 5 items was considered relevant to measure physical functioning. Comprehensiveness was considered insufficient by both patients and experts. Furthermore, comprehensibility was considered inadequate. Several items were found ambiguous or double barreled. Regarding interpretability, floor or ceiling effects were not found. This study showed concerns about the content validity of the HOOS-PS: most items are considered not relevant, the HOOS-PS is considered not comprehensive, and several items are considered not comprehensible. These findings challenge the applicability of the HOOS-PS in clinical practice, research, value-based healthcare, and benchmarking. • This study showed that the content validity of the Hip Disability and Osteoarthritis Outcome Score-Physical Function Shortform (HOOS-PS) in patients undergoing hip arthroplasty is problematic in 3 areas: (1) lack of relevance, (2) insufficient comprehensiveness, and (3) insufficient comprehensibility of the items. • Given that the HOOS-PS does not reflect physical functioning in total hip arthroplasty patients, this will challenge the applicability of the HOOS-PS in clinical practice, research, and benchmarking. • The lack of content validity in the observed data can subsequently lead to drawing incorrect conclusions. [ABSTRACT FROM AUTHOR]

Background: When treating cancer patients, the progression of symptoms is accompanied by the deterioration of systemic conditions and motor function. From a risk-benefit perspective, a certain level of physical function must be maintained to continue cancer treatment. Recently, outpatient cancer treatment has become more common. Motor function is important to determine the feasibility of continuing cancer treatment. The study aimed to evaluate the motor function of patients with visceral cancer using locomo tests established by Japanese Orthopaedic Association.Methods: Locomo tests were performed, and the results were compared with data from non-cancer individuals. Background data were matched by propensity score matching. Data from 53 cancer patients (group C) were compared with that of 75 non-cancer patients (group N).Results: The average score in the two-step test of group C was lower than that of group N (1.27: 1.37, p = 0.004). The average function in the stand-up test of group C was worse than that of group N (p = 0.001). The average score in the 25-question geriatric locomotive function scale (GLFS) of group C was significantly higher than that of group N (19.92: 5.29, SE 2.21, p < 0.001). Higher 25-question GLFS scores indicate reduced mobility. The proportion of the locomo stage 2 in group C was significantly higher than in group N (51%: 13%, p < 0.001). The results of the two field tests revealed a clinically minimal difference between the two groups, but a statistically significant difference. Locomo tests may be detect potential motor dysfunction in outpatient cancer patients with apparently maintained motor function.Conclusions: Even in cancer patients who attend outpatient clinics, their motor functions could be potentially impaired. Therapeutic interventions to maintain and enhance motor function for cancer patients could be useful for continuing cancer treatment, and furthermore, improving prognosis. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the relationship between frequently used patient-reported outcome (PRO) measures and a multitask performance outcome (PerfO) measure of general physical function (PF) and to examine the association of these measures with depressive mood, pain, and age.Methods: Frequently used PRO measures of general PF (Patient-Reported Outcomes Measurement Information System [PROMIS] PF item bank, PROMIS PF Short Form 20a, Short Form 36 Physical Function Scale) and a PerfO test battery, namely, the Physical Performance Test (PPT), were administered to 78 adult patients from 3 inpatient clinics (cardiology and angiology, rheumatology and clinical immunology, and psychosomatic medicine) at Charité - Universitätsmedizin Berlin. Pearson correlations were used to investigate the associations between PRO measures and the PPT. To explore the predictive value of age, depressive symptoms, and pain intensity, we conducted multiple linear regression analysis for each PF measure.Results: We found strong linear relationships between PRO measures and PPT sum scores. Correlations between PPT sum scores and PROMIS PF T-scores were r > 0.75. For all PRO and PerfO measures, age was a predictor of general PF whereas depressive mood was not found to be a relevant predictor. Moreover, pain intensity was found to be a significant predictor of PRO measures but not for PPT sum scores.Conclusions: Our findings suggest that frequently used PRO measures and a multitask PerfO measure of general PF can be used to measure a common PF construct. Nevertheless, PF scores based on PRO measures should ideally be controlled for self-rated pain intensity. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to compare the treatment preference among oncologists, patients with lung cancer, and their family members in China.Methods: A face-to-face discrete choice experiment survey was conducted among oncologists, patients, and their family members. Participants completed 13 choice sets describing 6 key attributes, namely, overall survival time, risk of severe adverse effect, severity of pain, appetite, physical functioning status, and monthly cost. Mixed logit model and latent class analysis were used to estimate attribute level preference weights and the relative importance (RI) for attributes. The willingness to pay (WTP) and maximum acceptable risk (MAR) were also estimated. The RI, WTP, and MAR of oncologists, patients, and family members were compared.Results: A total of 121 oncologists and 161 dyads of patients and family members completed the survey. Overall survival time, physical functioning status, and pain were the 3 most important attributes across all 3 groups. Oncologists and family members had higher RI on overall survival time than patients (48% and 51% vs 38%). Patients had higher RI on physical functioning status and pain (23% and 14%) than oncologists (13% and 12%) and family members (16% and 11%). For extending survival, patients had the least WTP, and family members had the highest MAR. The latent class analysis identified 2 classes in the patient group and 3 classes in oncologist and family member groups.Conclusions: There were differences in preferences for survival, risk, quality of life, and costs associated with cancer treatments among patients, oncologists, and family members. This finding highlights the need of involving patients in treatment decision making in China. [ABSTRACT FROM AUTHOR]

