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Abstract Background Systemic inflammatory factors can predict the survival prognosis of gastric cancer (GC) patients after neoadjuvant chemotherapy (NACT). However, whether longitudinal changes in systemic inflammatory factors are associated with short - and long-term outcomes has not been reported. Methods This study is a retrospective analysis of 216 patients with advanced gastric cancer who received NACT between January 2011 and June 2019, comparing receiver operating characteristic (ROC) curves for screening suitable inflammatory markers. Group-based trajectory modeling (GBTM) was used to analyze longitudinal changes in inflammatory markers during NACT to identify different potential subgroups and to compare postoperative complications, recurrence-free survival (RFS), and overall survival (OS) among subgroups. Results Ultimately, neutrophil-lymphocyte ratio (NLR) had the highest area under the curve (AUC) value in predicting prognosis was included in the GBTM analysis. Three trajectories of NLR were obtained: Stable group (SG) (n = 89), Ascent-descend group (ADG) (n = 80) and Continuous descend group (CDG) (n = 47). Compared with SG, ADG and CDG are associated with an increased risk of postoperative recurrence and death. The median time of RFS and OS of SG was longer than that of ADG and CDG (median RFS 81 vs. 44 and 22 months; median OS 69 vs. 41 and 30 months). In addition, CDG had significantly higher postoperative serious complications than SG and ADG (17 (36.2%) vs. 17 (19.1%) and 12 (15.0%); p = 0.005). Conclusion There were different trajectories of NLR during NACT, and these potential trajectories were significantly associated with severe postoperative complications, recurrence, and mortality in patients with GC.

Abstract Background The number of people living with dementia (PLWD) continues to increase, particularly those with severe symptomatology. Severe symptoms and greater ill-health result in more acute care need. Early healthcare interventions can prove beneficial. Healthcare use has not been analysed as a holistic set of interlinked events. This study explores different healthcare pathways among PLWD, social or spatial inequalities in healthcare pathways and subsequent mortality risk. Methods Group-based trajectory models (GBTM) were applied to electronic healthcare records. We generated clusters of PLWD with similar five-year, post-diagnosis trajectories in rates of primary and secondary healthcare use. Potential social and spatial variations in healthcare use clusters were examined. Cox Proportional Hazards used to explore variation in subsequent mortality risk between healthcare use clusters. Results Four healthcare use clusters were identified in both early- (n = 3732) and late-onset (n = 6224) dementia populations. Healthcare use variations were noted; consistent or diminishing healthcare use was associated with lower subsequent mortality risk. Increasing healthcare use was associated with increased mortality risk. Descriptive analyses indicated social and spatial variation in healthcare use cluster membership. Conclusion Healthcare pathways can help indicate changing need and variation in need, with differential patterns in initial healthcare use post-diagnosis, producing similar subsequent mortality risk. Care in dementia needs to be more accessible and appropriate, with care catered to specific and changing needs. Better continuity of care and greater awareness of dementia in primary can enhance prospects for PLWD. Research needs to further illuminate holistic care need for PLWD, including health and social care use, inequalities in care, health and outcomes.

This study has utilised National Oceanic and Atmospheric Administration (NOAA) NCEP/NCAR Reanalysis 1 project meteorological data and the HYSPLIT model to extract the air parcel trajectories for selected historical extreme rainfall events in South Africa. The k-means unsupervised machine learning algorithm has been used to cluster the resulting trajectories, and from this, the spatial origin of moisture for each of the rainfall events has been determined. It has been demonstrated that rainfall events on the east coast with moisture originating from the Indian Ocean have distinctly larger average maximum daily rainfall magnitudes (279 mm) compared to those that occur on the west coast with Atlantic Ocean influences (149 mm) and those events occurring in the central plateau (150 mm) where moisture has been continentally recirculated. Further, this study has suggested new metrics by which the HYSPLIT trajectories may be assessed and demonstrated the applicability of trajectory clustering in a region not previously studied. This insight may in future facilitate improved early warning systems based on monitoring of atmospheric systems, and an understanding of rainfall magnitudes and origins can be used to improve the prediction of design floods for infrastructure design. HIGHLIGHTS Clustering extreme rainfall events based on origins and storm track.; Observed differences in magnitude between event clusters.; Depth of rainfall events (mm/day) from weather systems originating in the Indian Ocean is larger than other events.;

