Incremental Steps Research Articles

Multi-stage generative adversarial networks for generating pavement crack images

The application of machine learning techniques in pavement health monitoring based on computer vision has greatly improved the accuracy and efficiency in the detection of pavement distress levels and categories. However, a persistent challenge in this field is the issue of sample imbalance, primarily arising from the scarcity of cracked pavement images, which hampers their effectiveness in road maintenance engineering. To address this issue and enhance the fast and stable generation of high-quality crack images for engineering purposes, this study proposes two frameworks based on Generative Adversarial Networks (GAN): Multi-Stage GAN-v1 and Multi-Stage GAN-v2. These frameworks break down the complex task of directly generating high-quality images into a series of incremental steps, gradually increasing the image resolution from initially generated low-precision images. Both versions, v1 and v2, consist of multiple sequentially connected generation units, with each unit utilizing the Wasserstein Generative Adversarial Network-Gradient Penalty (WGAN-GP). Furthermore, v2 has the additional capability of generating pavement crack images of specified types and simultaneously providing crack segmentation labels. This feature significantly enhances the practical applicability of the generated data in engineering contexts. In a comprehensive case study, the evaluation results clearly illustrate the superior image generation quality from the two proposed frameworks. Moreover, the results from ablation experiments, involving the training of nine state-of-the-art crack semantic segmentation and object detection networks using both generated images and real images, demonstrate the effective utility of these generated images for training pavement distress detection networks.

Prediction of cardiovascular risk factors from retinal fundus photographs: Validation of a deep learning algorithm in a prospective non-interventional study in Kenya.

Hypertension and diabetes mellitus (DM) are major causes of morbidity and mortality, with growing burdens in low-income countries where they are underdiagnosed and undertreated. Advances in machine learning may provide opportunities to enhance diagnostics in settings with limited medical infrastructure. A non-interventional study was conducted to develop and validate a machine learning algorithm to estimate cardiovascular clinical and laboratory parameters. At two sites in Kenya, digital retinal fundus photographs were collected alongside blood pressure (BP), laboratory measures and medical history. The performance of machine learning models, originally trained using data from the UK Biobank, were evaluated for their ability to estimate BP, glycated haemoglobin, estimated glomerular filtration rate and diagnoses from fundus images. In total, 301 participants were enrolled. Compared with the UK Biobank population used for algorithm development, participants from Kenya were younger and would probably report Black/African ethnicity, with a higher body mass index and prevalence of DM and hypertension. The mean absolute error was comparable or slightly greater for systolic BP, diastolic BP, glycated haemoglobin and estimated glomerular filtration rate. The model trained to identify DM had an area under the receiver operating curve of 0.762 (0.818 in the UK Biobank) and the hypertension model had an area under the receiver operating curve of 0.765 (0.738 in the UK Biobank). In a Kenyan population, machine learning models estimated cardiovascular parameters with comparable or slightly lower accuracy than in the population where they were trained, suggesting model recalibration may be appropriate. This study represents an incremental step toward leveraging machine learning to make early cardiovascular screening more accessible, particularly in resource-limited settings.

Incremental Ramp Load Protocol to Assess Inspiratory Muscle Endurance in Healthy Individuals: Comparison with Incremental Step Loading Protocol.

Protocols for obtaíníng the maxímum threshold pressure have been applied wíth límited precision to evaluate ínspiratory muscle endurance. In thís sense, new protocols are needed to allow more relíable measurements. The purpose of the present study was to compare a new incremental ramp load protocol for the evaluation of ínspíratory muscle endurance wíth the most used protocol in healthy indíviduals. This was a prospective cross-sectional study carried out ín a síngle center. Nínety-two healthy indíviduals (43 men [22 ± 3 years] and 49 women [22 ± 3 years]) were randomly allocated to perform: (i) íncremental ramp load protocol and (íí) íncremental step loadíng protocol. The sustained pressure threshold (or maximum threshold pressure), maximum threshold pressure/dynamic strength índex ratío, time untíl task faílure, as well as dífference between the mean heart rate of the last five mínutes of baselíne and the peak heart rate of the last 30 seconds of each protocol were measured. Incremental ramp load protocol wíth small íncreases in the load and starting from mínímum values of strength index was able to evaluate the inspiratory muscle endurance through the maxímum threshold pressure of healthy indívíduals. The present study suggests that the íncremental ramp load protocol is able to measure maximum threshold pressure in a more thorough way, wíth less progression and greater accuracy in the load stratification compared to the límited incremental step loading protocol and with a safe and expected cardiovascular response in healthy individuals.