China is on the brink of transitioning into an aged society, resulting in a growing demand for an age-friendly street-built environment. However, previous research has paid limited attention to the differentiated walking needs of older adults. To address this gap, this study investigated the relationship between street-built environments and the subjective perception of older adults with different physical capabilities, focusing on safety, comfort, and interest. The older adults were classified into three types based on their physical mobility abilities. The TrueSkill algorithm was used to develop an online image selection website to obtain perception scores for sampled pictures from these three types of older adults. Image segmentation and deep learning were combined to extract indices of street view factors, and machine learning was used to train a scoring prediction model for all streetscape pictures of the area. The study found differences in the subjective perception among all three types of older adults, namely independent elderly (A), mediated-assisted elderly (B), and dependent elderly (C). Type A older adults might be attracted to factors related to the interest of walking despite their negative impact on safety and comfort; Type B older adults were more concerned about street conditions for safety and comfort. Type C older adults were prone to the convenience of barrier-free access and visibility. This study contributes to the study of walkability by providing a research framework for the subjective walking perceptions of older adults with different physical capabilities. Additionally, the visualized walkability map can serve as a reference for architects and urban designers, further strengthening the development of age-friendly communities with the aid of human-centric computational analysis, evaluation, and design. • Refines walkability research for older adults by categorizing and studying them based on walking abilities, showing differences by physical conditions. • Explores the relationship between subjective perceptions and the objective built environment, focusing on long-established communities. • Uncovers implicit needs and tendencies using picture selection and the TrueSkill rating method. • Uses pedestrian-perspective street view images instead of the commonly used vehicular-perspective images for research. [ABSTRACT FROM AUTHOR]

Estimating the illuminant from a color-biased image is an ill-posed problem without prior information or invariance about the surfaces of a scene. Based on the classical image formation model, we have developed a heuristic approach to obtain the illuminant color by computing the ratio of the average of all pixels over the color-biased scene to that over the roughly recovered scene obtained by local normalization in each channel. The computed ratio represents an estimated invariance across color channels (IACC), ranging between the average reflectance of surfaces and the maximum reflectance of surfaces of a scene, modulated by the illuminant color. This work builds a mathematical foundation for IACC and explains why it is suitable for illuminant estimation. The core discovery is that the magnitude relationship of the average reflectances of surfaces between any two color channels is opposite to that of the maximum reflectances of surfaces for most natural scenes. As a result, we have designed two approaches for explicitly learning IACC of an image, resulting in very accurate illuminant estimation. The first approach involves a novel shallow model based on diagonal or non-diagonal matrices, together with the learned model parameters, to improve IACC performance. The second approach applies IACC as a constraint to optimize a novel deep learning approach, which has achieved state-of-the-art performance on two benchmarks. An interesting finding is that the output of the learned network, constrained only by IACC loss, provides a coarse estimation of intrinsic images such as albedo from the input color-biased image. • Biologically inspired image invariance (IACC) with mathematical basis is developed. • IACC guided shallow illuminant estimation (IE) model obtains competitive performance. • IACC guided deep IE obtains SOTA performance and learns physical albedo. [ABSTRACT FROM AUTHOR]

In this work, the synergistic effect of polyaniline (PANI) and Ce cations was utilized to develop a graphene oxide (GO) electrophoretic deposition (EPD) green epoxy (EP) coating with a physical barrier and corrosion inhibition. PANI and Ce cation not only form a protective layer with inhibition but also convert the negative charge of GO to a positive charge, thus satisfying the conditions of cathodic electrophoretic deposition (C -EPD). Anti-corrosion test results showed that the GO/PANI/Ce(NO 3) 3 (GPC)/EP composite coating has the highest impedance, with the impedance modulus at day 35 three orders of magnitude higher than that of the neat EP coating. The passivation film generated by the GPC inhibits large corrosion extensions; it produces a significant self-healing effect, as evidenced by the corrosion morphology, the XPS analysis, and the stable value of the impedance modulus. This work provides a new strategy for manufacturing high-performance electrophoretic epoxy coatings with self-healing properties. [Display omitted] [ABSTRACT FROM AUTHOR]

Background: Most systematic reviews of opioids for chronic pain have pooled treatment effects across individual opioids under the assumption they provide similar benefits and harms. We examined the comparative effects of individual opioids for chronic non-cancer pain through a network meta-analysis of randomised controlled trials.Methods: We searched MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials to March 2021 for studies that enrolled patients with chronic non-cancer pain, randomised them to receive different opioids, or opioids vs placebo, and followed them for at least 4 weeks. Certainty of evidence was evaluated using the GRADE approach.Results: We identified 82 eligible trials (22 619 participants) that evaluated 14 opioids. Compared with placebo, several opioids showed superiority to others for analgesia and improvement in physical function; however, when restricted to pooled-effect estimates supported by moderate certainty evidence, no differences between opioids were evident. Among opioids with moderate certainty evidence, all increased the risk of gastrointestinal adverse events compared with placebo, although no opioids were more harmful than others. Low to very low certainty evidence suggests that extended-release vs immediate-release opioids may provide similar benefits for pain relief and physical functioning, and gastrointestinal harms.Conclusions: Our findings support the pooling of effect estimates across different types and formulations of opioids to inform effectiveness for chronic non-cancer pain. [ABSTRACT FROM AUTHOR]