The Asian tropopause aerosol layer (ATAL) is present during the Asian summer monsoon season affecting the radiative balance of the atmosphere. However, the source regions and transport pathways of ATAL particles are still uncertain. Here, we investigate transport pathways from different regions at the model boundary layer (MBL) to the ATAL by combining two Lagrangian transport models (CLaMS, Chemical Lagrangian Model of the Stratosphere; MPTRAC, Massive-Parallel Trajectory Calculations) with balloon-borne measurements of the ATAL performed by the Compact Optical Backscatter Aerosol Detector (COBALD) above Nainital (India) in August 2016. Trajectories are initialised at the measured location of the ATAL and calculated 90 d backwards in time to investigate the relation between the measured, daily averaged, aerosol backscatter ratio and source regions at the MBL. Different simulation scenarios are performed to find differences and robust patterns when the reanalysis data (ERA5 or ERA-Interim), the trajectory model, the vertical coordinate (kinematic and diabatic approach) or the convective parameterisation are varied. The robust finding among all scenarios is that the largest continental air mass contributions originate from the Tibetan Plateau and the Indian subcontinent (mostly the Indo-Gangetic Plain), and the largest maritime air mass contributions in Asia come from the western Pacific (e.g. related to tropical cyclones). Additionally, all simulation scenarios indicate that the transport of maritime air from the tropical western Pacific to the region of the ATAL lowers the backscatter ratio (BSR) of the ATAL, while most scenarios indicate that the transport of polluted air from the Indo-Gangetic Plain increases the BSR. While the results corroborate key findings from previous ERA-Interim-based studies, they also highlight the variability in the contributions of different MBL regions to the ATAL depending on different simulation scenarios.

Abstract Background Frailty, cognitive impairment, and depressive symptoms are closely interrelated conditions in the aging population. However, limited research has longitudinally analyzed the concurrent trajectories of these three prominent conditions in older adults in China. This study aimed to explore the eight-year trajectories of frailty, cognitive impairment, and depressive symptoms, and to identify individual-level and structural-level factors associated with the trajectories. Methods Four waves of data from the China Health and Retirement Longitudinal Study (2011–2018) were used to identify 6,106 eligible older adults. The main measures included frailty by the frailty index constructed using 30 indicators, cognitive impairment by the summary score of immediate and delayed word recall, figure drawing, serial subtraction, and orientation, and depressive symptoms by the Center for Epidemiologic Studies Depression Scale. Multi-trajectory models identified the trajectories of frailty, cognitive impairment, and depressive symptoms over time. Multinomial logistic regression was employed to estimate the associations between individual-level capital factors and one structural factor (hukou and geographic residency) with the identified trajectories, adjusting for demographic characteristics. Results Four trajectories emerged: (1) worsening frailty, worsening cognitive impairment, depression (14.0%); (2) declining pre-frailty, declining cognition, borderline depression (20.0%); (3) pre-frailty, worsening cognitive impairment, no depression (29.3%); and (4) physically robust, declining cognition, no depression (36.7%). Using the “physically robust, declining cognition, no depression” as the reference, not working, no social activity participant, worse childhood family financial situation, and poorer adult health were most strongly associated with the “worsening frailty, worsening cognitive impairment, depression” trajectory; worse health during childhood had the highest association with the “declining pre-frailty, declining cognition, borderline depression” trajectory; less education, lower household consumption, and rural hukou had the greatest association with the increased likelihood of the “pre-frailty, worsening cognitive impairment, no depression” trajectory. Conclusions Findings could inform the understanding of the interrelationship of frailty, cognitive impairment, and depressive symptoms in older adults in China and may help practitioners detect adults at risk for adverse trajectories to implement strategies for proper care.

Objectives: This study examined long-term changes in body composition and bone mineral characteristics among male long-distance runners from a high-profile university team, focusing on concerns about impaired musculoskeletal development due to extreme leanness and weight management practices in this population., Methods: Trajectory analyses were performed using multilevel modeling of 608 dual-energy x-ray absorptiometry datasets from 109 runners (mean age, height, and weight of 18.0 years, 171.4 cm, and 56.8 kg at baseline, respectively) collected biannually over 4 years., Results: Linear increases in total and regional lean mass (LM) were observed on average, with the increase in leg LM being double that of arm LM (0.07 vs. 0.03 kg per occasion, respectively). Similarly, total bone mineral density (BMD) and content (BMC) exhibited linear growth on average, with BMD accrual being greater in the legs than in the arms (0.004 vs. 0.001 g/cm 2 per occasion, respectively). However, rib BMD and BMC were predicted to decrease. Individually predicted growth rates in total LM were significantly associated with those in total BMD (r = 0.347, p < 0.001) and BMC (r = 0.424, p < 0.001)., Conclusions: These results indicate site-specific musculoskeletal adaptations to intensive long-distance running training. Moreover, a random slope model accurately captured the trajectories of most dependent variables, highlighting the heterogeneity of training responses. The predictive models developed in this study offer practical strategies for identifying runners at risk of suboptimal physical development, thereby facilitating the development of personalized conditioning programs., (© 2024 Wiley Periodicals LLC.)