Dynamic Modeling and Simulation of a Discrete Incremental Hydraulic Positioning System Controlled by Binary Valves

This article presents the conceptual design, operation principle, dynamic modeling, and simulation results of a discrete incremental hydraulic positioning system (DIHPS) intended for use in high-precision, heavy-load industrial automation solutions. An original solution for precise incremental step positioning using DIHPS is proposed, comprising an n-step linear double-acting hydraulic actuator (HA) with a double rod, cylinder sleeve with outflow gaps, binary valves (BVs) bleed-off into the tank, and fixed throttle valves (TRVs) at the inlets of the actuator chambers. The discrete incremental shift of the HA is determined by controlling the opening and closing of the individual BVs, and the step shift of the HA piston stops at the opening location of the BV. A dynamic model of incremental step shift for DIHPS is developed, considering the behavior and relationships of its individual elements. A dynamic model of HA with and without a hydropneumatic accumulator (HPA) is presented. HPA has been shown to effectively dampen piston vibrations and pressure peaks at the HA stop position. The design assumptions, dynamic models, and discrete incremental positioning of the DIHPS are verified by simulation tests and assessed with quantitative indicators. Innovative DIHPSs have significant practical potential in the discrete incremental positioning of heavy loads.

532 Application of the CTME Maturity Model in a CTSA Hub: An Initiative to Improve Clinical Research Operations

OBJECTIVES/GOALS: The CTSA consortium’s Informatics Enterprise Committee has developed a maturity assessment model for Clinical Trial Management Ecosystems (CTME). This poster will show the improvements achieved using this model at the University of Iowa as well as guidance on how to apply it at other CTSA hubs. METHODS/STUDY POPULATION: The CTME maturity model consists of 11 categories including, study management; regulatory; financial; and reporting. Each category has 3 subcategories: standardization; complexity; and monitoring, while each subcategory is comprised of 1 to 5 maturity statements: initial; developing; aspiring; capable; and efficient. The maturity assessment team at Iowa—comprised of key personnel from clinical research and compliance, accounting, and administration—have used the CTME maturity model to assess Iowa’s research performance across the 11 categories. The initial maturity ratings for each category revealed any gaps in research operations, which led to developing strategies to address the gaps. RESULTS/ANTICIPATED RESULTS: The assessment team initiated a CTME maturity planning project—holding regular meetings to review Iowa’s CTME research maturity and plan changes to improve our CTME maturity ratings. This analysis is done at the statement level to minimize the scope of actions needed and keep resource loads for improvements low. Proposed improvements are assigned to a team member who serves as an “accountability leader.” Such leaders develop action plans aimed at increasing maturity at least one level. The leaders are responsible for acquiring the resources to carry out the plan. Each action plan identifies qualifiers reviewed by the team to confirm that the maturity level has been met. DISCUSSION/SIGNIFICANCE: The CTME maturity model has been shown to be effective in identifying gaps in organizational operations at the University of Iowa, where it has led to incremental steps to improve clinical research operations. The utilization of the model at other CTSA hubs will be discussed at this session.

