Analysis Program Research Articles

Evaluation of the Integration of Topological Optimisation in the Process Chain for Manufacturing Customised Orthopaedic Devices via Additive Manufacturing

Purpose: The effectiveness of the customised solutions compared to the conventional ones and the emergence of advanced production technologies, such as Additive Manufacturing (AM) techniques, strengthened the trend towards an enhanced individualization of the clinical treatments. In the present research, the value of topological optimisation (TO) in the manufacturing process of tailor-made orthopaedic appliance (upper-limb orthosis) was analysed. Methodology: From the morphology of a patient's arm, orthotic models were developed. Nonparametric optimization (Simulia Tosca) was performed, based on the Finite Element Analysis (FEA) program (Abaqus), and contributed to the development of TO orthotic models with diverse levels of volume reduction fraction. The modelling and manufacturing framework for customising orthotic solutions was evaluated with a discussion on the feasibility of lightweight and high-performance products, encompassing production time and cost. Pilot products were produced with a Material Extrusion (MEX) printer. Findings: TO proved to be a practical and valuable approach for the advanced customisation of orthopaedic devices, offering lightweight solutions able to withstand stresses also during patient rehabilitation and remission. From the rapid prototyping perspective, specific strategies must be adopted to prevent the escalation of production costs and time. Originality: The research delves into the overall benefit of implementing an advanced modelling technique within the context of manufacturing highly customised orthoses, analysing how TO activity impacts the rapid prototyping process. Beyond product evaluation, the analysis explores broader implications, including the assessment of feasibility and the development of strategies for integrating the approach into clinical workflows and hospital settings.

Role Conflict: A Qualitative Study on Female Academics with Administrative Duties

Role stressors have negative effects on individual and organizational processes. Role conflict is one of the role stressors. In this research, the concept of role conflict is handled. Studies have shown that female academics are experiencing role conflict, and that role conflict is an obstacle in various areas of their lives. In this context, the sample of the study consists of female academics with administrative duties in a state university in Turkey. Within this framework, it is aimed to explore the experiences of female academics with administrative duties towards role conflict. For this purpose, interviews were held with 16 female academics with administrative duties at a state university in Turkey using a semi-structured questionnaire. The data obtained from the interviews were coded and categorized through MAXQDA v.24.6.0 qualitative data analysis program. As a result of the analysis, themes related to the expressions evoked by the concept of role conflict, the causes of role conflict, the consequences of role conflict, and the coping methods of role conflict were formed.

Structural behavior of ferrocement beams with circular openings

The construction sector is a major contributor to resource consumption and waste generation. Therefore, developing more efficient and sustainable materials and infrastructure is a top priority for achieving the Sustainable Development Goals. This research aims to contribute to this effort by studying the behavior of ferrocement beams with circular openings, with the goal of understanding their behavior under various loads and determining their potential use in designing more resilient and sustainable structures. Fifteen beams with different reinforcement mesh types were subjected to experimental testing under four-point loading, one group serves as the control with conventional reinforcement, while others vary in mesh type and opening configurations. All beams maintained approximately close reinforcement ratios, employing either two layers of welded galvanized steel mesh or a single layer of expanded steel mesh. Using numerical models, all fifteen beams were analyzed with the structural analysis program ANSYS V. 15 to study their non-linear shear behaviors and compare them with experimental data, focusing on load-deflection curves and failure modes. Results show that beams reinforced with expanded steel mesh achieved higher ultimate loads than those with welded mesh, with increases up to 81.59% depending on the opening configuration. However, beams with openings generally exhibited reduced ultimate loads, averaging 26.85% for welded mesh and 32.13% for expanded mesh, compared to beams without openings. Vertical openings, particularly with multiple openings, resulted in significant load decreases.

Using temperature coefficients to support resonance assignment of intrinsically disordered proteins.