• Study suggests exercise may help prevent traffic injuries. • Elderly people who do not exercise have a gap between their awareness and behavior when crossing the street. • A high percentage of elderly people are able to react in some way when they are about to have an injury. Introduction: In recent years, the percentage of elderly fatalities in traffic crashes in Japan has been increasing and has exceeded 50% since 2010. The fatality rate is high for the elderly due to the deterioration of physical functions. Method: The purpose of this study was to reduce the high fatality rate of elderly people at the time of the crash and to find out the effective exercise elements for maintaining physical functions, and to deter traffic crashes and reduce the fatality rate of the elderly people. Results: The effect of exercise on improving and maintaining physical fitness was remarkable, and even when encountering a near miss injuries or crashes, the percentage of the group that was able to respond in some way to a near miss or crashes was higher in the group that regularly exercised. The elderly who do not exercise tend to take longer to start crossing and tend to check both sides of the road less often while crossing. In addition, when they were about to encounter a car, they tended to continue walking, which tended to lead to dangerous crossing. Conclusion: As a result of the questionnaire survey, the possibility of preventing traffic crashes by participating in sports was confirmed. As a result of running experiments using a crossing simulator, it was found that elderly people who do not exercise have a gap between their usual awareness of crossing and their actual behavior. Practical implications: Through the discovering elements of exercise that are useful in reducing injuries will make it possible to provide accurate guidance and training to elderly people with reduced physical functions, and it is expected that pedestrians will be able to avoid traffic injuries with their own abilities. [ABSTRACT FROM AUTHOR]

Objectives: Many trials conclude "no clinically meaningful detriment" to health-related quality of life (HRQL) or function between arms, even when notable differential toxicity is observed. Mean change from baseline analyses of function or HRQL can possibly obscure important change in subgroups experiencing symptomatic toxicity. We evaluate the impact of diarrhea, a key treatment arm toxicity, on patient-reported HRQL and functioning in clinical trials submitted to US Food and Drug Administration.Methods: This study used 4 randomized, breast cancer trials (adjuvant to late-line metastatic) as case examples. Diarrhea, physical functioning (PF), and global health status and quality of life (GHS/QoL) from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 were analyzed at baseline and approximately 3 and 6 months.Results: Generally, patients reporting very much diarrhea at months 3 and 6 had worse PF (9-19 points lower) and GHS/QoL (16-19 points lower) than patients reporting no diarrhea regardless of treatment arm. In the change from baseline analysis, patients reporting very much diarrhea also experienced a greater decrease in PF (6-13 points) and GHS/QoL (6-16 points) versus patients reporting no diarrhea in both arms.Conclusions: In trials with moderate to large differences in symptomatic toxicity by arm, reporting "no meaningful difference in functioning and HRQL between arms" based on mean change from baseline analysis is insufficient and may obscure important impacts on subgroups experiencing symptomatic adverse events. Additional exploratory analyses with simple data visualizations evaluating functioning or HRQL in patient subgroups experiencing expected symptomatic toxicities can further inform the safety and tolerability of an investigational agent. [ABSTRACT FROM AUTHOR]

In recent years the focus of healthcare and nutritional science in older adults has shifted from mortality towards physical performance and quality of life. The aim of this review was to summarize observational studies on physical performance in malnourished (MN) or at risk of malnutrition (RMN) older adults compared with well-nourished (WN) older adults. Eligible studies had to report on nutritional status and objectively measured physical performance in older adults (≥60 y). MN or RMN groups had to be compared with a WN group, measured with a validated nutrition screener. Ovid Medline and Web of Science were searched until 13 November, 2020. Study quality was scored using a modified Newcastle–Ottawa Scale (NOS). Results were analyzed by meta-analysis when possible, or narratively reviewed otherwise. Forty-five studies (16,911 participants in total) were included from studies in outpatient clinics (n = 6), nursing homes (n = 3), community-dwelling older adults (n = 20), hospitalized patients (n = 15), or a combination (n = 1). Studies used 11 different screeners of malnutrition, and 8 types of physical performance measures. Meta-analysis showed that compared with MN, WN groups had better hand grip strength (mean difference [MD] = 4.92 kg; 95% CI: 3.43, 6.41; P < 0.001; n = 23), faster gait speed (MD = 0.16 m/s; 95% CI: 0.05, 0.27; P = 0.0033; n = 7), performed faster on timed-up-and-go (MD = –5.94 s; 95% CI: –8.98, –2.89; P < 0.001; n = 8), and scored 1.2 more short physical performance battery points (95% CI: 1.32, 2.73; P < 0.001; n = 6). Results were less pronounced when compared with RMN. Narratively, all studies showed an association for knee extension strength, 6-min walking test, and multicomponent tests, except for the chair stand test. Study limitations include no studies scoring "good" on NOS, lack of confounder adjustment, and high heterogeneity. Overall, evidence from cross-sectional studies indicate an association between malnutrition and worse physical performance in older adults. This study is registered in PROSPERO as CRD42020192893. [ABSTRACT FROM AUTHOR]