An Incremental Step Sensing MPPT Based SI-SIDO Energy Harvester With >99% Peak MPPT Efficiency for an Input Power Range of 30 μW to 33 mW

An Incremental Step Sensing MPPT Based SI-SIDO Energy Harvester With >99% Peak MPPT Efficiency for an Input Power Range of 30 μW to 33 mW

A new approach to MPPT hybrid incremental conductance-sliding mode control for PV grid-connected

As photovoltaic energy is clean, renewable, and less noisy, it is increasingly integrated into the grid. This integration aims to overcome energy deficits and get rid of pollution from conventional sources. In this paper, a two-stage configuration of PV energy conversion to a three-phase grid has been studied. The control of this configuration can be divided into two parts, such as DC bus control and AC bus control. The DC bus is controlled by MPPT control. The AC bus is controlled by DC link voltage control, phase-looked loop control, and voltage source inverter control. The contribution in this study aims to improve the quality of energy injected via a new hybrid approach to MPPT control. The proposed control is a combination of robust sliding-mode control and incremental inductance. Unlike conventional hybridization, the proposed control estimates correct the error upon entry of the conductance incremental control. This correction provides an adaptive incremental step for increment conductance control. The proposed control is compared with three other controls under MATLAB/Simulink. Such as incremental conductance, variable step size incremental conductance, and conventional hybrid MPPT incremental inductance-sliding mode control. The simulation results show a remarkable minimization of the ripple phenomenon and the chatter phenomenon. Thus, the quality of the energy injected into the network is improved, such as by reducing the total harmonic distortion of the current and increasing efficiency.

TIKP: Text-to-Image Knowledge Preservation for Continual Semantic Segmentation

Continual Semantic Segmentation (CSS) is an emerging trend, where catastrophic forgetting has been a perplexing problem. In this paper, we propose a Text-to-Image Knowledge Preservation (TIKP) framework to address this issue. TIKP applies Text-to-Image techniques to CSS by automatically generating prompts and content adaptation. It extracts associations between the labels of seen data and constructs text-level prompts based on these associations, which are preserved and maintained at each incremental step. During training, these prompts generate correlated images to mitigate the catastrophic forgetting. Particularly, as the generated images may have different distributions from the original data, TIKP transfers the knowledge by a content adaption loss, which determines the role played by the generated images in incremental training based on the similarity. In addition, for the classifier, we use the previous model from a different perspective: misclassifying new classes into old objects instead of the background. We propose a knowledge distillation loss based on wrong labels, enabling us to attribute varying weights to individual objects during the distillation process. Extensive experiments conducted in the same setting show that TIKP outperforms state-of-the-art methods by a large margin on benchmark datasets.

Comparative analysis of two custom-made mandibular advancement devices with varied designs for treating moderate to severe obstructive sleep apnea

IntroductionCustom-made titratable mandibular advancement device (MAD) treatment can nowadays be considered a promising first-line treatment in patients with mild to severe obstructive sleep apnea (OSA). Specific manufacturing designs and titration mechanisms of MAD are on the market, characterized by their titration approach, vertical opening, and materials selection.The wing-designed MAD (SomnoDent® Flex™, SomnoMed Ltd, Sydney, Australia) has a lateral screw mechanism to advance the lower jaw in incremental steps of 0.1 up to 6.0 mm. The newer uniquely designed custom-made MAD with passive mouth closing (SomnoDent® Avant™ SomnoMed Ltd, Sydney, Australia) has a frontal exchangeable advancement strap of fixed lengths as a specific titration mechanism, all supporting freedom of lateral movement.We aimed to assess the associations between the type of MAD prescribed and OSA treatment outcome. MethodsData from 209 patients (165 male, mean age 53.9 (±10.9) years, median baseline BMI and AHI 27.02 [24.8; 29.7] kg/m2 and 22.8 [17.7; 31.6]/hour sleep, respectively) were collected.Of this cohort, 91 patients with the traditional, wing-based SomnoDent® Flex™ and 118 patients with SomnoDent® Avant™. All patients were diagnosed with a type 1 polysomnography demonstrating moderate to severe OSA (15 ≤ AHI ≤65 per hour sleep). The selected MAD was fitted in the so-called maximal comfortable protrusion.After 3 months of subjective titration until resolution of subjective symptoms and/or achieving physical limits, a checkup with validated home sleep monitoring was conducted. Treatment success was defined as “AHI reduction ≥50% with MAD compared to baseline AHI and AHI with MAD <10 events per hour”. ResultsThese real-world data set showed that 67% of patients achieved treatment success, with a statistically significant reduction in AHI from 22.8 [17.7; 31.6] to 7.45 [3.4; 15.0]/h sleep. The SomnoDent® Avant™ achieved 75% treatment success versus 56% for the traditional, wing-based SomnoDent® Flex™ (P < 0.05). Overall, AHI reduction was 70% for SomnoDent® Avant™ (P < 0.05) vs. 63% for SomnoDent® Flex™ (P < 0.05). ConclusionsThis study shows that choice of MAD design can impact the treatment outcome and could become an important consideration in selecting the type of MAD for personalized treatment for OSA patients. While the results of the traditional wing-based MAD design were comparable to the therapeutic outcome with other titratable, custom-made MADs, the MAD with the passive mouth closing feature showed significantly greater reduction in total AHI potentially due to encouraged nasal breathing, reduced mouth breathing and lesser vertical opening thereby decreasing the probability of tongue base collapse.