The resonance assignment of large intrinsically disordered proteins (IDPs) is difficult due to the low dispersion of chemical shifts (CSs). Luckily, CSs are often specific for certain residue types, which makes the task easier. Our recent work showed that the CS-based spin-system classification can be improved by applying a linear discriminant analysis (LDA). In this paper, we extend a set of classification parameters by adding temperature coefficients (TCs), i.e., rates of change of chemical shifts with temperature. As demonstrated previously by other groups, the TCs in IDPs depend on a residue type, although the relation is often too complex to be predicted theoretically. Thus, we propose an approach based on experimental data; CSs and TCs values of residues assigned using conventional methods serve as a training set for LDA, which then classifies the remaining resonances. The method is demonstrated on a large fragment (1-239) of highly disordered protein Tau. We noticed that adding TCs to sets of chemical shifts significantly improves the recognition efficiency. For example, it allows distinguishing between lysine and glutamic acid, as well as valine and isoleucine residues based on , N, and C data. Moreover, adding TCs to CSs of , N, , and C is more beneficial than adding CSs. Our program for LDA analysis is available at https://github.com/gugumatz/LDA-Temp-Coeff .

Experiences of migrant seasonal agricultural worker mothers in earthquakes: A phenomenological study.

Seasonal agricultural migration leads to both economic hardship and humanitarian challenges. Individuals involved in this migration face severe poverty and deprivation, with mothers critical participants in agrarian work, being especially vulnerable due to challenging conditions and family responsibilities. This study explores the experiences of migratory seasonal agricultural worker mothers and their children, particularly how the earthquake in Turkey impacted them on February 6, 2023. This descriptive phenomenological study was conducted with seasonal agricultural worker mothers who participated in hazelnut harvest in northern Turkey between August and September 2023. Study data were obtained from 22 mothers who agreed to participate. Data were analyzed using the MAXQDA 2022 qualitative data analysis program. It has been determined that the earthquake affects both mothers and children, creates confusion in mothers, creates fear, anxiety, and insecurity in children, and causes behavioral problems such as insomnia and loss of appetite. It has also been determined that positive changes occur in mothers' parenting practices and strengthen family ties. It has been revealed that mothers derive their psychological resilience from their belief systems and social interactions. It was concluded that earthquake experiences positively and negatively affected migratory seasonal agricultural worker mothers and caused emotional and behavioral problems in children.

The effect of anxiety levels in women with hypertensive disorders on the pregnancy course and outcome

Aim. To analyze the influence of anxiety levels in women with hypertensive disorders on the pregnancy course and outcome in order to identify the relationship between the psycho-emotional state of pregnant women and the probability of developing complications or adverse consequences. Materials and methods. 120 pregnant women were examined and divided into three groups: group 1 – pregnant women with chronic arterial hypertension (CAH), n = 40; group 2 – pregnant women who developed gestational hypertension, n = 40; group 3 – pregnant women without hypertensive disorders, n = 40. The women underwent specialized psychometric testing to assess anxiety/stress levels. The analysis was carried out using the Spielberger–Hanin Scale, the Psychological Stress Scale (PSM-25) and the Impact of Traumatic Event Rating Scale (IES-R). Statistical processing of the results and graphic design were performed using a Microsoft Excel 2016 spreadsheet and the comprehensive data analysis program Statistica 10 for Windows. Results. An elevated level of state and trait anxiety according to the Spielberger–Hanin scale prevailed in pregnant women with CAH, which was an additional stress factor and required continuous monitoring even before the pregnancy onset. Evaluating the IES-R scale results, high levels of the intrusion subscale in all studied groups could be caused directly by pregnancy as a stressful factor. According to the avoidance subscale, we have seen similar results, so, pregnancy contributed to overstraining psychological defense mechanisms. However, the predominance in the group of women with gestational hypertension have suggested that high blood pressure after 20 weeks of pregnancy was one of the contributory factors in the activation of mechanisms for avoiding anxiety. The results of the hyperarousal subscale have demonstrated that the presence of hypertensive disorders (before or during pregnancy) caused the autonomic nervous system activation with the body hyperreactivity. The absence of a high level of stress according to the PSM-25 in all studied groups has demonstrated that women did not experience mental discomfort, which required the use of a wide range of methods to reduce it. Cesarean section was the prevailing delivery mode, the highest percentage was among women with CAH. This group also had the highest number of premature births and the maximum proportion of complications in newborns, indicating the influence of CAH as a negative factor in pregnancy outcomes. Conclusions. The results of this study have demonstrated that an increased level of anxiety in pregnant women could negatively affect their health, as well as the fetal development. In addition, concomitant hypertensive disorders in pregnancy could significantly complicate the pregnancy course, increasing the risk for premature birth and complications in newborns. Therefore, in today’s realities, it is extremely necessary to assess the psycho-emotional state of women in advance, involve specialist physicians, develop and implement a set of psycho-prophylactic measures to increase the neuropsychological stability of pregnant women and reduce the number of negative perinatal outcomes.