Background: Previous studies have demonstrated geographical disparities regarding the quality of care for acute myocardial infarction (AMI). The aim of this study was two-fold: first, to calculate the proportion of patients with AMI who received primary percutaneous coronary interventions (pPCIs) by secondary medical areas (SMAs), which provide general inpatient care, as a quality indicator (QI) of the process of AMI practice. Second, to identify patterns in their trajectories and to investigate the factors related to regional differences in their trajectories., Methods: We included patients hospitalized with AMI between April 2014 and March 2020 from the national health insurance claims database in Japan and calculated the proportion of pPCIs across 335 SMAs and fiscal years. Using these proportions, we conducted group-based trajectory modeling to identify groups that shared similar trajectories of the proportions. In addition, we investigated area-level factors that were associated with the different trajectories., Results: The median (interquartile range) proportions of pPCIs by SMAs were 63.5% (52.9% to 70.5%) in FY 2014 and 69.6% (63.3% to 74.2%) in FY 2020. Four groups, named low to low (LL; n = 48), low to middle (LM; n = 16), middle to middle (MM; n = 68), and high to high (HH; n = 208), were identified from our trajectory analysis. The HH and MM groups had higher population densities and higher numbers of physicians and cardiologists per capita than the LL and LM groups. The LL and LM groups had similar numbers of physicians per capita, but the number of cardiologists per capita in the LM group increased over the years of the study compared with the LL group., Conclusion: The trajectory of the proportion of pPCIs for AMI patients identified groups of SMAs. Among the four groups, the LM group showed an increasing trend in the proportions of pPCIs, whereas the three other groups showed relatively stable trends., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Itoshima et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Frailty correlates with worse post-operative outcomes and higher surgical costs, but the long-term impact on healthcare utilization remains ill-defined. We sought to evaluate patterns of healthcare utilization pre- and post-surgery among patients with gastrointestinal cancer and characterize the association with frailty., Study Design: Data on patients who underwent surgical resection for liver, biliary, pancreatic, colon and rectal cancer were obtained from the 2005-2020 SEER-Medicare database. Frailty was assessed using the claims-based frailty index. Group-based trajectory modelling identified clusters of patients with discrete patterns of healthcare utilization. Multivariable regression was performed to predict cluster membership based on preoperative factors, including frailty., Results: Among 66,684 beneficiaries, four distinct utilization trajectories based on data from 12 months before and after surgery were identified. Following a surge in utilization during the month of surgery, most patients reverted to pre-surgery baseline utilization (low: n=6588, 9.9%; moderate: n=17,627, 26.4%; high: n=29,850, 44.8%). However, a notable trajectory involving 12,619 (18.9%) patients was identified, wherein surgery precipitated a transition from a "low" pre-surgery utilization state to a "high" utilization state post-surgery. Frail patients were more likely to be among those individuals who transitioned to high utilizers (low: 4.2% vs. vs. transition: 12.6% vs. high: 7.5%; p<0.001). On multivariable analysis incorporating preoperative variables, frailty was associated with high group trajectory membership (ref: least and moderate; highest: OR 4.90, 95%CI 4.49-5.35; p<0.001)., Conclusions: Patients with gastrointestinal cancer demonstrated distinct clusters of healthcare utilization after surgical resection. Preoperative predictive models may help differentiate different health care utilization trajectories to help tailor care for patients in the postoperative period., (Copyright © 2024 by the American College of Surgeons. Published by Wolters Kluwer Health, Inc. All rights reserved.)

In order to study Bacillus subtilis biofilm formation in microdroplets, we use microfluidics technology to make the droplets and confocal microscopy to capture bacterial movement and biofilm formation in the droplets. We develop a multi-target tracking methodology, using a YOLOv5 detector to identify cells and a DeepSORT algorithm to track cell movements. We find that Bacillus subtilis bacteria with autonomous migration and biofilm-forming ability prefer to cluster and swarm near the microdroplet surface, rather than in the droplet interior. Bacterial mobility depends on phenotype and spatial location within the droplet. The motile cells move about 3.5 times faster than the matrix-producing cells. When the cells are near the wall of the droplet, the direction of the motion of motile cells is along that wall. When the cells are inside the droplet, the direction of the motion of motile cells is disordered, i.e., there is no clear directional or goal-oriented movement. This contrast increases the cell contact probability and facilitates the formation of a Bacillus subtilis biofilm in the droplet. Furthermore, we develop a mathematical model to describe the motion behavior of Bacillus subtilis in microdroplets, which is useful for exploring the influence of motility on biofilm formation., Competing Interests: The authors declare no competing financial or other interests., (© 2024 Author(s).)

