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Aim. To develop a valid, reliable assessment tool to measure risk factors associated to low back pain (LBP) in intensive care unit (ICU) nurses. Background. LBP is defined as the pain extending from the 12th rib to the iliac crest and often coexists with buttock pain. Nursing has been identified among the top professions at risk of LBP. A mean of 70% prevalence per year in ICU nurses was reported, exceeding those employed in heavy industry. Environmental factors in workplace were also most important risks related to LBP in this population except factors including individual, physical, psychosocial, and lifestyle. However, there is lack of tools to assess environmental risk related to LBP for nurse managers currently. Methods. Focus group interviews, field research, and panel discussion were used to develop item pool. Two-round expert reviews and preinvestigation were carried out to form initial scale named Environmental Risk Assessing Instrument-Occupational Low Back Pain in Nurses (ERAI-N). A cross-sectional survey with 188 ICU participants in Hunan Province in China was implemented to collect data. Cronbach's alpha, split-half reliability, and test-retest reliability were used to test ERAI-N's reliability. Expert review was performed to test ERAI-N's content validity, and confirmatory factor analysis (CFA) was performed to assess its construct validity, being carried out in IBM SPSS Amos 26 Graphics. Results. Final version of ERAI-N scale had five dimensions with 18 items that were space, equipment, belief, guideline, and safe culture. ERAI-N scale's score of Cronbach's alpha, Guttman split-half, and intraclass correlation coefficient (ICC) was 0.958, 0.927, and 0.994, respectively. Item-level content validity scores ranged from 0.89 to 1.0, and scale-level content validity was 0.983. Standardized factor loadings ranged from 0.567 to 0.974. Model adjusted fit statistics were as follows: the chi-square statistic and degrees of freedom (χ2/df) = 3.943, root mean square error of approximation (RMSEA) = 0.071, incremental fit index (IFI) = 0.905, comparative fit index (CFI) = 0.904, parsimony normed fit index (PNFI) = 0.641, and parsimonious comparative fit index (PCFI) = 0.661. Conclusions. ERAI-N scale had moderate reliability, content validity, and construct validity. Implications for Nursing Management. Designers may use ERAI-N scale to plan the interior layout when design a new ICU. Nurse managers might utilize this instrument as a managing tool to assess whether there is environmental risk factors related to LBP in ICU. [ABSTRACT FROM AUTHOR]

White light endoscopy is the most pivotal tool for detecting early gastric neoplasms. Previous artificial intelligence (AI) systems were primarily unexplainable, affecting their clinical credibility and acceptability. We aimed to develop an explainable AI named ENDOANGEL-ED (explainable diagnosis) to solve this problem. A total of 4482 images and 296 videos with focal lesions from 3279 patients from eight hospitals were used for training, validating, and testing ENDOANGEL-ED. A traditional sole deep learning (DL) model was trained using the same dataset. The performance of ENDOANGEL-ED and sole DL was evaluated on six levels: internal and external images, internal and external videos, consecutive videos, and man–machine comparison with 77 endoscopists in videos. Furthermore, a multi-reader, multi-case study was conducted to evaluate the ENDOANGEL-ED's effectiveness. A scale was used to compare the overall acceptance of endoscopists to traditional and explainable AI systems. The ENDOANGEL-ED showed high performance in the image and video tests. In man–machine comparison, the accuracy of ENDOANGEL-ED was significantly higher than that of all endoscopists in internal (81.10% vs. 70.61%, p < 0.001) and external videos (88.24% vs. 78.49%, p < 0.001). With ENDOANGEL-ED's assistance, the accuracy of endoscopists significantly improved (70.61% vs. 79.63%, p < 0.001). Compared with the traditional AI, the explainable AI increased the endoscopists' trust and acceptance (4.42 vs. 3.74, p < 0.001; 4.52 vs. 4.00, p < 0.001). In conclusion, we developed a real-time explainable AI that showed high performance, higher clinical credibility, and acceptance than traditional DL models and greatly improved the diagnostic ability of endoscopists. [ABSTRACT FROM AUTHOR]