EXAMINING THE EFFECT OF EMOTIONAL INTELLIGENCE LEVELS OF MANAGEMENT CANDIDATE STUDENTS ON THEIR SUBJECTIVE WELL-BEING

The primary objective of this research is to ascertain the impact of future manager students' emotional intelligence levels on their subjective well-being. The study was carried out on a sample of students who were pursuing their studies at Khazar University, namely within the Faculty of Economics and Management. The study used a survey as the primary approach for data collecting. The convenience sampling technique, which is often used in the literature, was chosen as the sample method. The survey was developed and completed using an online platform. A cohort of 250 students was surveyed, and comment was obtained from 160 of them. The collected data underwent several analytical procedures, including frequency analysis, reliability analysis, regression analysis, and correlation analysis, using the SPPS (Statistical Analysis Programme). In line with the study goal, a total of five hypotheses were formulated to facilitate the analysis process. Consistent with the findings, a significant correlation was seen between emotional intelligence and its many sub-dimensions, namely Self-Awareness, Social Awareness, Self-Control, and Relationship Management. Furthermore, the regression analysis yielded findings indicating a positive relationship between emotional intelligence and its sub-dimensions.

Degradation Pattern of a Biodegradable and Photocurable Sealants Based on Hyaluronic Acid : A Serial Magnetic Resonance Imaging Observational Study in Rat Craniectomy Model.

The aim of this study is evaluating in vivo degradation of photocrosslinkable hyaluronic acid (HA)-based dural sealant (HA photosealant) using magnetic resonance imaging (MRI) and histopathological analysis to assess its biodegradability and effectiveness in preventing cerebrospinal fluid (CSF) leakage. HA photosealants were applied to the incised dura in a rat craniectomy and durotomy. The HA photosealant quickly seal the wound upon low-energy visible light exposure (405 nm, < 5 s, < 1 J/cm2). The degradation of HA photosealants was tracked through serial MRI scans at 1, 2, and 4 weeks post-application. The remaining area of HA photosealants on the dura was measured using image processing program for volumetric analysis. Additionally, histopathological analyses were performed to evaluate the biocompatibility and effectiveness of the dural repair. The MRI and histopathological analyses showed that the HA photosealants achieved progressive degradation while successfully preventing CSF leakage without any adverse tissue reactions. The residual area of HA photosealants measured at 2 weeks ranged from 41.36% to 94.88%, with an average of 66.57%. At 4 weeks, a more distinct degradation pattern was observed compared to 2 weeks, showing a residual area of 10.28% to 56.12%. The HA photosealants maintained structural integrity until dural regeneration was complete. HA photosealant showed gradual degradation in vivo while maintaining mechanical strength until the dura was repaired for preventing CSF leakage without inflammation and toxicity. HA photosealant has great potentials for clinical application for dural repair with biodegradable properties and biocompatibility.

Developing an achievement test on length measurement

In this study, it was aimed to explain the development process of the achievement test related to the subject of measuring length in the 2nd grade mathematics course. Within the scope of the study, in line with the 2018 Primary School Mathematics Curriculum, the list of achievements related to the subject of measuring length in the second-grade mathematics course was determined and a specification table was created according to the achievements. In line with this table, 25 multiple-choice trial items were created. The items were placed in the test in accordance with the level of difficulty and face validity of the test after receiving expert opinion. A period of 30 minutes was determined for the implementation of the test. The test was applied one-to-one with the think aloud technique to 5 students who had studied the subject of length measurement in the 3rd grade. According to the results obtained in the applications, necessary arrangements were made on the points that were not understood in the items. For the application of the test, 211 students studying in the central primary schools in Efeler district of Aydın province in the second semester of 2021-2022 academic year were determined by random sampling method. The results of the test were analyzed by TAP test analysis program and Tetrachoric Factor analysis. Twenty-two items with an item discrimination index of 0.40 and above were included in the test. However, as a result of the tetrachoric factor analysis, 2 more items were removed from the test due to the fact that the items' Measure of Sampling Adequacy (MSA): value and item loadings were below the expected value. Thus, a final test consisting of 20 multiple-choice items was created to be used in the study. As a result of the reliability analysis of the test, the KR 20 value was found to be 0.85. The answer time of the test was determined as 25 minutes. It was revealed that the test is a valid and reliable test that can determine the achievement of 2nd grade students on the subject of length measurement.