Due to the emergence of AI systems that interact with the physical environment, there is an increased interest in incorporating physical reasoning capabilities into those AI systems. But is it enough to only have physical reasoning capabilities to operate in a real physical environment? In the real world, we constantly face novel situations we have not encountered before. As humans, we are competent at successfully adapting to those situations. Similarly, an agent needs to have the ability to function under the impact of novelties in order to properly operate in an open-world physical environment. To facilitate the development of such AI systems, we propose a new benchmark, NovPhy, that requires an agent to reason about physical scenarios in the presence of novelties and take actions accordingly. The benchmark consists of tasks that require agents to detect and adapt to novelties in physical scenarios. To create tasks in the benchmark, we develop eight novelties representing a diverse novelty space and apply them to five commonly encountered scenarios in a physical environment, related to applying forces and motions such as rolling, falling, and sliding of objects. According to our benchmark design, we evaluate two capabilities of an agent: the performance on a novelty when it is applied to different physical scenarios and the performance on a physical scenario when different novelties are applied to it. We conduct a thorough evaluation with human players, learning agents, and heuristic agents. Our evaluation shows that humans' performance is far beyond the agents' performance. Some agents, even with good normal task performance, perform significantly worse when there is a novelty, and the agents that can adapt to novelties typically adapt slower than humans. We promote the development of intelligent agents capable of performing at the human level or above when operating in open-world physical environments. Benchmark website: https://github.com/phy-q/novphy. [ABSTRACT FROM AUTHOR]

In the field of hardware security, the physical unclonable function (PUF) is known as a significant advancement for its unique and unclonable outputs, serving as a 'digital fingerprint' for electronic devices. This distinctiveness is crucial for high-security tasks such as device authentication and cryptographic key generation. The PUF's input-output combinations, known as challenge-response pairs (CRPs), are essential to its functionality. Although the Ring Oscillator (RO) PUF is notable for its security advantages and straightforward implementation, it's considered a 'weak' PUF due to its limited CRPs, highlighting a demand for more robust and secure PUF designs. This paper introduces a novel configurable inversion unit (CIU), integrating two universal logic gates, NAND and NOR, to be utilized in building various configurable ring oscillator (CRO) PUF models. Using the newly proposed CIU, we introduce two distinct CRO-PUF configurations. The first one includes 16-ring oscillators, while the second has 8-ring oscillators. A modified version of this CIU is introduced to increase the size of CRPs that a PUF can handle. A comprehensive assessment process of these configurations underscores the superior performance of these models across various parameters, including reliability, distinctiveness, balance, bit-aliasing, and randomness. • MUX-based CRO PUFs mainly utilize inverters and XOR gates. • XOR gates in CRO-PUFs, with/without MUXs, boost RO-PUF efficacy. • Few CRO-PUF designs use NAND/NOR universal gates. • More ring oscillators in PUFs link to better security. [ABSTRACT FROM AUTHOR]

The 3D reconstruction is generally defined as the process of capturing the shape and appearance of real objects. By reconstructing 3D digital model from a series of 2D slices, it brings considerable convenience to visualize internal structure and decipher structure-property relation of a material. Nowadays, the 3D reconstruction is becoming a cutting-edge technique in depicting the internal structure and evaluating the physical performance of targeted materials. Recent years, generative machine learning methods, such as generative adversarial networks (GAN), have achieved tremendous success in AI-generated physical content (AIGPC). However, lots of technical challenges remain, including oversimplified models, oversized dataset requirement and inefficient convergence. These difficulties are caused by the insufficient ability to capture detailed features and the inadequacy of the generated model quality. To this end, a novel generative model is developed, which combines the multiscale features of U-net and the synthesis ability of GANs. With the help of the multiscale channel aggregation module, the hierarchical feature aggregation module and the convolutional block attention module, our model is developed to capture the features of the material microstructure better. The loss function is refined by combining the image regularization loss with the Wasserstein distance loss. In addition, the anisotropy index is adopted to measure anisotropic degree of selected samples quantitively. The results demonstrate that the 3D structures generated by the proposed model retain high fidelity with ground truth samples. With remarkable performance, the proposed model not only overtakes traditional GAN, but will shed a brilliant light on AIGPC and physical 3D reconstruction. [Display omitted] [ABSTRACT FROM AUTHOR]

