Development Process Research Articles

Prevalence and characteristics of osseous bridging between vertebral bodies in the cervical spine: A skeletal study.

Osseous bridging (OB) in three or more segments of motions (SOMs) of the mobile spine was initially defined as diffuse idiopathic skeletal hyperostosis (DISH), located particularly in the thoracic spine (T-spine). This pathological phenomenon is often characterized by calcification and ossification, which take place simultaneously or separately. The soft tissues, mainly ligaments and entheses, are calcified, with bone formation not originating from the anterior longitudinal ligament (ALL). DISH formation can involve osteophytes, which are created by the ossification process and can involve soft tissue such as the ALL. The ALL can also be calcified. Until recently, the prevalence of DISH in the general population was considered low (0%-5%) and rare in the cervical spine (C-spine). In a cross-sectional observational skeletal study, we investigated the prevalence and location of C-spine OB between vertebral bodies with fewer than three SOMs. We tested a large sample (n = 2779) of C-spines housed in the Cleveland Museum of Natural History (Ohio, USA). The human sources of the samples had died between the years 1912 and 1938 and represented both sexes and two different ethnic groups: Black Americans and White Americans. The process development can be seen on the ALLs as calcification, osteophytosis, and candle-shaped. Among all of the specimens, 139 (5%) were affected by OB, mostly in one SOM. Prevalence tended to be higher in women, White Americans, and the older age group. The levels most affected were C3-C4, followed by C2-C3 and subsequently, C5-C6. OB involving two consecutive SOMs was found only at C5-C7. We believe it is important to respond to the presence of a single SOM with a presumptive diagnosis of OB and to follow up, identify whether the diagnosis is correct, and take preventive action if possible. There is a need for updated diagnostic criteria and research approaches that reflect contemporary lifestyle factors and their impact on spine health.

The growth of nursing professional values - A grounded theory.

The formation of nursing professional values is crucial to the development of the nursing profession, but it is influenced by various factors. The process of shaping nursing professional values in different growth contexts has been overlooked. In order to establish professional values in the context of Chinese nursing, it is necessary to investigate the evolution of nursing professional values throughout history. To develop a theory of professional values growth from a nursing context. Design: This study adopted a grounded theory approach from Strauss and Corbin. From November 2021 to March 2022, a total of 33 participants were included. Data were collected using a semi-structured interview over telephone or online or face to face and were analysed using open, axial, and selective coding, with the help of MAXQDA 2020. The research was approved by the Ethics Committee of the China Medical University. All participants signed the informed consent and agreed to be interviewed before the study. The study has developed a theoretical construct of nursing professional values growth that consists of five dimensions: key aspects, decisive opportunities, drivers, embodiment, and shaping outcomes. And key aspects include four subcategories (the initial stage, the consciousness stage, the core stage, and the action stage). Decisive opportunities come from organisations and individuals. Drivers consist of social culture and self-trait, and embodiment covers two subcategories (humanism and ethical emotions). The last dimension is shaping outcomes, which consists of three subcategories (maintaining the original intention, professionalism, and instilling professional values). The theory demonstrates the individual development process of nursing professional values in different interactive contexts, the context of its interaction with social and personal values is revealed, and the dynamics and mechanisms of the formation of personal psychological qualities in professional values from a nursing context are discovered. This theory reveals the mechanisms that shape nursing professional values and can provide guidance for the growth of nursing students' professional values.

A Review of Anode Materials for Dual-Ion Batteries.

Distinct from "rocking-chair" lithium-ion batteries (LIBs), the unique anionic intercalation chemistry on the cathode side of dual-ion batteries (DIBs) endows them with intrinsic advantages of low cost, high voltage, and eco-friendly, which is attracting widespread attention, and is expected to achieve the next generation of large-scale energy storage applications. Although the electrochemical reactions on the anode side of DIBs are similar to that of LIBs, in fact, to match the rapid insertion kinetics of anions on the cathode side and consider the compatibility with electrolyte system which also serves as an active material, the anode materials play a very important role, and there is an urgent demand for rational structural design and performance optimization. A review and summarization of previous studies will facilitate the exploration and optimization of DIBs in the future. Here, we summarize the development process and working mechanism of DIBs and exhaustively categorize the latest research of DIBs anode materials and their applications in different battery systems. Moreover, the structural design, reaction mechanism and electrochemical performance of anode materials are briefly discussed. Finally, the fundamental challenges, potential strategies and perspectives are also put forward. It is hoped that this review could shed some light for researchers to explore more superior anode materials and advanced systems to further promote the development of DIBs.