Background: Tandem colonoscopy studies have found that about one in five adenomas are missed at colonoscopy. It remains debatable whether the combination of a computer-aided polyp detection (CADe) system with a computer-aided quality improvement (CAQ) system for real-time monitoring of withdrawal speed results in additional benefits in adenoma detection or if the synergetic effect may be harmed due to excessive visual burden resulting from information overload. This study aimed to evaluate the interaction effect on improving the adenoma detection rate (ADR).Methods: This single-center, randomized, four-group, parallel, controlled study was performed at Renmin Hospital of Wuhan University. Between 1 July and 15 October 2020, 1076 patients were randomly allocated into four treatment groups: control 271, CADe 268, CAQ 269, and CADe plus CAQ (COMBO) 268. The primary outcome was ADR.Results: The ADR in the control, CADe, CAQ, and COMBO groups was 14.76 % (95 % confidence interval [CI] 10.54 to 18.98), 21.27 % (95 %CI 16.37 to 26.17), 24.54 % (95 %CI 19.39 to 29.68), and 30.60 % (95 %CI 25.08 to 36.11), respectively. The ADR was higher in the COMBO group compared with the CADe group (21.27 % vs. 30.6 %, P = 0.024, odds ratio [OR] 1.284, 95 %CI 1.033 to 1.596) but not compared with the CAQ group (24.54 % vs. 30.6 %, P = 0.213, OR 1.309, 95 %CI 0.857 to 2.000, respectively).Conclusions: CAQ significantly improved the efficacy of CADe in a four-group, parallel, controlled study. No significant difference in the ADR or polyp detection rate was found between CAQ and COMBO. [ABSTRACT FROM AUTHOR]

Background and Study Aims: Endoscopic reports are essential for the diagnosis and follow-up of gastrointestinal diseases. This study aimed to construct an intelligent system for automatic photo documentation during esophagogastroduodenoscopy (EGD) and test its utility in clinical practice.Patients and Methods: Seven convolutional neural networks trained and tested using 210,198 images were integrated to construct the endoscopic automatic image reporting system (EAIRS). We tested its performance through man-machine comparison at three levels: internal, external, and prospective test. Between May 2021 and June 2021, patients undergoing EGD at Renmin Hospital of Wuhan University were recruited. The primary outcomes were accuracy for capturing anatomical landmarks, completeness for capturing anatomical landmarks, and detected lesions.Results: The EAIRS outperformed endoscopists in retrospective internal and external test. A total of 161 consecutive patients were enrolled in the prospective test. The EAIRS achieved an accuracy of 95.2% in capturing anatomical landmarks in the prospective test. It also achieved higher completeness on capturing anatomical landmarks compared with endoscopists: (93.1% vs. 88.8%), and was comparable to endoscopists on capturing detected lesions: (99.0% vs. 98.0%).Conclusions: The EAIRS can generate qualified image reports and could be a powerful tool for generating endoscopic reports in clinical practice. [ABSTRACT FROM AUTHOR]

Objective: DBPR108, a novel dipeptidyl-peptidase-4 inhibitor, has shown great antihyperglycemic effect in animal models. This study was to evaluate the efficacy and safety of DBPR108 monotherapy in type 2 diabetes mellitus (T2DM).Methods: This was a 12-week, double-blind, placebo-controlled phase II clinical trial. The newly diagnosed or inadequately controlled untreated T2DM patients were randomized to receive 50, 100, 200 mg DBPR108 or placebo in a ratio of 1:1:1:1. The primary efficacy outcome was HbA1c change from baseline to week 12. Relevant secondary efficacy parameters and safety were assessed. The clinical trial registration is NCT04124484.Results: Overall, 271 of the 276 randomized patients, who received 50 mg (n = 68), 100 mg (n = 67), 200 mg (n = 69) DBPR108 or placebo (n = 67), were included in full analysis set. At week 12, HbA1c change from baseline was -0.04 ± 0.77 in placebo group, -0.51 ± 0.71, -0.75 ± 0.73, and -0.57 ± 0.78 (%, p < .001 vs. placebo) in 50, 100, and 200 mg DBPR108 groups, respectively. Since week 4, DBPR108 monotherapy resulted in significant improvements in secondary efficacy parameters. At end of 12-week treatment, the goal of HbA1c ≤7% was achieved in 29.85, 58.82, 55.22, and 47.83% of the patients in placebo, 50, 100, and 200 mg DBPR108 groups, respectively. The incidence of adverse events did not show significant difference between DBPR108 and placebo except mild hypoglycemia in DBPR108 200 mg group.Conclusions: The study results support DBPR108 100 mg once daily as the primary dosing regimen for T2DM patients in phase III development program. [ABSTRACT FROM AUTHOR]