River recovery is defined as the trajectory of change that a reach takes towards an improved condition. In geomorphic terms, this includes improvement in both the physical structure and function of a river. While there are numerous case studies that track river recovery at the reach scale, there is a lack of work that characterises the patterns of recovery across diverse river types. Here we use ergodic reasoning to quantitatively analyse changes in the assemblage of geomorphic units (GUs) that occur for rivers that are known to be at different stages of geomorphic recovery. We aim to understand how the physical structure of different river types change as recovery occurs. In this study, we adopted a semi-automated method to map GUs using Open Access LiDAR and Sentinel remote sensing imagery. We analyse the assemblage of GUs for 78 river sections that span eight river styles, three valley settings and two bed material textures – sand and gravel. We find that the patterns of river recovery vary for different river styles. Confined and laterally unconfined rivers exhibit linear and non-linear increases in richness, abundance, evenness, and diversity of GUs during recovery. Partly confined rivers show more variable trends for these measures, and channelised fill rivers show decreased diversity. During recovery, sand bed rivers are more susceptible to adjustment than gravel bed rivers. The presence of benches and islands indicates that recovery is underway across most river types. A statistically significant increase in abundance and area of benches and pools, and a decrease in abundance and area of floodplain steps can also be used to indicate that recovery is underway. Additionally, in early stages of recovery, adjustments take place at the unit level. Then as recovery progresses, adjustments tend to occur at the sub-unit level as evidenced by bank-attached bars becoming more compound in structure. Determining the indicator GUs and changes in assemblages to 'look out for' while in the field or on remote sensing images can aid the detection and analysis of river recovery, providing invaluable insight for process-based and recovery-enhancement approaches to river management. [Display omitted] • Patterns of geomorphic recovery vary across different river styles. • Different mixes of metrics can be used to track geomorphic river recovery. • Recovery is not always linear and morphology does not always become more complex. • Changes in assemblages of units and some individual units can detect recovery. [ABSTRACT FROM AUTHOR]

[Display omitted] • An ultra-fast humidity sensor based on C 60 -OH/PDDA/SiO 2 composite is proposed. • A human-machine interface based on an ultra-fast humidity sensor is presented for assisting aphasia patients with semantic expressions. • This interface is particularly suitable for aphasic patients with limited physical mobility. Communication between aphasic patients and health care professionals (HCPs) is often difficult, which is even more complex for aphasic patients with limited physical mobility. In this study, we have proposed a C 60 -OH/PDDA/SiO 2 -based humidity sensor with an extremely short response/recovery time (13 ms/30 ms). This is closely related to the electrostatic adsorption of PDDA which effectively alleviates the aggregation of C 60 -OH and the introduction of SiO 2 microspheres which increases the diffusion space of water molecules. The fast response and recovery rates gave the sensor good respiratory monitoring capability, which can be used to develop a human–machine interface (HMI) to assist aphasic patients for semantic expression. In this HMI, aphasia patients can generate different respiratory signals through the ultrafast humidity sensors to express specific semantics (such as thirst, hunger, etc.). In contrast to traditional semantic expression devices, this interface does not require the user to have vocal or physical movement, and therefore is extremely friendly to aphasic patients with limited mobility. [ABSTRACT FROM AUTHOR]

The challenge of ensuring compliant behavior in aerial manipulators during physical interactions is addressed in this study. This work presents a coordinated interactive framework for aerial manipulators, specifically designed to ensure compliant physical interactions during contact with the surroundings. Without the reliance on force sensors, an external force estimator is employed to recognize interaction intentions. The coordinated framework leverages a Model Predictive Control (MPC) planner equipped with adaptive weights, facilitating the coordination of movements for both the quadrotor and manipulator. The adaptive adjustment of weights in the cost function allows for the attainment of diverse interaction behaviors in response to unexpected external forces. Notably, the methodology stands out from current control strategies by incorporating autonomous stiffness adjustment in response to interaction forces, thereby optimizing the delicate balance between safety and precision. The passivity of the system is guaranteed by using a Lyapunov-like function during the physical interaction. The effectiveness of the proposed framework is validated by experiments for the scenario of human operator and aerial manipulator collaborative work. [ABSTRACT FROM AUTHOR]

Silicon Physical unclonable functions (PUFs) are regarded as emerging hardware security primitives that can be used for generating secret keys for cryptographic algorithms. Unfortunately, the reliability issues greatly limit the applications of most PUFs since ambient noises and aging issues may alter the output responses of the PUFs. In this paper, a novel error calibration technique (ECT) based on average sampling circuit (ASC) and self-checking circuit (SCC) is proposed for significantly boosting the reliability of PUFs. The primary role of ASC is filtering the ambient noises that may affect the output responses of the PUFs. In contrast, SCC rehabilitates the PUFs once aging issues damage the process mismatches within the PUFs. As shown in the result, a PUF with the proposed ECT is able to achieve a 99% reliability with a 50 Mbps throughput. • Regular PUFs have poor reliability issues due to the effects of ambient noises and aging issues. • Error calibration technique (ECT) is able to the improve the corresponding reliability significantly by filtering critical noises. • An ECT-based PUF offers a high throughput without causing much area overhead. [ABSTRACT FROM AUTHOR]