Stenopool: A Comprehensive Platform for Consolidating Diabetes Device Data.

The growing adoption of diabetes devices has highlighted the need for integrated platforms to consolidate data from various vendors and device types, enhancing the patient experience and treatment. This shift could pave the way for a transition from conventional outpatient diabetes clinics to advanced home monitoring and virtual care methods. Overall, we wished to empower individuals with diabetes and healthcare providers to interpret and utilize information from diabetes devices more effectively. Stenopool integrates most diabetes devices for glucose monitoring and insulin administration in our clinic. The platform was initially developed with inspiration from open-source software, and the current version is a unique digital platform for managing and analyzing diabetes device data. The development process, outcomes, and status are described. Since November 2021, Stenopool has been used in our outpatient clinic to integrate over 30 different diabetes devices from around 7000 individuals. Data are primarily uploaded via wired connections, but also using semi-automated and automated cloud-to-cloud data transfers. The platform offers a streamlined workflow for healthcare providers and displays data from various glucose meter, insulin pump, and continuous glucose monitor (CGM) vendors on a single screen in a manner that healthcare providers can modify. A data warehouse with data from Stenopool and electronical health records is nearing completion, preparing the development of tools for population health management, quality assessment, and risk stratification of patients. Using Stenopool, we aimed to enhance diabetes device data management, facilitate the future for virtual patient care pathways, and improve outcomes. This article outlines the platform's development process and challenges.

Социально-культурно-экономический процесс развития здорового образа жизни россиян: вклад визионеров П.И. Макушина и Н.С. Кузьмина

The study of the socio-cultural and economic process of developing a healthy lifestyle of modern Russians necessitates turning to the heritage of the visionaries of the past, covering cultural, educational, housing and everyday practices of pre-revolutionary and Soviet Russia. The methodological basis of the study was an interdisciplinary approach (political economic, philosophical, cultural), as well as the method of dialectical unity of knowledge of the processes of socio-cultural and economic development of society. The continuity of the main components of a person’s healthy lifestyle, his culture, including the forms of organizing cultural education, housing and everyday life, formed by different generations of Russians, is substantiated. The process of transforming pre-revolutionary people's houses (Tomsk people's house of P.I. Makushin) into Soviet and modern cultural houses and leisure centers is described. The significance and influence of the socio-economic experiment of implementing the idea of scientific organization of housing and life on the basis of complete socialization is shown - the project of the «Anzhero-Sudzhensky house-commune» by N.S. Kuzmina, (his other architectural projects) on the healthy lifestyle of modern Russians. Scientific novelty: for the first time, the experience of cultural, educational and housing practices of two Siberian personalities - entrepreneur P.I. Makushin and architect N.S. Kuzmin, which had an important influence on the formation and development of a healthy lifestyle of Russians in the past and present, the visionary nature of their content is revealed. The research findings can be used to form the cultural policies at both regional and federal levels to increase the level of socio-economic well-being of Russians and preserve cultural heritage visionaries.

Do Interventions Meet the Needs of Caregivers of Cardiac Patients?: A Scoping Review.

Interventions targeting the needs of caregivers of cardiac patients are few, and in most cases, no effect is found on caregivers' well-being. A closer look at the existing interventions will provide a solid foundation for future efforts to develop effective interventions targeted at caregivers of cardiac patients. The study's objective was to scrutinize and discuss interventions targeting caregivers of cardiac patients and contribute to reflections that will improve future interventions. Systematic scoping of the literature within the field was conducted through a literature search in PubMed, EMBASE, CINAHL, PsycINFO, and Cochrane Library from January 2011 to May 2022. The development of search terms and inclusion criteria was inspired by the Patient problem/population, Intervention, Comparison/Control, and Outcome approach, and the Medical Research Council framework for developing and evaluating complex interventions served as the underlying basis for the analysis. Eleven articles were included. The interventions reported in the articles were generally not systematically developed and did not include field-specific, methodological, and theoretical reflections. Furthermore, the development process behind the studies seemed not to be transparent. Lack of systematic methodology and methodological transparency in the reviewed studies hinders further testing of interventions and might explain lack of evidence for effective interventions within the field. More systematic, needs-based, and well-documented interventions targeting caregivers of various kinds of cardiac patients are needed to develop the field to the benefit of caregivers, patients, and society.