Background: Lanreotide autogel is a somatostatin analog (SSA) approved for the treatment of acromegaly in 73 countries worldwide; however, it is not yet approved in China. The aim of this study was to evaluate the efficacy and safety of lanreotide autogel compared with lanreotide 40 mg prolonged release (PR) in Chinese patients with active acromegaly. Methods: LANTERN was a phase 3, randomized, open-label, non-inferiority study. Patients with active acromegaly who had undergone surgery ≥3 months prior, or were unlikely or unable to undergo surgery, were treated with lanreotide autogel 60/90/120 mg (monthly deep subcutaneous injection) or lanreotide 40 mg PR (intramuscular injection every 7, 10, or 14 days) for 32 weeks. Primary endpoint was mean change-from-baseline in age-adjusted insulin-like growth factor-1 (IGF-1) standard deviation scores (SDS) at the end-of-study. Secondary endpoints included: growth hormone (GH) levels ≤2.5 μg/L or ≤ 1.0 μg/L, ≥20% reduction in tumor volume (TV) and safety. Results: In total, 128 patients were randomized and received study treatment. Lanreotide autogel was non-inferior to lanreotide 40 mg PR: treatment difference (95% CI) for IGF-1 SDS between groups was − 0.32 (− 0.74, 0.11; per protocol population) and − 0.27 (− 0.63, 0.09; intention-to-treat [ITT] population), respectively. Reductions in IGF-1 (− 6.453 vs − 7.003) and GH levels (− 9.548 μg/L vs − 13.182 μg/L), and the proportion of patients with ≥1 acromegaly symptom (− 20.3% vs − 32.5%) were observed from baseline to end-of-study in lanreotide autogel and lanreotide 40 mg PR groups, respectively. In the lanreotide autogel group, 45.5% (25/55) patients achieved ≥20% reduction in TV compared with 50.9% (25/53) in lanreotide 40 mg PR group (ITT). Safety profiles were similar in both treatment groups. Conclusions: Lanreotide autogel was non-inferior to lanreotide 40 mg PR in Chinese patients with active acromegaly after 32 weeks of treatment. Trial registration: Retrospectively registered on ClinicalTrials.gov: NCT02493517 (9 July 2015); prospectively registered on chinadrugtrials.org.cn: CTR20140698 (24 October 2014). [ABSTRACT FROM AUTHOR]

[Display omitted] China vigorously promotes taxi electrification in some cities due to increasingly severe energy and environmental problems. However, there is still a lack of research comparing fuel taxi electrification paths. Our study compared the comprehensive benefits of Beijing's taxi electrification paths from the perspective of the taxi and taxi energy-supply stations. In addition, a sensitivity analysis of the economic benefits of the two electrification paths was conducted. The results show that the economic and environmental benefits of electric taxis are significantly better than those of fuel taxis. The economic and social benefits of battery-swapping stations are also better than those of battery-charging stations. This study verifies that the electrification of the fuel taxi is a more environmentally friendly and economically feasible initiative and that the battery swapping path is better than the battery charging path. [ABSTRACT FROM AUTHOR]

Magnetic lead screw (MLS) is a new type of high performance linear actuator that is attractive for many potential applications. The main difficulty of the MLS technology lies in the manufacturing of its complicated helical-shape magnetic poles. Structure simplification is, therefore, quite essential in promoting the MLS technology. In this paper, a new approach is proposed for forming the required helical-shape magnetic poles in a much simpler way. It is demonstrated that the traditional ring-shape magnetic poles, by proper rotating or shaping, can well approximate the complicated helical-shape magnetic poles. The performance of the new structure is compared with a MLS with ideal helical-shape magnetic poles using 3-D finite-element analysis. Halbach and flux concentration designs using the new approach are introduced. [ABSTRACT FROM AUTHOR]

This paper analyses both the cordon and area pricings from the perspective of travel demand management. Sensitivity analysis of various performance measures with respect to the toll rate and demand elastic parameter is performed on a virtual grid network. The analysis shows that cordon pricing mainly affects those trips with origins outside of the Central Business District and destinations inside, while area pricing imposes additional cost on the trips with either origins or destinations in the Central Business District. Though both pricing strategies are able to alleviate traffic congestion in the charging area, area pricing seems more effective, however, area pricing owns the risk to detour too much traffic and thus cause severe congestion to the network outside of the Central Business District. Following the sensitivity analysis, a unified framework is proposed to optimize the designs of the both pricing strategies, which is flexible to account for various practical concerns. The optimization models are formulated as mixed-integer nonlinear programs with complementarity constraints, and the solution procedure is composed of solving a series of nonlinear programs and mixed-integer linear programs. Results from the numerical examples are in line with the findings in the sensitivity analysis. Under the specific network settings, cordon pricing achieves the best system performance when the toll rate reaches the maximum allowed, while area pricing finds the optimal design scheme when the toll rate equals half of the maximum allowed. [ABSTRACT FROM AUTHOR]

Abstract: With the progress of simulation technologies, many transportation simulation packages were developed. However, little information is available to the users in applying these models to the most appropriate situations, or even seldom with the simulation accuracy of the individual model. This study conducts a comparative analysis of two popular simulation models (VISSIM and CORSIM), based on their simulation performances on an urban transportation network. Road network and field traffic data from North Bund, Hongkou District, Shanghai, China were used as the simulation background and input. Sensitivity analysis was carried out to compare the performance of both models based on four key indices, namely software usability, average control delay, average queuing length, and cross-sectional traffic volume. Advantages of each simulator were identified based on comparison analyses of simulations with different levels of congestion and intersection geospatial scales. The main performance difference was found lying in the default parameter configuration within the models, including driver behavior settings, traffic environment settings, and vehicle types, etc. Consequently, it was recommended that analysts should choose their appropriate tools based on intersection type and level of saturation within the simulation case. [Copyright &y& Elsevier]