Self-healing mechanism of SBS modified bitumen based on dynamic acylhydrazone bonds. [Display omitted] • A self-healing agent with acylhydrazone bond was synthesized. • The introduction of acylhydrazone bonds significantly improved the crack self-healing performance of SBS modified bitumen. • The effect of acylhydrazone self-healing agent on the properties of SBS modified bitumen was investigated. Styrene-butadiene-styrene triblock copolymer (SBS) modified bitumen (SMB) with excellent self-healing performance not only saves resources, but is also important for the sustainable development of pavement and construction industry. In this paper, a self-healing agent (SHA) with acylhydrazone bond was synthesized, and the dynamic acylhydrazone bond was introduced into the SBS molecular chains to prepare the self-healing SMB (SHMB). The structure of SHA was characterized, and the physical properties, chemical structure, microstructure and self-healing performance of the SHMB were investigated. Fourier transform infrared (FTIR) spectra and nuclear magnetic resonance spectra demonstrated that SHA was successfully synthesized. The physical performances of SMB were significantly improved by SHA and its optimal dosage was 0.6 %. FTIR indicated that the dynamic acylhydrazone bond was introduced into the SBS molecular chains, and formed hydrogen bonds in SHMB. The fluorescence microscope showed that SHMB had a denser network structure than SMB. The crack healing observation indicated that the crack healing speed of SHMB was much higher than that of SMB. The break tensile performance recovery showed that the recovery rate of elongation at break (R ε) of SMB and SHMB were 14.38 % and 58.27 % after self-healing at 25℃ for 32 h, and the R ε of SMB and SHMB was elevated to 50.12 % and 92.58 % after self-healing at 40℃ for 4 h, which indicated that the introduction of dynamic acylhydrazone bonds greatly enhanced the self-healing ability of SHMB. [ABSTRACT FROM AUTHOR]

This paper investigates the impacts of weather shocks on athlete performance, focusing on soccer players in the Chinese Soccer Super League over three consecutive seasons from 2014 to 2016. Utilizing daily meteorological data, we construct the temperature and precipitation bin variables to explore the marginal effects on the physical and cognitive performance of soccer players. The empirical findings document a sizeable impact of high temperatures and heavy precipitation on players' performance indicators, including physical performance and cognitive performance. Specifically, relative to conditions with temperatures below 15 °C, the total running distances, the number of passes, and the number of fouls for soccer players significantly decrease by 7.6%, 6.0%, and 23.1%, respectively, when temperatures exceed 30 °C. The results for precipitation bins show that relative to conditions with precipitation below 0.1 mm, the total running distances, the number of passes, and the number of fouls for soccer players significantly decrease by 1.2%, 8.2%, and 4.7%, respectively, when precipitation exceeds 50 mm. Moreover, the heterogeneity analysis reveals that the negative effects of high temperatures and heavy precipitation are more pronounced and significant for older players, for matches performed away from home, and for matches performed in areas with higher temperatures or more precipitation. Evidence of player adaptations suggests that players from regions with higher temperatures or more precipitation perform better in terms of physical and cognitive abilities when playing in areas with lower temperatures or less precipitation compared to players from regions with lower temperatures or less precipitation when they compete in areas with higher temperatures or more precipitation. Finally, policy suggestions are proposed to mitigate the impact of weather shocks on soccer players and to promote the sustainability of the soccer industry. [ABSTRACT FROM AUTHOR]

The concrete industry has been responsible for significant depletion of natural resources and at end-of-life significantly contributes to global waste production. To date experimental studies have typically explored the use of single generation recycled aggregates (RA) in concrete production, however, to move towards a circular economy the concrete industry needs to embrace the use of multi-generation recycled aggregate concrete (MGRAC). In this paper the physical and mechanical performance of 45 concrete mix designs over 4 generations of concrete production is explored. At each generation a series of mixes are conducted at various water to cement ratios (w/c) and with a range of blends of virgin and recycled aggregates from differing generations to capture the impact on material properties. The physical and mechanical properties are quantified for both the aggregates and the concretes at each generation. The results show that the physical properties and some mechanical properties of the concrete and RA decrease with respect to virgin aggregate concrete and virgin aggregate but, implementing a 50% replacement of VA can slow down intergenerational degradation. Furthermore, the blending RA from a range of generations can also slow intergenerational degradation but to a lesser extent. Effective aggregate properties are determined, and direct relationships confirmed indicating potential for informed mix design based on an understanding of a few simple aggregate properties. [ABSTRACT FROM AUTHOR]

Integrated computational materials engineering (ICME) has significantly enhanced the systemic analysis of the relationship between microstructure and material properties, paving the way for developing high-performance materials. However, analyzing microstructure-sensitive material behavior remains challenging due to the scarcity of three-dimensional (3D) microstructure datasets. Moreover, this challenge is intensified if the microstructure is anisotropic, as this also results in anisotropic material properties. This paper presents a framework for reconstructing anisotropic microstructures solely based on two-dimensional (2D) micrographs using conditional diffusion-based generative models (DGMs). The proposed framework involves the spatial connection of multiple 2D conditional DGMs, each trained to generate 2D microstructure samples for three orthogonal planes. The connected multiple reverse diffusion processes then enable effective modeling of a Markov chain for transforming noise into a 3D microstructure sample. Furthermore, a modified harmonized sampling enhances the sample quality while preserving the spatial connection between the slices of anisotropic microstructure samples in 3D space. The 2D-to-3D reconstructed anisotropic microstructure samples are evaluated regarding the spatial correlation function and the physical material behavior to validate the proposed framework. The results demonstrate that the framework can reproduce the statistical distribution of material phases and properties in 3D space. It highlights the potential application of the proposed 2D-to-3D reconstruction framework in establishing microstructure-property linkages, which could aid high-throughput material design for future studies. [ABSTRACT FROM AUTHOR]