Can Listening to a Verbal Trauma Report Induce Intrusions? - Replication of a Randomized Trial.

Recent evidence suggests that indirect verbal exposure to traumatic events can be sufficient to cause intrusions and other posttraumatic stress symptoms. In this study, we used a verbal trauma report to experimentally induce intrusions and a tactile task to manipulate the putative processes underlying intrusion development. Our findings indicate that the verbal report indeed induced intrusive recall. Moreover, the verbal report induced negative mood, state anxiety, and state dissociation, with mood and state dissociation predicting intrusion development. Additionally, the tactile task interfered with intrusion formation as indicated by the primary diary measure, but not the retrospective self-report. However, these results await further replication as this and previous trials suffered from limited statistical power. The findings support the reports by trauma therapists who experience secondary traumatization. They also challenge the assumption that all intrusions develop bottom-up from low-level sensory input via sensory representations. Future studies should explore differential processes for intrusion development based on their modality.

Probiotic potential of lactic acid bacteria isolated from Ethiopian traditional fermented Cheka beverage

Introduction: Lactic acid bacteria (LAB) are a cluster of microbes distributed in a variety of environments and have potential probiotic activity to improve human well-being. This study was aimed at assessing the probiotic potential of LAB isolated from Cheka, an Ethiopian traditionally fermented beverage.MethodPure isolates obtained from 16 Cheka samples from Konso (n = 8) and Derashe (n = 8) were characterized morphologically, biochemically, and physiologically by considering basic criteria to identify the LAB. The probiotics properties of the LAB were evaluated in vitro at low pH values (2.0 and 3.0), and two bile salt concentrations (0.3 and 0.5%) for 3 and 6 h. The 16 S rRNA gene sequencing was done using an ABI 3730xl sequencer, and the gene sequences were aligned.ResultsOf the 27 pure isolates, 11 isolates were proven to be LAB with non-motile, negative for catalase, and non-spore former characteristics. Based on cultural characteristics and sugar fermentation ability, the 11 isolates were assembled into the genera Lactobacillus (55%), Lactococcus (18%), Pediococcus (18%), and Leuconostoc (9%). At pH 3.0 and a bile salt concentration of 0.3%, isolate ChK-11 showed a better survival rate (97 and 94%) than other isolates [ChK-7 (93 and 80%) > ChD-5 (84 and 76%) > ChD-8 (46 and 36%) > ChK-4 (41 and 34%)] for 6 and 3 h, respectively. According to 16 S rRNA sequencing results, isolates ChK-11 and ChK-7 were found to be Weissella paramesenteroides and Leuconostoc pseudomesenteroides with sequence similarity of 99 and 91%, respectively.ConclusionsIn the present study, probiotic LAB (Weissella paramesenteroides and Leuconostoc pseudomesenteroides) was successfully isolated and sequenced from Cheka samples. The findings of this in vitro study indicated that fermented beverages like Cheka are a source of the LAB with probiotic functional properties. Overall, Weissella paramesenteroides and Leuconostoc pseudomesenteroides isolates, which showed promising probiotic properties under in vitro conditions, can be used for starter culture development for the Cheka fermentation process.

Asymmetric Atomic Dual-Sites for Photocatalytic CO2 Reduction.

Atomically dispersed active sites in a photocatalyst offer unique advantages such as locally tuned electronic structures, quantum size effects, and maximum utilization of atomic species. Among these, asymmetric atomic dual-sites are of particular interest because their asymmetric charge distribution generates a local built-in electric potential to enhance charge separation and transfer. Moreover, the dual sites provide flexibility for tuning complex multielectron and multireaction pathways, such as CO2 reduction reactions. The coordination of dual sites opens new possibilities for engineering the structure-activity-selectivity relationship. This comprehensive overview discusses efficient and sustainable photocatalysis processes in photocatalytic CO2 reduction, focusing on strategic active-site design and future challenges. It serves as a timely reference for the design and development of photocatalytic conversion processes, specifically exploring the utilization of asymmetric atomic dual-sites for complex photocatalytic conversion pathways, here exemplified by the conversion of CO2 into valuable chemicals.