Abstract: This research investigates using cryogenic saline mist, in comparison to the conventional saline irrigation, in neurosurgical bone grinding to prevent thermal injury to surrounding nerves and to increase the visibility of surgical area for endoscopic operations. Delivery of cryogenic mist directly towards the grinding zone along with a backward grinding motion was found important to maximize and localize the cooling effect, thus reducing bone temperature rise. Experimental results also showed a pre-cooling effect of the cryogenic mist that helps reduce the initial temperature of bone prior to the occurrence of grinding. [Copyright &y& Elsevier]

Abstract: To prevent soil loss and achieve better ecological environments, soil conservation measures have been taken during the past decades in the western Loess Plateau of China. In this paper, a case study was taken in Luoyu valley and Lver valley, two sub-watersheds of Xihe watershed and comparison was carried out between them. The main object of this study is to monitor land use/cover changes in the two similar small watersheds utilizing SPOT5 imageries by object-oriented human–computer interactive classification method, further develop the method of spatio-temporal analysis of land use/cover change by using pattern metrics of change trajectories and relative land use suitability index (R) in smaller watersheds, and make comparisons between the two similar small watersheds, taking water and soil conservation measures into consideration. Results show that combining GIS and RS, this method can be perfectly applied to make comparisons between different small watersheds with similar geographical backgrounds. And land use/cover spatiotemporal dynamic change characteristics can be preferably expressed by pattern metrics of change trajectories and R values based on topographical data. Different emphases have been laid according to their own geological backgrounds in the two watersheds and human activities have different effects on the landscapes of the two watersheds. The main change pattern is from slope farmland to terrace (322, the largest in Luoyu valley) or to economic fruit forest (344, the largest in Lver valley). R value of every slope grade in both of the two watersheds drops with the rising of slope degree on the whole and it shows that there is still much to do for people in the two watersheds in consideration that all the R values are still lower than 0.7. [Copyright &y& Elsevier]

Although the repetitive scheduling method (RSM) is more visual and straightforward and is easier to use, the network model is more commonly accepted by both owners and contractors as a means for modeling repetitive projects. In this paper, a method for converting an RSM into an equivalent network model is proposed, and the cause of differing makespans and critical paths in the relevant literature is examined. Using the proposed method for converting an RSM into a network model enables the transfer of both resource continuity requirements and distance constraints. For three different distinguishing cases, a comparison of critical paths and activity criticality is made between an RSM and a network model, with the results showing that the RSM coincides completely with the network in terms of the makespan, critical path, and activity criticality. From this comparison, variances in makespan and criticality in existing literature are caused by the conversion of backward-controlling RSM segments containing two or more subactivities, without maintaining resource continuity. This paper can help researchers to better understand the relationship between these two methodologies. It offers practitioners a method for easily and accurately converting an RSM to a network model when contractually required, and practitioners can accrue the benefits of both methodologies. [ABSTRACT FROM AUTHOR]

Abstract The demand for parking spaces in city centers often exceeds the supply. The spatial distribution of such spaces is uneven, which leads to the overheating of hot parking lots. To balance existing conflicts, parking charge and reservation mechanisms are usually utilized to improve the overall efficiency of parking spaces. This study aims to analyze and compare the benefits of these instruments and provide operational suggestions for urban parking managers. To achieve this goal, we introduce an agent simulation system and construct a simulation framework of parking charge and reservation. Then, the average travel time and total parking space utilization time are combined as a comprehensive benefit with different weights, and the benefits of parking charge and reservation are analyzed and compared under the corresponding weight. Parking charge and reservation are considered comprehensively in a combined simulation example. Results show that parking charge and reservation can remarkably improve the comprehensive benefit, and parking charge can achieve the maximum comprehensive benefit when the fee is high. When the fee is low, such as less than 26 yuan/h, the reservation mechanism can achieve a good level of benefit. Thus, parking reservation in most cities in China is an effective means to manage popular parking lots when the parking fee is low and difficult to increase. Highlights • An agent-based simulation model is established to describe the process of cruising for available parking spaces. • Comprehensive benefit analysis and comparison of parking charge and reservation mechanisms through the simulation model. • Parking charge mechanism can achieve the best comprehensive benefit with a higher parking fee for hot parking lots. • Parking reservation mechanism can quickly and effectively improve the comprehensive benefit with present low parking fee standard. [ABSTRACT FROM AUTHOR]