Assistive product (AP) aims to provide supplementary treatment for patients' physical function and daily activities to improve their functional status. One challenge in the AP design is prioritizing design requirements (DRs) based on patient requirements (PRs) involving diverse and variable interaction behaviors. This work developed and applied a quality function deployment method based on the spherical fuzzy bipartite graph (SFBG-QFD) to comprehensively consider the dependency relationship between PRs and DRs during AP design. Specifically, a spherical fuzzy bipartite graph is constructed in the PR-DR relationship matrix. The projection algorithm generates the one-mode spherical fuzzy graphs of PRs and DRs, reflecting the internal relationship of PR-PR and DR-DR pairs. Subsequently, the interaction influence of PRs and DRs is defined as an additional criterion for the QFD method. Through the SFBG-QFD method, designers can better consider the uncertainty of interaction between different types of requirements and make more reliable decisions. The effectiveness of the proposed method is verified through the AP design for pneumoconiosis patients, and the stability and potential of the proposed method are emphasized through comparative studies. [ABSTRACT FROM AUTHOR]

Core-shell ZrC/Ti 2 AlC reinforced intermetallic composite coatings were successfully prepared by laser cladding in-situ reaction using TiAl–TiC–Al powder preset on R60702 zirconium alloy surface. As-obtained coatings showed good metallurgical bonding with substrates. Composite coatings mainly contained dendritic ZrC/Ti 2 AlC reinforced phase with core-shell structure and intermetallic matrix of Ti x Al y and Zr x Al y , with small amounts of Ti 3 AlC. During laser pool solidification, TiC nucleated at boundary of primary precipitated ZrC dendrite. Al atoms then diffused into TiC outer layer during subsequent solidification process to finally form core-shell structure with ZrC as core and Ti 2 AlC as outer layer. Ti 2 AlC phase of shell structure improved physical performance between hard ZrC particles and matrix in terms of hardness and thermal expansion coefficient. The maximum hardness of cladding layer (848.8 HV) was 5-fold higher than that of zirconium alloy substrate. Also, no cracking was found inside the coatings or at the junction with substrates. In sum, these findings look promising for future applications of MAX phase composite coatings in nuclear power equipment. [ABSTRACT FROM AUTHOR]

There is no "gold standard" tool for the assessment of frailty in cirrhosis. This study compares Liver Frailty Index (LFI), Short Physical Performance Battery (SPPB), Fried Frailty Criteria (FFC), and Clinical Frailty Scale (CFS) for frailty assessment and ascertains its impact on predicting mortality and hospitalizations in a cohort of outpatients with cirrhosis. 116 patients were enrolled in this prospective observational cohort study. Frailty assessment was done using LFI, SPPB, FFC, and CFS. All patients were followed up for 6 months. The primary outcome was the first of either all-cause unplanned hospitalization or all-cause mortality occurring within 6 months of the study period. 100 (86.2%) males and 16 (13.8%) females with a mean age of 50.2 (48.4–51.9, 95% CI) years were included. The most common cause of cirrhosis was alcoholic liver disease (47.4%) followed by hepatitis C (12.9%) and Nonalcoholic steatohepatitis (NASH) (10.3%). There was no significant difference in prevalence of frailty based on LFI (43.1%), FFC (36.2%), CFS (44%), and SPPB (47.4%) (P > 0.05). Frail patients had worse outcomes compared to the Not frail group. At 6 months, the mortality rate in Frail patients was 42% versus 1.5% for the Not frail; hospitalization in Frail patients occurred in 92% versus 6% in the Not frail. On multivariable analysis, independent predictors of mortality were Frailty [OR 14 (1.4–54.2)], alcohol-related cirrhosis [OR 4.2 (1.1–16.3)], Child-Turcotte-Pugh (CTP) [OR 2.1 (1.4–2.9)] and Chronic liver disease questionnaire (CLDQ) [OR 0.1 (0.1–0.4)] scores. LFI, SPPB, FFC, and CFS are comparable in frailty assessment in patients with cirrhosis. Importantly, comparability of the commonly used scores for frailty assessment and prediction of hospitalization and mortality allows flexibility for clinical application. [ABSTRACT FROM AUTHOR]

In this paper, we derive the time-fractional Cahn–Hilliard equation from continuum mixture theory with a modification of Fick's law of diffusion. This model describes the process of phase separation with nonlocal memory effects. We analyze the existence, uniqueness, and regularity of weak solutions of the time-fractional Cahn–Hilliard equation. In this regard, we consider degenerating mobility functions and free energies of Landau, Flory–Huggins and double-obstacle type. We apply the Faedo–Galerkin method to the system, derive energy estimates, and use compactness theorems to pass to the limit in the discrete form. In order to compensate for the missing chain rule of fractional derivatives, we prove a fractional chain inequality for semiconvex functions. The work concludes with numerical simulations and a sensitivity analysis showing the influence of the fractional power. Here, we consider a convolution quadrature scheme for the time-fractional component, and use a mixed finite element method for the space discretization. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine whether responses to Patient-Reported Outcomes Measurement Information System Short Form v2.0 - Physical Function 8c (PROMIS PF8c) items differed when the use of a 7-day recall period was compared with no specified recall period.Methods: Using a within-subject design, we surveyed 1810 individuals from the US general population, administering PROMIS PF8c at survey beginning and end. The order of measure presentation was randomly assigned. We calculated recall difference scores (RDSs) as no recall score minus 7-day recall score using both item response theory-based T scores and raw summed scores. We examined the distribution and created Bland-Altman plots for both RDSTscore and RDSRaw. We also calculated correlations between no recall versus 7-day recall T score and raw scores. Finally, we determined whether differences in no recall versus 7-day recall scores were associated with patient-reported PF.Results: RDSTscore and RDSRaw had means (root mean square differences) of 0.00 (5.43) and -0.04 (3.79), respectively. The vast majority (%) of RDSTscore and RDSRaw values fell between the Bland-Altman limits of agreement (-10.65 to 10.66 and -7.46 to 7.38, respectively). Pearson's correlations between no recall and 7-day recall for T scores and raw scores were 0.88 and 0.87, respectively. Effect sizes for mean RDSTscore and RDSRaw compared across level of Eastern Oncology Cooperative Group performance status, patient global impression of PF severity, and single PF items were near 0.Conclusions: We did not find any significant recall period effect on PF8c responses. Therefore, we recommend the use of the PROMIS physical function standard, with no specified recall time period. [ABSTRACT FROM AUTHOR]