Background: Previous natural history studies highlighted a consistent heterogeneity of disability trajectories among individuals with primary or secondary progressive multiple sclerosis (MS). However, evidence on disability progression in relapsing onset MS is scarce.The aim of this study was to investigate heterogeneity in disability accumulation over 10 years following a first clinical diagnosis of central nervous system demyelination (FCD) and identify genetic, demographic, environmental and clinical factors associated with these trajectories., Methods: We used group-based trajectory models to measure heterogeneity in disability trajectories based on the Expanded Disability Status Scale (EDSS) in a prospectively assessed cohort of 263 participants. To capture sustained neurological impairments and avoid issues related to significant changes in EDSS associated with relapse, we did not consider EDSS points recorded within 3 months of a relapse., Results: We identified three distinct and clinically meaningful disability trajectories: No/minimal, moderate and severe. Those in the no/minimal disability trajectory showed no appreciable progression of disability (median EDSS∼1 at 10-year review) while those in the moderate and severe disability trajectories experienced disability worsening (median time to reach EDSS 4 was 9 and 7 years, respectively). Compared with the no/minimal disability trajectory, those with older age, a higher number of relapses within the first 5 years post-FCD, and a higher number of comorbidities at baseline were more likely to be in the worse disability trajectory. Surprisingly, baseline MRI and anatomical site of initial symptoms did not influence long-term outcomes., Conclusions: Those at higher risk of faster MS disability progression can be identified based on their early clinical characteristics with potential therapeutic implications for early intervention and treatment escalation., Competing Interests: Competing interests: BVT has received compensation for consulting, talks and advisory/steering board activities for Merck, Novartis, Biogen and Roche. He receives research funding support from MS Research Australia, Medical Research Future Fund Australia and the National Health and Medical Research Council Australia., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: This study aimed to identify Dizziness-Related Disability (DRD) recovery trajectories in pediatric concussion and assess clinical predictors of disability groups., Materials and Methods: In this prospective cohort study, 81 children (8-17 years) diagnosed with an acute concussion took part in 3 evaluation sessions (baseline, 3-month, and 6-month). All sessions included the primary disability outcome, the Dizziness Handicap Inventory (DHI) to create the DRD recovery trajectories using group-based multi-trajectory modeling analysis. Each independent variable included general patients' characteristics, premorbid conditions, function and symptoms questionnaires, and clinical physical measures; and were compared between the trajectories with logistic regression models., Results: Low DRD (LD) trajectory ( n  = 64, 79%), and a High DRD (HD) trajectory ( n  = 17, 21%) were identified. The Predicting and Preventing Postconcussive Problems in Pediatrics (5P) total score (Odds Ratio (OR):1.50, 95% Confidence Interval (CI): 1.01-2.22), self-reported neck pain (OR:7.25, 95%CI: 1.24-42.36), and premorbid anxiety (OR:7.25, 95%CI: 1.24-42.36) were the strongest predictors of belonging to HD group., Conclusions: Neck pain, premorbid anxiety, and the 5P score should be considered initially in clinical practice as to predict DRD at 3 and 6-month. Further research is needed to refine predictions and enhance personalized treatment strategies for pediatric concussion.

Objective: This study was undertaken to examine the association between different patterns of antiseizure medication (ASM) use during pregnancy and adverse obstetric outcomes (preterm birth, low birth weight [LBW], and small for gestational age [SGA])., Methods: This retrospective cohort study used the Birth Certificate Application and National Health Insurance data in Taiwan (January 1, 2004 through December 31, 2018). We retrieved weekly ASM among pregnant women with epilepsy who were prepregnancy chronic users and used group-based trajectory modeling to identify distinct patterns of use. Logistic regressions were adopted to examine the association between patterns of ASM use and risk of preterm birth, LBW, and SGA. In addition, we revealed postnatal ASM utilization pattern among these prepregnancy chronic users as an exploratory study., Results: Of 2175 pregnant women with epilepsy, we identified four patterns of ASM use during pregnancy: frequent and continuous (64.87%), frequent but discontinuous (7.08%), intermittent (19.72%), and intermittent and discontinuous users (8.32%). Compared to frequent and continuous users, the adjusted odds ratios for preterm birth in frequent but discontinuous, intermittent, and intermittent and discontinuous users were .83 (95% confidence interval [CI] = .47-1.48), .71 (95% CI = .47-1.05), and .88 (95% CI = .52-1.49), respectively. Similar results were observed for LBW and SGA. In the exploratory study, we found that most of our study subjects maintained the same patterns before and after delivery., Significance: After considering duration and timing of exposure, our study did not find an association between four distinct patterns of ASM use and adverse obstetric outcomes among women with epilepsy. The findings suggested that optimal seizure control could be received for pregnant women with epilepsy after evaluating the risks and benefits., (© 2024 International League Against Epilepsy.)