An ANS/ATFs‐based unsymmetric solid‐shell finite element algorithm for high‐quality finite deformation analysis of hyper‐elastic shell

AbstractAn effective updated Lagrangian (UL) algorithm is designed for extending the recent distortion‐tolerant unsymmetric 8‐node, 24‐DOF hexahedral solid‐shell element, US‐ATFHS8, to finite deformation analysis of hyper‐elastic shell structures. The distinguishing feature of this unsymmetric element is that two different interpolation schemes are employed for virtual displacement and real stress calculations, respectively. The assumed natural strain (ANS) method with shell assumptions, referring to the current configuration, is introduced to modify the strain tensors derived from the assumed virtual displacement fields in terms of isoparametric coordinates, thereby mitigating shear locking and trapezoidal locking. On the other hand, the analytical trial functions (ATFs) derived from the general solutions of homogenous governing equations for linear elasticity are updated in each increment step to obtain the incremental deformation gradient, which is then utilized for calculating the real stresses for curing the numerical difficulties in large deformation problems. Numerical examples show that the proposed algorithm enables the hyper‐elastic solid‐shell element US‐ATFHS8 to exhibit excellent performance in both regular and distorted meshes and yield considerable results even when other models cannot work.

Achieving Sustainable Development Goals Through Microfinance: An Incremental Steps Towards Growth.

In order to access a brighter and more sustainable future for all by the year 2030 the UN Members have adopted the Sustainable Development Goals (SDGs). The three most important global challenges they tackle are ensuring that everyone lives in peace and prosperity, protecting the environment, and ending poverty. The 17 Goals are critical worldwide development initiatives that balance social, economic, and environmental sustainability. They are all interconnected and interdependent. At present Microfinance Institutions (MFINs) are playing very crucial role to make banking and financial services available for remote people which is contributing directly or indirectly for achievement of SDG.  Among four of SDGs, notably No Poverty, Quality Education, Gender Equality and promoting Decent work &amp; Economic growth, and reducing inequality, are closely tied to the concepts of microfinance. Their growth is depicted through increasing Gross loan Portfolio (GLP) in recent years. The purpose of this paper is to look into how these 4 goals can be met in India through microfinance practices. For investigating the linkage between SDG and Microfinance tools like CAGR, Pearson Correlation has been used.  

Reliability Improvement in Vertical NAND Flash Cells Using Adaptive Incremental Step Pulse Programming (A-ISPP) and Incremental Step Pulse Erasing (ISPE)

Reliability Improvement in Vertical NAND Flash Cells Using Adaptive Incremental Step Pulse Programming (A-ISPP) and Incremental Step Pulse Erasing (ISPE)