Implementing active learning in a teaching–learning sequence on rolling motion for mechanical engineers

In this work, we describe a teaching–learning sequence (TLS) on rolling motion, designed and implemented within a Physics 1 course for Mechanical Engineers. The TLS was grounded in Physics Education Research findings and employed active learning strategies, particularly simulation-based exercises that included both conceptual questions and quantitative tasks. We detail and reflect on the development process of the TLS, focussing in particular on the alignment between the identified learning goals and the proposed instructional activities. We present data on students’ attainment of these learning goals, utilizing a post-instruction conceptual survey and an analysis of students’ performance in the final exam. Our research aims to contribute to the implementation of research-based, active learning sequences in large-enrollment contexts, specifically in those courses where both conceptual understanding and formal problem solving are valued.

Construction of a Multi-Label Classifier for Extracting Multiple Incident Factors From Medication Incident Reports in Residential Care Facilities: Natural Language Processing Approach.

Medication safety in residential care facilities is a critical concern, particularly when nonmedical staff provide medication assistance. The complex nature of medication-related incidents in these settings, coupled with the psychological impact on health care providers, underscores the need for effective incident analysis and preventive strategies. A thorough understanding of the root causes, typically through incident-report analysis, is essential for mitigating medication-related incidents. We aimed to develop and evaluate a multilabel classifier using natural language processing to identify factors contributing to medication-related incidents using incident report descriptions from residential care facilities, with a focus on incidents involving nonmedical staff. We analyzed 2143 incident reports, comprising 7121 sentences, from residential care facilities in Japan between April 1, 2015, and March 31, 2016. The incident factors were annotated using sentences based on an established organizational factor model and previous research findings. The following 9 factors were defined: procedure adherence, medicine, resident, resident family, nonmedical staff, medical staff, team, environment, and organizational management. To assess the label criteria, 2 researchers with relevant medical knowledge annotated a subset of 50 reports; the interannotator agreement was measured using Cohen κ. The entire data set was subsequently annotated by 1 researcher. Multiple labels were assigned to each sentence. A multilabel classifier was developed using deep learning models, including 2 Bidirectional Encoder Representations From Transformers (BERT)-type models (Tohoku-BERT and a University of Tokyo Hospital BERT pretrained with Japanese clinical text: UTH-BERT) and an Efficiently Learning Encoder That Classifies Token Replacements Accurately (ELECTRA), pretrained on Japanese text. Both sentence- and report-level training were performed; the performance was evaluated by the F1-score and exact match accuracy through 5-fold cross-validation. Among all 7121 sentences, 1167, 694, 2455, 23, 1905, 46, 195, 1104, and 195 included "procedure adherence," "medicine," "resident," "resident family," "nonmedical staff," "medical staff," "team," "environment," and "organizational management," respectively. Owing to limited labels, "resident family" and "medical staff" were omitted from the model development process. The interannotator agreement values were higher than 0.6 for each label. A total of 10, 278, and 1855 reports contained no, 1, and multiple labels, respectively. The models trained using the report data outperformed those trained using sentences, with macro F1-scores of 0.744, 0.675, and 0.735 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. The report-trained models also demonstrated better exact match accuracy, with 0.411, 0.389, and 0.399 for Tohoku-BERT, UTH-BERT, and ELECTRA, respectively. Notably, the accuracy was consistent even when the analysis was confined to reports containing multiple labels. The multilabel classifier developed in our study demonstrated potential for identifying various factors associated with medication-related incidents using incident reports from residential care facilities. Thus, this classifier can facilitate prompt analysis of incident factors, thereby contributing to risk management and the development of preventive strategies.

Cultivating a psychological health and safety culture for interprofessional primary care teams through a co-created evidence-informed toolkit.

The psychological health and safety of healthcare workers workplaces and learning environments impacts the quality of healthcare services. To facilitate the psychological health and safety of interprofessional primary care teams, we curated a bilingual toolkit of 122 psychological health and safety resources comprising a multi-level categorization addressing individual, team, organization, and system-level interventions. The resources in the toolkit are organized by 7 themes, based on a clustering of the 15 psychosocial factors. Adopting the framework built on the 7 themes, this article describes the toolkit development process and how it addresses the key factors for psychologically healthy and safe workplaces to foster interprofessional collaboration. Implementation of the interventions in the toolkit is an important next step for which health system leadership is critical. Additionally, we identify several gaps and call on researchers, educators, and health leaders to address them in their future work.