PurposeFatigue is recognized as one of the most burdensome and long-lasting adverse effects of cancer and cancer treatment. We aimed to characterize long-term fatigue trajectories among breast cancer survivors.MethodsWe performed a detailed longitudinal analysis of fatigue using a large ongoing national prospective clinical study (CANcer TOxicity, ClinicalTrials.gov identifier: NCT01993498) of patients with stage I-III breast cancer treated from 2012 to 2015. Fatigue was assessed at diagnosis and year 1, 2, and 4 postdiagnosis. Baseline clinical, sociodemographic, behavioral, tumor-related, and treatment-related characteristics were available. Trajectories of fatigue and risk factors of trajectory-group membership were identified by iterative estimates of group-based trajectory models.ResultsThree trajectory groups were identified for severe global fatigue (n = 4,173). Twenty-one percent of patients were in the high-risk group, having risk estimates of severe global fatigue of 94.8% (95% CI, 86.6 to 100.0) at diagnosis and 64.6% (95% CI, 59.2 to 70.1) at year 4; 19% of patients clustered in the deteriorating group with risk estimates of severe global fatigue of 13.8% (95% CI, 6.7 to 20.9) at diagnosis and 64.5% (95% CI, 57.3 to 71.8) at year 4; 60% were in the low-risk group with risk estimates of 3.6% (95% CI, 2.5 to 4.7) at diagnosis and 9.6% (95% CI, 7.5 to 11.7) at year 4. The distinct dimensions of fatigue clustered in different trajectory groups than those identified by severe global fatigue, being differentially affected by sociodemographic, clinical, and treatment-related factors.ConclusionOur findings highlight the multidimensional nature of cancer-related fatigue and the complexity of its risk factors. This study helps to identify patients with increased risk of severe fatigue and to inform personalized interventions to ameliorate this problem.

Objective To evaluate the placement feasibility and safety of the newly designed retropharyngeal reduction plate by cadaveric test and to perform morphometric trajectory analysis. Methods The five cadaveric specimens with intact atlantoaxial joint were enrolled in this study. They were used for simulating the placement process and evaluating the placement feasibility of the retropharyngeal reduction plate. The atlantoaxial dislocation (AAD) of five cadaveric specimens were obtained by proper external force after dissecting ligaments. The retropharyngeal reduction plate was placed on atlantoaxial joint of cadaveric specimens. The X‐ray and three‐dimensional (3D) spiral CT were used for evaluating the placement safety of retropharyngeal reduction plate. The DICOM data was obtained after 3D spiral CT scanning for the morphometric trajectory analysis. Results The reduction plates were successfully placed on the atlantoaxial joint of five cadaveric specimens through the retropharyngeal approach, respectively. The X‐ray and 3D spiral CT showed the accurate screw implantation and satisfying plate placement. The length of the left/right atlas screw trajectory (L/RAT) was, respectively, 1.73 ± 0.01 cm (LAT) and 1.71 ± 0.02 cm (RAT). The length of odontoid screw trajectory (OST) was 1.38 ± 0.02 cm. The length of the left/right axis screw trajectory (L/RAXT) was, respectively, 1.67 ± 0.02 cm (LAXT) and 1.67 ± 0.01 cm (RAXT). There was no statistical significance between left side and right side in terms of AT and AXT (P > 0.05). The angles of atlas screw trajectory angle (ASTA), axis screw trajectory angle (AXSTA), and odontoid screw trajectory angle (OSTA) were 38.04° ± 2.03°, 56.92° ± 2.66°, and 34.78° ± 2.87°, respectively. Conclusion The cadaveric test showed that the retropharyngeal reduction plate is feasible to place on the atlantoaxial joint, which is also a safe treatment choice for atlantoaxial dislocation. The meticulous preoperative planning of screw trajectory based on individual differences was also vital to using this technique.