Tourism Development in Post-War Settings: The Influence of The Slow City Movement

Wars can inflict profound harm upon a nation's cultural, historical, and natural treasures, jeopardizing tourism resources and potentially leading to their depletion or destruction. However, with meticulous and judicious post-war tourism development planning, these crises can be transformed into opportunities. However, it’s rare to find countries that have emerged from conflict and shifted their focus towards tourism. This research delves into such a nation, one scarred by the ravages of war, to evaluate its tourism potential and its challenges, as perceived by stakeholders. The study not only examines the current state but also forecasts the future implications for urban tourism development amidst the seldom-addressed post-war obstacles in tourism literature. Its primary goal is to delineate the perspectives of local stakeholders on tourist development in a post-war context and to elucidate the role of revitalization in catalyzing the Slow City Movement's growth. Employing qualitative methodologies for data collection and analysis, the study closely intertwines with pertinent literature. Data analysis is facilitated by MAXQDA, a robust qualitative data analysis program, ensuring a comprehensive exploration of stakeholder perspectives and insights into post-war tourism development.

An educational computational program for nonlinear geometric analysis of truss structures using the Finite Element Method based on Positions

This study describes an educational computational program for the analysis of truss structures using the Finite Element Method based on Positions (FEMP). FEMP adopts the nodal positions of discretized elements as degrees of freedom, in contrast to the displacements used in conventional Finite Element Method (FEM). This approach enables FEMP to straightforwardly and naturally incorporate geometric nonlinearity into its positional formulation, simplifying the nonlinear geometric analysis of structures. The developed educational program provides a range of functionalities, allowing users to conduct both static and dynamic analyses of truss structures.

Implementation of Gaussian quadrature in Python program for grillages with curved elements

This paper demonstrates the development of a Python program for linear-elastic structural analysis of grillages featuring circumferential arc-shaped and regular straight elements subjected to concentrated and distributed loads. The algorithm is based on the Finite Element Method. The force method was employed to compute the flexibility matrix, followed by the determination of the stiffness matrix and load vectors through inversion. A Gauss-Legendre Quadrature was incorporated in order to have a better control on accuracy for displacements, rotations, forces and moments. Results were validated through comparisons with literature data and similar software where curved structures are simulated using numerous straight elements. It was demonstrated that the Python-based program yields results closer to the exact solution with simplified input data, highlighting the effectiveness of both programming language and Gauss quadrature technique in structural analysis.

Computational Modeling for Evaluation of Plane Frames in Seismic Zones

Seismic events, also known as earthquakes, induce dynamic effects on structures due to the abrupt movement of the ground, potentially leading these structures to collapse. These earthquakes are often associated with the movement of tectonic plates and primarily occur in regions near the edges of these plates, where interactions are more intense. However, there exists a specific category of earthquakes called ‘induced seismic events’, which are triggered by human activities such as mining, natural resource extraction, and fluid injection into the ground. There has been an increase in the occurrence of these earthquakes in some countries, raising concerns among authorities, especially in urban areas. In this context, our work aims to present a computer program for the dynamic analysis of plane frames, focusing on the structural behavior of such frames under the influence of seismic events. We consider seismic actions as stipulated in the Brazilian standard NBR 15421/23, as well as real induced earthquakes. The results obtained are essential for understanding the behavior of the analyzed structures and are necessary to ensure proper structural design, providing greater safety when these structures are subjected to this type of action.

Study of the influence of construction stages on the analysis of tall reinforced concrete buildings