Deciphering interfacial properties and intermediaries via probing lattice deformations: Growth solution chemistry for mixed/pure phase metal oxide/perovskites

pH of the growth solution of nanomaterials has been employed as a controlling agent in the morphology and synthesis of various metal oxides. The key points in the reconciliation with the thus formed nanostructures inevitably revolve around the impact of H+ and OH- ions on the oxide phases formed during various stages of the phase evolution. Here, a careful elucidation of acidic and alkaline conditions that influence the evolution of the perovskite of Strontium titanate (STO) has been done taking care to avoid the influence of other reagents by avoiding their use altogether. Multiple incremental steps of the growth solution’s pH were the only variable, allowing a direct correlation of the alkalinity with the several interesting materializations of the perovskite composition. The fundamental aspects on the development of the different phases such as the lattice strains due to expansions and contractions of the lattice, integration of shallow level defects as a result of the growth conditions, visualizations of the interfaces between multiple phases which were always present when the growth conditions were not completely alkaline have been revealed through different structural and morphological characterizations. The catalytic property of the samples prepared at different pH levels investigated using UV light exhibited markedly different photocatalytic activity toward Rhodamine B (RhB). We propose that the tuned phase compositions and morphologies are the reason for the observed variations. The different compositions of intermediaries are interesting candidates for different applications that are concerned with defect and interface engineering, and the data presented herewith reveal precise conditions for achieving each of these interesting compositions as well as realizing pristine STO without the typical presence of secondary phases such as carbonates.

Heart Rate Variability Thresholds: Agreement with Established Approaches and Reproducibility in Trained Females and Males.

To determine in trained females and males: i) the agreement between the gas exchange threshold (GET), lactate threshold 1 (LT1) and heart rate variability threshold 1 (HRVT1), as well as between the respiratory compensation point (RCP), lactate threshold 2 (LT2) and heart rate variability threshold 2 (HRVT2) and ii) the reproducibility of HRVT1 and HRVT2 during two-min incremental step protocols. Fifty-seven trained participants (24 females) completed a 2 min step incremental test to task failure. Nineteen participants (8 females) completed a second test to evaluate reproducibility. Gas exchange and ventilatory responses, blood lactate concentration, and RR time series were recorded to assess the oxygen consumption (V̇O2) and heart rate (HR) associated with the GET, RCP, LT1, LT2, HRVT1 and HRVT2. V̇O2-GET vs V̇O2-HRVT1 and HR-GET vs HR-HRVT1 were statistically different for females (29.5 ± 4.0 vs 34.6 ± 6.1 mL·kg-1·min-1; 154 ± 11 vs 166 ± 12 bpm) and for males (33.9 ± 4.2 vs 42.7 ± 4.6 mL·kg-1·min-1; 145 ± 11 vs 165 ± 9 bpm) (p < 0.001). V̇O2 and HR at HRVT1 were greater than at LT1 (p < 0.05). V̇O2-RCP vs V̇O2-HRVT2 and HR-RCP vs HR-HRVT2 were not statistically different for females (40.1 ± 4.7 vs 39.5 ± 6.7 mL·kg-1·min-1; 177 ± 9 vs 176 ± 9 bpm) and males (48.4 ± 5.4 vs 47.8 ± 4.8 mL·kg-1·min-1; 176 ± 8 vs 175 ± 9 bpm) (p > 0.05). V̇O2 and HR responses at LT2 were similar to HRVT2 (p > 0.05). Intraclass correlation (ICC) for V̇O2-HRVT1, HR-HRVT1, V̇O2-HRVT2, and HR-HRVT2 indicated good reproducibility when comparing the two different timepoints to standard methods. Whereas HRVT2 is a valid and reproducible estimate of the RCP/LT2, current approaches for HRVT1 estimation did not show good agreement with outcomes at GET and LT1.

Tribological investigations of hemp reinforced NAO brake friction polymer composites with varying percentage of resin loading

NAO brake friction materials with 4%, 5%, and 6% (w/v) sodium hydroxide treated hemp fiber reinforcement having 25% wt. fiber loading and fixed percentage of phenol formaldehyde resin content (20% wt.) along with other fillers have been studied and reported by the authors earlier. However, the effect of variations in the resin content on the tribological performance has been studied and reported in the present paper. Five variants were prepared with varying percentages of phenol formaldehyde resin from 12% wt. to 22% wt. with incremental steps of 2% wt, along with the optimum of 6% (w/v) sodium hydroxide treated hemp fibers and other fillers. The prepared test variants’ tribological characterization was done using Taguchi’s L25 orthogonal array on a pin-on-disc experimental setup, as per ASTM G99, at room temperature and compared with the best of the earlier studied friction composite. Fade and recovery tests of the best of the earlier studied and present ones were performed on a chase tribology tester per SAE J661 standards. The results revealed moderate coefficient of friction of 0.4496, lower wear rate of 0.57 gm, and better fade recovery for the HF25P20 variant compared to its counterparts studied here.