Background: Managing systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) is pivotal in acute aortic dissection (AAD) care. However, no prior studies have jointly analyzed the trajectories of these parameters. This research aimed to characterize their joint longitudinal trajectories and investigate the influence on AAD prognosis. Methods: We included AAD patients from the Medical Information Mart for Intensive Care (MIMIC)-IV database. Using group-based multi-trajectory modeling (GBMTM), we identified combined trajectories of SBP, DBP, and HR within the initial 24 h of intensive care unit (ICU) admission. Cox proportional hazard regression, log-binomial regression, and logistic regression were employed to assess the association between trajectory groups and mortality outcomes. Results: Data from 337 patients were analyzed. GBMTM identified five combined trajectory groups. Group 1 featured rapidly declining SBP and DBP with high pulse pressure and low HR; Group 2 showed high to moderate SBP with slight rebound and persistently low HR; Group 3 displayed persistently moderate BP and HR; Group 4 was characterized by moderate blood pressure with persistently high HR; and Group 5 had high to moderate SBP with slight rebound, high but gradually declining DBP, and slightly high HR. Group 3 demonstrated a lower risk of mortality, with an adjusted hazard ratio of 0.32 (95 % CI, 0.14–0.74), and the adjusted relative risks for in-hospital, 30-day, and 1-year mortalities were 0.37 (95 % CI, 0.15–0.87), 0.25 (95 % CI, 0.10–0.62), and 0.41 (95 % CI, 0.22–0.79), respectively. The time-independent C-index curve demonstrated that the multi-trajectory groups had higher C-index values than any univariate trajectory groups or admission values of SBP, DBP, and HR. Conclusions: Utilization of GBMTM can yield data-driven insights to identify distinct subphenotypes in AAD patients. The combined trajectories of SBP, DBP, and HR within 24 h of ICU admission significantly influenced the mortality rate.

Abstract In this paper, the optimal time planning of vibration separation trajectory of Hippophae rhamnoides fruit is studied for space manipulator using the I-PSO algorithm. The first step is to analyze the motion of the robotic arm's joints, which are limited in range and speed, in combination with a 3–5–3 polynomial interpolation, an improved Particle swarm optimization with adaptive inertia weight and asynchronous learning factor is proposed, and the specific process is given. Experimental images and data show that the improved particle swarm optimization algorithm can ensure the continuity of joint acceleration and velocity, and the optimal vibration trajectory time is 0.536539094 s Compared with the planned system trajectory time of 0.71022 s, the speed increased by 24.5%. The results of the orthogonal experiment show that the average fruit drop rate reaches 96.19%, which verifies the validity and reliability of the I-PSO algorithm for optimal time planning of seabuckthorn fruit separation vibration trajectory.

Abstract Background The COVID-19 pandemic has posed a global health threat and has had a profoundly negative impact on the work and lives of healthcare workers. However, few people know how their experiences have evolved over time. Aims To describe healthcare workers’ experiences during clinical responses to COVID-19 and how they changed over time. Design A longitudinal qualitative study. Methods We undertook a series of four semi-structured qualitative interviews of 14 healthcare workers called as 1st responders to the COVID-19 pandemic. Participants were recruited through purposive snowball sampling. Interviews were undertaken between May 2020 and May 2022 and trajectory approach was used to reveal individual experiences over time. This paper follows the COREQ (Consolidated criteria for Reporting Qualitative Research) guidance. Results Data analysis yielded the following four themes: (1) Changes in emotions; (2) Changes in organization and management of care; (3) Changes in knowledge and capabilities; and (4) Changes in outlook on life and career. Conclusion Healthcare workers have become stronger in the pandemic and have demonstrated a high degree of professional loyalty and responsibility. However, there is a need to focus on the issue of jealousy and create a harmonious and safe work environment to reduce harm to healthcare workers. Additionally, human resource management strategies must support well-being of healthcare workers and maximize the efficiency of human resource utilization to enable them to respond to current and future needs and emergencies.