Management of Stage III Non-Small Cell Lung Cancer: ASCO Rapid Recommendation Update.

ASCO Rapid Recommendation Updates highlight revisions to select ASCO guideline recommendations as a response to the emergence of new and practice-changing data. The rapid updates are supported by an evidence review and follow the guideline development processes outlined in the ASCO Guideline Methodology Manual. The goal of these articles is to disseminate updated recommendations, in a timely manner, to better inform health practitioners and the public on the best available cancer care options. Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See appendix for disclaimers and other important information (Appendix 1 and Appendix 2, online only).

Adaptive Space Search-based Molecular Evolution Optimization Algorithm.

In drug development process, a significant portion of budget and research time are dedicated to the lead compound optimization procedure in order to identify potential drugs. This procedure focuses on enhancing the pharmacological and bioactive properties of compounds by optimizing their local substructures. However, due to the vast and discrete chemical structure space and the unpredictable element combinations within this space, the optimization process is inherently complex. Various structure enumeration-based combinatorial optimization methods have shown certain advantages. However, they still have limitations. Those methods fail to consider the differences between molecules and struggle to explore the unknown outer search space. In this study, we propose an adaptive space search-based molecular evolution optimization algorithm (ASSMOEA). It consists of three key modules: construction of molecule-specific search space, molecular evolutionary optimization, and adaptive expansion of molecule-specific search space. Specifically, we design a fragment similarity tree in molecule-specific search space, and apply a dynamic mutation strategy in this space to guide molecular optimization. Then we utilize an encoder-encoder structure to adaptively expand the space. Those three modules are circled iteratively to optimize molecules. Our experiments demonstrate that ASSMOEA outperforms existing methods in terms of molecular optimization. It not only enhances the efficiency of the molecular optimization process, but also exhibits a robust ability to search for correct solutions. The code is freely available on the web at https://github.com/bbbbb-b/MEOAFST. Supplementary data are available at Bioinformatics online.

Negative Photoconductivity Transistors for Visuomorphic Computing.

Visuomorphic computing aims to simulate and potentially surpass the human retina by mimicking biological visual perception with an artificial retina. Despite significant progress, challenges persist in perceiving complex interactive environments. Negative photoconductivity transistors (NPTs) mimic synaptic behavior by achieving adjustable positive photoconductivity (PPC) and negative photoconductivity (NPC), simulating "excitation" and "inhibition" akin to sensory cell signals. In complex interactive environments, NPTs are desired for visuomorphic computing that can achieve a better sense of information, lower power consumption, and reduce hardware complexity. In this review, it is started by introducing the development process of NPTs, while placing a strong emphasis on the device structures, working mechanisms, and key performance parameters. The common material systems employed in NPTs based on their functions are then summarized. Moreover, it is proceeded to summarize the noteworthy applications of NPTs in optoelectronic devices, including advanced multibit nonvolatile memory, optoelectronic logic gates, optical encryption, and visual perception. Finally, the challenges and prospects that lie ahead in the ongoing development of NPTs are addressed, offering valuable insights into their applications in optoelectronics and a comprehensive understanding of their significance.

Product Development Anxiety: A Contingency Planning Model for Innovative Production Companies

This paper investigates the possible failure modes of the product development process in production companies that are active in the B2C markets with a focus on household products. Since these cases require short lead times and are difficult to differentiate, in many instances the result will not be the desired one and could affect profitability for a season or for good. A model of these possibilities is created and an approach to plan contingencies for their solutions is proposed in the article. The main guideline is to switch from failure probability determination to accepting failure as inevitable and using digital solutions to reinforce the development process to offset its impact. For this goal, an Industry 5.0 Abatement Factor (abbreviated IFAF) is introduced in the contingency planning approach, which factors in the evaluation of the low cost of digital instruments and the proper mix of Technology, Humans, and AI (abbreviated THAI). The new working procedure based on these concepts and their interlinkages is discussed based on specific examples.