Measurement properties of the incremental step test for people with chronic obstructive pulmonary disease: a cross-sectional study

ObjectivesThe new incremental step test (IST) is a field test that was developed for people with chronic obstructive pulmonary disease (COPD), based on the characteristics of the incremental shuttle walk...

Aerodatabase Development and Integration and Mission Analysis of a Mach 2 Supersonic Civil Aircraft

The request for faster and greener civil aviation is urging the worldwide scientific community and aerospace industry to develop a new generation of supersonic aircraft, which are expected to be environmentally sustainable and to guarantee a high-level protection of citizens. A key aspect to monitor the potential environmental impact of new configurations is the aerodynamic efficiency and its impact onto the real mission. To pursue this goal, this paper discloses increasing-fidelity aerodynamic modeling approaches to improve the conceptual design of high-speed vehicles. The disclosed methodology foresees the development of aerodynamic aerodatabases by means of incremental steps starting from simplified methods (panels methods and/or low-fidelity CFD simulations) up to very reliable data based on high-fidelity CFD simulations and experimental measurements with associated confidence levels. This multifidelity approach enables the possibility of supporting the aircraft design process at different stages of its design cycle, from the estimation of preliminary aerodynamic coefficients at the beginning of the conceptual design, up to the development of tailored aerodatabases at advanced design phases. For each design stage, a build-up approach is adopted, starting from the investigation of the clean external configuration up to the complete one, including control surfaces’ effects and, if any, the effects of the integration of the propulsive effects. In addition, the applicability of the approach is guaranteed for a wide range of supersonic and hypersonic aircraft, and the developed methodology is here applied to the characterization of Mach 2 aircraft configuration, a relevant case study of the H2020 MORE&amp;LESS project.

Vibration control of an eleven-story structure with MR and TMD dampers using MAC predictive control, considering nonlinear behavior and time delay in the control system

In the last two decades, model predictive control has made significant progress in research and industrial process control. This achievement is through the high ability of model predictive control to solve industrial process control problems in the time domain. It is applicable in many control systems, such as delayed systems, univariate and multivariable systems, non-minimum phase systems, and unstable systems. This strategy is essentially for controlling delayed systems. It is possible to create a time delay in transmitting structure movement data in the systems that use sensors and receivers of sensor-recorded data, which is a factor to reduce the efficiency of the control system and even the instability of the structure. In this study, to investigate and compensate the effect of time delay in the hybrid vibration control system, an 11-story structure with a tuned mass damper and an MR damper was used by model algorithmic control (MAC) and nonlinear behavior of the structure in the control process. The linear and nonlinear structural models are created in OpenSEES, the control system in MATLAB; and the TCP/IP connection method was used to connect two programs. The fuzzy decision system is based on accelerating and decelerating movement. The structure has been subjected to seven earthquakes with maximum accelerations of 0.1 g to 1.0 g with an incremental step of 0.1 g. According to the results of incremental dynamic analysis, the average percentage of the fuzzy control system performance reduction, considering the time delay, is 15.28% and 38.57% for the maximum displacement and base shear in the linear structure, and 8.04% and 5.97% for the nonlinear structure, respectively. The assumed time delays have been effectively overcome using the model algorithmic control system (MAC), determining the prediction horizon of the structural behavior, and optimizing the control force in the control horizon. The performance of the MAC control system has been better than the fuzzy control system and the passive control with TMD. The average improvement percentage of the results of the maximum linear and nonlinear structural displacement response is respectively equal to 10.2 and 11.8 with the MAC control system, compared to the fuzzy control system without time delay. For the maximum base shear, it is equal to 8.32 and 2.49, respectively.