Abstract Background The prevalence of hypertension is high (25.2% in 2012) and there were a large number of patients with hypertension (more than 200 million) in China. Township health centres in rural areas and community health centres in urban areas are responsible for hypertension management. This study aims to identify trends in hypertension management output and related facility-level, geographical and economic factors in primary care facilities and to assess the effect of the national project of basic public health services in China from 2009 to 2017. Methods A cross-sectional survey (2018) was combined with retrospective data collection (2009–2017) from 685 primary care facilities in six provinces in China. The hypertension management output was indicated by the number of patients with hypertension under management per 10,000 population. Latent class growth analysis and group-based trajectory models were applied to classify trajectories and determine associations with facility-level, geographic and economic characteristics. Results The trend in the output increased rapidly from 2009 to 2012 with an average growth rate of 54.58% and slowed down from 2012 to 2017 (growth rate of 5.94%). Five trajectories of the output were identified and labelled according to baseline status and increase rates: low-gradually increasing (16.9%), middle-slightly increasing (16.2%), low-sharply increasing (7.9%), middle-sharply increasing (34.2%) and persistently high (24.9%). The time-stable characteristics, including region (eastern, central or western), district (urban or rural), landform, were associated with hypertension management output of the facilities. Number of public health physicians was a significant time-dependent characteristic influencing management output. Conclusions Five latent trajectories of hypertension management output were identified. The output was still at a low level compared with the prevalence of hypertension. Hypertension screening in young people need to be emphasized. Facilities are recommended to establish good relationships with residents for better hypertension management outcomes especially in urban areas.

IntroductionThe COVID-19 pandemic resulted in a series of significant changes and adjustments within dentistry, as dental professionals dealt with temporary closures of dental practices, increased use of personal protective equipment, a reduction of clinical procedures, and extensions to training programmes. Recent research has illustrated the impact of the pandemic on the dental profession, indicating that many dental professionals felt emotionally exhausted and experienced significant uncertainty and anxiety. This qualitative study aimed to understand how these experiences and emotions changed over the course of six months, in dental trainees and primary dental care staff in Scotland.MethodsA longitudinal diary study was conducted (June—December 2020) with dental trainees and primary dental care staff. The diary asked respondents to answer three questions related to their emotional exhaustion, on a weekly basis. There was also an open question asking respondents to describe any significant issues or concerns they had experienced during the preceding week because of the impact of the COVID-19 pandemic on their work or training. This qualitative data was explored using a trajectory analysis approach to determine specifically changes over time.ResultsThe trajectory analysis revealed several key concerns prevalent amongst respondents, and how they fluctuated over the six months. Concerns included: the impact of the pandemic on respondents' future careers and on dentistry more generally; adapting to new working environments; the impact on their patients' dental treatment and oral health; the impact on their health and wellbeing; financial considerations and adjusting to new safety measures as part of the remobilization of dental services.DiscussionIn the second half of 2020, as the UK was adjusting to the introduction of new COVID-19 safety measures in everyday life, the dental profession were grappling with significant changes to their working environment, including PPE, redeployment, use of aerosol generating procedures (AGPs), and timelines for re-opening practices. This longitudinal diary study has shown some parts of the dental profession in Scotland expressed very varied and personal concerns and anxieties related to COVID-19. Respondents' candor in their diary entries revealed explicit, frequent and high levels of uncertainty and worry related to their training and career. Collectively, the data corpus highlighted the emotional toll these anxieties have taken on the dental professions in Scotland.ConclusionThese findings demonstrate the need for (a) increased provision of mental health and wellbeing support services for dental staff and (b) the study of the linkage between organization of pandemic management to the working practices of staff delivering services. Interventions, at various levels, should take into consideration the fluctuating nature of dental professionals' concerns and anxieties over time, to address both immediate and longer-term issues.

Single-particle tracking is a powerful technique to investigate the motion of molecules or particles. Here, we review the methods for analyzing the reconstructed trajectories, a fundamental step for deciphering the underlying mechanisms driving the motion. First, we review the traditional analysis based on the mean squared displacement (MSD), highlighting the sometimes-neglected factors potentially affecting the accuracy of the results. We then report methods that exploit the distribution of parameters other than displacements, e.g., angles, velocities, and times and probabilities of reaching a target, discussing how they are more sensitive in characterizing heterogeneities and transient behaviors masked in the MSD analysis. Hidden Markov Models are also used for this purpose, and these allow for the identification of different states, their populations and the switching kinetics. Finally, we discuss a rapidly expanding field—trajectory analysis based on machine learning. Various approaches, from random forest to deep learning, are used to classify trajectory motions, which can be identified by motion models or by model-free sets of trajectory features, either previously defined or automatically identified by the algorithms. We also review free software available for some of the analysis methods. We emphasize that approaches based on a combination of the different methods, including classical statistics and machine learning, may be the way to obtain the most informative and accurate results.