County-level total factor productivity of food in China and its spatio-temporal evolution and drivers

In the context of the ongoing process of high-quality development in the new era, which is focused on improving total factor productivity, it is of great importance to explore the spatial and temporal variations of total factor productivity growth and its driving factors in China’s county regions’ grain cultivation industry. This paper employs a three-stage DEA-Malmquist productivity method, the Gini coefficient method, and a panel fixed-effects model to analyze data from Chinese counties between 2009 and 2019. The analysis indicates that the growth of county food total factor productivity (FTFP) exhibits a fluctuating upward trend during the examination period, with an average annual growth rate of 2.43%. This is primarily driven by technological progress, yet the core driving role of technological efficiency is not effectively played. The average annual growth rate of county FTFP varies across different regions. The highest average annual growth rate of county FTFP in the eastern region and the primary grain-producing area is 2.75 and 3.04%, respectively. The lowest growth rates were observed in the western region and the main grain marketing area, at 1.44 and 1.23%, respectively. Secondly, the Gini coefficient of county FTFP continues to demonstrate a persistent upward trend during the examination period, with an average annual growth rate of 14.729%. The primary factor contributing to the observed variation in total factor productivity growth of the food sector at the regional level is the existence of disparate technological progress. Thirdly, there is a notable positive correlation between county financial deepening and financial self-sufficiency rates and county FTFP growth, with impact coefficients of 0.0503 and 0.0924, respectively. Conversely, county population density, degree of economic development, farmers’ income level, and industrial structure exert a significant negative influence on county FTFP growth and technological progress.

Recent developments in selective laser processes for wearable devices

Recent developments in selective laser processes for wearable devices

Innovations report: A grading committee for a required fourth-year emergency medicine clerkship.

Assessment of medical students in the clinical learning environment is fraught with challenges. Seemingly small variations in clinical clerkship evaluation can significantly impact a student's future. As such, the integrity of the grade selection process must be heavily scrutinized. Group decision making in the form of a clerkship grading committee may be part of a solution to address this complex problem. We conducted a retrospective observational study to describe grading committee decisions for a required fourth-year EM clerkship from August 2021 to April 2022. Literature on best practices for group decision making and assessment were reviewed. This informed the development and implementation of the committee process. Each committee meeting was video recorded and coded for discussion time per student, times the committee grade differed from historical-grade cutoffs with reasoning, and the frequency a committee member voiced a first-hand account of student performance. Data from nine meetings was reviewed (86 students). The mean discussion time per student was 2 min 13 s (range 11 s to 9 min 22 s). The final committee decision differed from historical-grade cutoffs for nine students (10%), six were adjusted above and three below. In 64% (55/86) of student reviews a committee member voiced a first-hand experience of working with the student. Positive grade adjustments were made due to outlier evaluations and negative adjustments were made for professionalism concerns. Grading committees are a means to conduct a comprehensive review of student performance and offer shared ownership of the grade decision among committee members. More study is needed to directly determine their potential benefit and role in clerkship grading.

Minimal model identification of drum brake squeal via SINDy

AbstractThe industrial standard in the design and development process of NVH(Noise Vibration Harshness) characteristic of brakes is the application of Finite Element(FE) models with a high number of degrees of freedom in the range of one or several millions. Nevertheless, parallel experimental investigations are still indispensable. On the other hand, minimal models with, due to the inclusion of the self-excitation process, at least two degrees of freedom are well known to be capable to explain qualitatively phenomena as instability of the desired non-vibrating solution or limit cycle oscillation but are in general very inaccurate in predicting the dynamics of a specific real brake. This is because the underlying physical assumptions are already too restrictive and model parameters (especially those referring to nonlinearities) are widely unknown. To overcome this problem, the data-driven modeling approach SINDy(Sparse Identification of Nonlinear Dynamics) is applied to identify appropriate nonlinear functions for a brake squeal minimal model. A problem thereby is the limited database. It turns out that the naive implementation of the method yielding the lowest possible residuum does not necessarily provide physically meaningful models and results, respectively. Instead, a constrained model that incorporates physical knowledge is used to robustly identify parameters and reproduce realistic dynamic behavior. Thereby, several appropriate models with coexisting limit cycles and stationary equilibrium are identified. In particular, it was found that the angular position of the brake drum has a significant influence on the model parameters and therefore must be taken into account in a model with long-term validity.