Clinical determinants of the modified incremental step test in adults with non-cystic fibrosis bronchiectasis.

This study primarily aimed to investigate the clinical determinants of the Modified Incremental Step Test (MIST) in adults with non-cystic fibrosis bronchiectasis (NCFB). A secondary objective was to compare the cardiopulmonary responses after the MIST and Incremental Shuttle Walk Test (ISWT), two commonly adopted symptom-limited maximum field tests in chronic respiratory diseases. Forty-six patients with clinically stable bronchiectasis participated in this cross-sectional study. MIST and ISWT were performed to determine exercise capacity, while disease severity, fatigue, and quality of life were assessed using the Bronchiectasis Severity Index (BSI), the Fatigue Severity Scale (FSS), and St. George's Respiratory Questionnaire (SGRQ), respectively. Quadriceps muscle strength was evaluated using a hand-held dynamometer, walking speed with a wireless inertial sensing device, and the level of physical activity (steps/day) with a pedometer. The BSI score, quadriceps muscle strength, daily step count, and the SGRQ total score explained 61.9% of the variance in the MIST (p < 0.001, R2 = 0.67, AR2 = 0.619). The BSI score (r = -0.412, p = 0.004), quadriceps muscle strength (r = 0.574, p = 0.001), daily step count (r = 0.523, p < 0.001), walking speed (r = 0.402, p = 0.006), FSS score (r = -0.551, p < 0.001), and SGRQ total score (r = -0.570, p < 0.001) correlated with the MIST. The patients achieved higher heart rates (HR), HR%, desaturation, dyspnea, and leg fatigue in the MIST compared to the ISWT (p < 0.05). Disease severity, quadriceps muscle strength, physical activity level, and quality of life were determinants of MIST. The advantages of the MIST, including higher cardiopulmonary response than ISWT and greater portability, which facilitates its use in various settings, make MIST the preferred choice for investigating symptom-limited exercise capacity in patients with NCFB.

A conceptual framework to help choose appropriate blue nature-based solutions

Biodiversity loss and climate change have severely impacted ecosystems and livelihoods worldwide, compromising access to food and water, increasing disaster risk, and affecting human health globally. Nature-based Solutions (NbS) have gained interest in addressing these global societal challenges. Although much effort has been directed to NbS in urban and terrestrial environments, the implementation of NbS in marine and coastal environments (blue NbS) lags. The lack of a framework to guide decision-makers and practitioners through the initial planning stages appears to be one of the main obstacles to the slow implementation of blue NbS. To address this, we propose an integrated conceptual framework, built from expert knowledge, to inform the selection of the most appropriate blue NbS based on desired intervention objectives and social-ecological context. Our conceptual framework follows a four incremental steps structure: Step 1 aims to identify the societal challenge(s) to address; Step 2 highlights ecosystem services and the underlying biodiversity and ecological functions that could contribute to confronting the societal challenge(s); Step 3 identify the specific environmental context the intervention needs to be set within (e.g. the spatial scale the intervention will operate within, the ecosystem's vulnerability to stressors, and its ecological condition); and Step 4 provides a selection of potential blue NbS interventions that would help address the targeted societal challenge(s) considering the context defined through Step 3. Designed to maintain, enhance, recover, rehabilitate, or create ecosystem services by supporting biodiversity, the blue NbS intervention portfolio includes marine protection (i.e., fully, highly, lightly, and minimally protected areas), restorative activities (i.e., active, passive, and partial restoration; rehabilitation of ecological function and ecosystem creation), and other management measures (i.e., implementation and enforcement of regulation). Ultimately, our conceptual framework guides decision-makers toward a versatile portfolio of interventions that cater to the specific needs of each ecosystem rather than imposing a rigid, one-size-fits-all model. In the future, this framework needs to integrate socio-economic considerations more comprehensively and be kept up-to-date by including the latest scientific information.