This dissertation project proposes to investigate the influence of considering construction stages in tall reinforced concrete buildings by evaluating conventional strategies, which do not take the construction stages into account, and strategies that consider them in an approximate way, including a model interpreted as a reference, known as construction effect. Nowadays, with the development of structural analysis and design programs, a change in the structural calculation is observed, moving from conventional models to those that describe the real sequence of loading and construction. Since the structure is subjected to internal forces as it is built, it is desirable for structural engineers to consider the loading being applied progressively and the evolution of the mechanical properties of materials with time. The conventional method, by considering the action of all loads on the completed structure and the modulus of elasticity of concrete at 28 days, does not reflect the reality of constructions. The main distinction between analysis strategies lies in how displacements along the height of the building are treated. In the conventional model, since the loads are applied in a single step, displacements occur simultaneously and cumulatively. On the other hand, in incremental analysis, the loads acting on a given floor do not cause displacements, or consequent internal forces, on an upper floor not yet built. Analysis without consideration of the construction stages may result in an inconsistent distribution of internal forces and may not represent the real behavior of the structure, wich may even result in inadequate design and consequent pathological manifestations and/or collapse of the structure. Therefore, it is intended to conduct a comparison between the methods of conventional analysis, axial stiffness increaser, called the approximate method, and incremental analysis, seeking to understand the main differences in terms of internal forces and the design of buildings. For this purpose, softwares for modeling, analysis, and structural design that allow the simulation of these strategies will be used.

Implementation of a Fatigue Analysis Program Based on the Dual Formulation of the Boundary Element Method

The study and analysis of fatigue are extremely important, given the countless financial and social losses caused by this damage process. For this reason, a complete computational program is implemented for two-dimensional fatigue analysis in cracked components, coded in Fortran 95 language. The Dual Boundary Element Method (DBEM) is used to evaluate the elastic fields of displacement and traction, through the placement of Boundary Integral Equations (BIE) of different natures on each of the crack faces. Stresses and strains at boundary points are evaluated through the hypersingular BIE. Once the variables of interest are obtained in the boundary, the fatigue subcritical propagation of cracks is evaluated based on the concepts of Linear Elastic Fracture Mechanics (LEFM). J-Integral is used to measure the stress intensity factors at the crack tip, due to its effectiveness, precision and excellent coupling with the dual formulation of the Boundary Element Method (BEM). The direction of crack propagation is defined by the Maximum Circumferential Stress criterion. Finally, the lifespan of the cracked component is determined using an adapted Paris Equation, in order to correctly evaluate mixed mode fracture and non-zero mean stresses. Furthermore, using the Rainflow Cycle Counting algorithm, the program is capable of evaluating components under the action of cyclic loads of variable amplitude. In order to evaluate the implemented computational program, two examples are presented. The first considers a Compact Mixed Mode (CMM) specimen under mixed mode fracture. The second example evaluates the driven wheel of an iron ore pelletizing furnace under cyclic loading of variable amplitude. According to the results presented, it is proved the effectiveness and reliability of the developed computational program, which allows to accurately analyze real situations of components under mode I, II or mixed mode fatigue.

Translational joint in a Finite Element Analysis program of 2D frames with straight and curved elements

This paper describes the development of an algorithm for the structural analysis of bidimensional frames with straight and curved elements that include a translational joint which can be set to any specified angle. The code was written in Fortran following a Finite Element Method-based structure. Three elements were considered: a circumferential arc-shaped; a straight bar with cross-sectional height varying according to a linear polynomial function; and the traditional straight element with constant inertia. All Stiffness matrices and load vectors were derived from the inversion of their corresponding Flexibility matrices obtained using the Force Method. In a few cases, a Gaussian Quadrature was needed in order to calculate the integral. The resulting program was validated against solutions found in the scientific literature in addition to structures created and solved by the authors using the Virtual Work Method, and it is shown to give very accurate predictions for displacements and rotations as well as reactions and internal forces (axial, shear and bending).

Computer Assisted Nodule Analysis and Risk Yield is Associated with Occult Lymph Node Status in Clinical Stage I-IIA Lung Adenocarcinoma Undergoing Resection