This paper examines explicit positive assessments (EPAs) in personal training, that is, the personal trainer's positive evaluations of the client's physical performance, including comments such as bra ('good'). The data consist of video-recorded training-sessions in Swedish from Finland and Sweden. The methodological framework is interactional linguistics, and the study explores the actions that EPAs perform as well as their linguistic design and embodied and sequential environment. The main actions performed by EPAs in personal training include transitioning between activities, encouraging the client, and making positive evaluations. The personal trainer (PT) may vary the lexical, syntactic, prosodic, and embodied features of the EPA to emphasize any of these actions or a combination of them. Overall, EPAs are a central resource for fulfilling the institutional goals of personal training by guiding the clients through the training-program and motivating them. In addition to their use as feedback on actions in the present moment, EPAs also include forward-focusing aspects aimed at guiding clients' future behavior. • Feedback is essential in personal training, as in other pedagogical settings. • We study feedback in the form of PTs' explicit positive assessments (EPAs). • Examples of EPAs are "good" and "well done". • EPAs are used for transitions, encouragement, and evaluations in personal training. • Prosodic and embodied features are especially crucial for the meaning of EPAs. [ABSTRACT FROM AUTHOR]

Evaluar la efectividad, la seguridad y los costes de etanercept biosimilar (BS) en pacientes con artritis reumatoide (AR), espondiloartritis (EspA) y artritis psoriásica (APs) y en comparación con su original, en condiciones de práctica clínica habitual. Estudio observacional retrospectivo. Se incluyeron 138 pacientes con AR, EspA o APs tratados con al menos una dosis de Benepali® (n = 79) o Enbrel® (n = 59). Como desenlace principal de efectividad del BS o de su original se usó el tiempo de retención del fármaco. Como desenlace secundario de efectividad se midió la proporción de pacientes que alcanzaban baja actividad o remisión a las 52 semanas. La seguridad fue evaluada mediante tasas de incidencia de efectos adversos. Se hizo un análisis de minimización de costes. No se observaron diferencias en cuanto a retención del tratamiento (mediana [intervalo de confianza del 95%, IC 95%] de 12,0 meses [10,2-12,0] para BS y 12,0 meses [12,0-12,0] para el original). Se obtuvieron mejorías similares después de 52 semanas en actividad inflamatoria y función física, excepto en los pacientes con EspA y APs, que en general obtuvieron mejores valores de BASDAI y ASDAS con el BS. No se registraron diferencias en el número total de efectos adversos (0,43 eventos/pacientes-año con BS frente a 0,53 con original). El uso del BS, en lugar de su original, supuso un ahorro neto para el centro de 118.383,55 € (1.747,2€/pacientes-año). El uso del BS parece tan eficaz y seguro como su original y mucho más coste-efectivo. To assess the effectiveness, safety and cost of Etanercept biosimilar in patients with rheumatoid arthritis (RA), spondyloarthritis (SpA) and psoriatic arthritis (PsA) compared to the standard drug in real clinical practice. Retrospective observational study. Case series of 138 patients with RA, SpA or PsA treated with at least one dose of Benepali® (n = 79) or Enbrel® (n = 59). Drug retention time was the primary efficacy endpoint compared to the biosimilar and the original. The proportion of patients achieving low disease activity or remission after 52 weeks was used as the secondary outcome. Safety was assessed by means of the adverse effects incidence rate. A cost minimization analysis was performed. No differences were observed regarding treatment retention time between drugs (median [95% confidence interval, 95% CI] at 12.0 months [10.2-12.0] for the biosimilar and 12.0 months [12.0-12.0] for the original). Similar improvements, in terms of inflammatory activity and physical function, were obtained after 52 weeks except for patients with SpA and PsA who, in general, experienced improvements of BASDAI and ASDAS with the original compared with the biosimilar. No significant differences were observed in the total number of adverse effects (.43 events/patient-years versus the biosimilar and.53 versus the original). Using the biosimilar in place of the original drug resulted in a net savings of 118,383.55 € (1,747.20 €/patient-years) for the hospital. The biosimilar Benepali is as effective and safe as the original and much more cost-effective. [ABSTRACT FROM AUTHOR]