Robot manipulators are robotic systems that are frequently used in automation systems and able to provide increased speed, precision, and efficiency in the industrial applications. Due to their nonlinear and complex nature, it is crucial to optimize the robot manipulator systems in terms of trajectory control. In this study, positioning analyses based on artificial neural networks (ANNs) were performed for robot manipulator systems used in the textile industry, and the optimal ANN model for the high-accuracy positioning was improved. The inverse kinematic analyses of a 6-degree-of-freedom (DOF) industrial denim robot manipulator were carried out via four different learning algorithms, delta-bar-delta (DBD), online back propagation (OBP), quick back propagation (QBP), and random back propagation (RBP), for the proposed neural network predictor. From the results obtained, it was observed that the QBP-based 3-10-6 type ANN structure produced the optimal results in terms of estimation and modeling of trajectory control. In addition, the 3-5-6 type ANN structure was also improved, and its root mean square error (RMSE) and statistical R2 performances were compared with that of the 3-10-6 ANN structure. Consequently, it can be concluded that the proposed neural predictors can successfully be employed in real-time industrial applications for robot manipulator trajectory analysis.

Objectives: This study aimed to identify the clusters of patients with different developmental trajectories of pain and disability after anterior cervical decompression and fusion (ACDF)., Methods: Group-based trajectory analysis among 318 patients undergoing the ACDF., Results: Three developmental trajectories of disability were identified: "Steadily good functioning," "Improved functioning," and "Steadily poor functioning." Three developmental trajectories of neck pain were identified: "Worsened pain," "Pain relief," and "Steadily severe pain." Two developmental trajectories of arm pain were identified: "Decreased arm pain" and "Severe arm pain with only short-term relief." No associations were found between sex, preoperative pain duration, or body weight and probability to be classified into a particular disability trajectory group. Female sex (relative risk ratio (RRR) 1.78) and longer history of preoperative pain (RRR 2.31-2.68) increased the probability to be classified into a group with steadily severe neck pain. Longer history of preoperative pain increased the probability to be classified into group with severe arm pain with only short-term pain relief (RRR 2.68)., Conclusion: After the ACDF, dissimilar developmental trajectories of pain and disability were identified between the patient clusters. While sex, preoperative pain duration, and body weight were not associated with differences in improvement in disability level, female sex and longer duration of preoperative pain were correlated with more severe neck and arm pain after surgery., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

We present theory and a simulation framework to model three-body collisions and gas phase recombination in dilute atom/diatom mixtures of pure oxygen (O/O2) and nitrogen (N/N2) using the Quasi-Classical Trajectory method. We formulate a three-body collision rate constant based on the lifetimes of binary collisions and initialize three-body collisions by sampling the arrival time of a third body within the lifetimes of pre-simulated binary collisions. We use this method to calculate distributions of recombined product energies, probabilities of recombination, and recombination rate constants through different collision pathways. Long-lived binary atom-diatom collisions are observed, but are too rare to play a dominant role in the recombination process for shock-heated air near the equilibrium conditions studied. The resulting recombination rate constants are within an order of magnitude of the predictions of detailed balance. Notably, the recombination simulation framework does not appeal to the principle of detailed balance and could be useful for studying conditions far from equilibrium. [ABSTRACT FROM AUTHOR]

Challenge Based Learning (CBL) is an educational approach that has gained popularity in response to the need for authentic learning environments. While the CBL literature is predominantly focused on cases of pedagogical implementations, the actual processes by which students develop CBL projects remain under-investigated. This shortitudinal study seeks to examine the phases of CBL project development and associated process behaviours at group level, as they unfold. The participants are 6 interdisciplinary student groups totalling 22 students enrolled in a first-year course on ethics and data analytics. Data was collected weekly throughout 10 weeks via reflective diaries (n = 15 students) and observation of course sessions (n = 22) and is complemented by interviews after course completion (n = 15). The data was subject to a thematic trajectory analysis. The study identifies 7 distinct phases in the temporal structure of a CBL project: gaining client know-how, articulating a problem, mapping the problem context, setting the aim, proposing an action path, testing and evaluating it, and implementing the solution. The article concludes with recommendations for further research into CBL project development processes, which may support the growing adoption of real-life interdisciplinary projects in engineering education. [ABSTRACT FROM AUTHOR]

Aiming at the lack of effective analysis and identification of operational area in the traditional battlefield situation awareness process, a method of aerial battlefield target trajectory analysis method for operational area extraction is proposed. Firstly, based on the improved Douglas-Peucker algorithm, the featured trajectory is extracted based on the original target trajectory, thus reducing the trajectory redundant information. Secondly, the clustering by fast search and find of density peaks (CFSFDP) algorithm is used to cluster the featured trajectory, which obtains multiple featured points clusters. Finally, each featured points cluster is scanned based on Graham's convex hull algorithm to obtain closed polygons to characterize the combat areas. The feasibility and effectiveness of the algorithm model are verified by several case simulations. [ABSTRACT FROM AUTHOR]