BackgroundCurrent staging work-up does not capture all occult lymph node (OLN) disease. We sought to determine if Computer Assisted Nodule Analysis and Risk Yield (CANARY) analysis could help distinguish OLN status in early-stage lung adenocarcinoma. MethodsRetrospective review of resected lung cancer patients from 2016-2021 was performed. Patients with surgically resected clinical stage I-IIA lung adenocarcinoma were included. Preoperative imaging was entered into the CANARY software, and each lesion was categorized into good, intermediate, and poor risk. OLN status was determined per pathology results. Pearson's Chi-square correlation, univariate and multivariate logistic regression models were used to assess OLN metastases as a function of CANARY risk profile, with statistical significance at α=0.05. ResultsIn total, the study cohort included 228 patients with median age of 70. By clinical stage, 195 (85.5%), 24 (10.5%), and 9 (3.9%) patients were determined to be in IA, IB, and IIA, respectively. 28 (12.3%) patients were found to have OLN metastases. Among them, 1 (3.6%), 3 (10.7%), and 24 (85.7%) patients had a good, intermediate, and poor CANARY risk profile, respectively. CANARY risk profile was significantly associated with OLN metastases (χ2=9.9, p=0.007). Relative to the good/intermediate group, patients with poor risk had a more-than 3-fold increase in likelihood of having OLN metastases (odd ratio [OR]=3.3, 95% confidence interval [CI]:1.6-9.2, p=0.007). ConclusionCANARY analysis was able to risk-stratify the likelihood of OLN metastases in early-stage lung adenocarcinoma. CANARY can provide an adjunctive non-invasive tool to aid in determining an appropriate individualized treatment plan. Micro-abstractWe were able to identify potential prognostic capability of the Computer Assisted Nodule Analysis and Risk Yield (CANARY) program in the determination of occult lymph node metastasis in clinical stage I-IIA lung adenocarcinoma. In a single-institution cohort of 228 patients, those with poor risk determined by Score Indicative of Lung Cancer Aggression (SILA) has a 3-fold increase in likelihood of having occult lymph node metastasis (odds ratios = 3.3 [1.6-9.2]).

The role of wise leadership in managing strategic ignorance in the public sector

This research aims to test and verify the validity of the relationship between wise leadership and the management of strategic ignorance in the public sector. This research seeks to answer the following question: Does the senior leadership in the Iraqi Ministry of Labour and Social Affairs rely on the philosophy of wise leadership in managing and leading the institution, dealing with employees, and making decisions? This study seeks to bridge the research gap between wise leadership and managing strategic ignorance, testing it in the Iraqi Public Environment Sector for the first time and explaining how strategic ignorance can be handled by applying the philosophy of wise leadership. The results of this study help to provide managers in the public sector, the ministry, and the study community with the necessary information that contributes to improving their leadership skills and reducing the level of cognitive ignorance among ministry employees. The descriptive analytical approach was adopted and a random sample of senior leaders in the ministry, who held the rank of general manager, department director, division official, and unit official, was chosen. The research sample consisted of 125 managers. The questionnaire was used as a tool for collecting data and the statistical analysis programme SPSS V.26 was relied upon to analyse data and test the validity of hypotheses. The research found that there is an impact and correlation between wise leadership and Strategic Ignorance Management for Government Institutions. In contrast, the research did not discover a relationship for the variable of understanding the essence in the management of strategic ignorance, as the senior leadership in the Ministry of Labour and Social Affairs relies on the philosophy of wise leadership in managing strategic ignorance in the ministry.

Emission reduction strategies and health: a systematic review on the tools and methods to assess co-benefits

ObjectiveThe objective of this study is to review the current literature on the health co-benefits of emission reduction strategies and the methods and tools available to assess them.DesignSystematic review conducted...

Design of and Early Insights From a Generalized Myasthenia Gravis Patient Engagement Research Council.

An exploratory focus group study was conducted to better understand the needs of patients living with generalized myasthenia gravis (gMG). US-based adults with gMG and caregivers of patients with gMG participated in a Patient Engagement Research Council between August 2022 and January 2023. The study consisted of a 15-min prework survey, followed by virtual focus groups facilitated using a semi-structured interview guide. Data concepts were identified using conversational analysis and by direct observation. All transcripts were coded based on concepts using a qualitative research analysis program (MaxQDA). 16 participants (13 patients, three caregivers) were recruited. Participants reported impact on daily activities, fatigue, and psychosocial problems. Many participants experienced delayed diagnosis and difficulty accessing specialist care. Participants described multiple barriers related to their gMG, including barriers to treatment, access-related issues, and communication disconnect between patients and healthcare professionals. Achieving stable disease was the most important goal. There was a preference for the autonomy of self-administered medications at home versus infusions. Study insights led to recommendations to guide patient and healthcare professional education. The study illustrates the need to improve access to specialist care, achieve earlier diagnosis, prioritize patients' preferences in disease management, and develop treatments that improve outcomes without additional burden. The data collected in this study was provided by the focus group participants, which included patients and caregivers of those with myasthenia gravis.