System Level Research Articles

Surgical complications: errors and adverse events.

Complications are a recognized hazard of surgery. The term is confusing; it has multiple meanings, including surgical error and adverse surgical outcomes. I propose the latter two terms are used. Grading of 'complications' is difficult but made easier by grading errors and outcomes separately, though they are not always linked. The exact grades are not established.Error avoidance requires efforts at a personal (surgeon) level, including training, learning and preparation, and at a systems level. Understanding human factors is important.The perspective of patients about adverse outcomes is not well understood. There is evidence that, unsurprisingly, patient perspectives may be different to surgeon perspectives. There are a range of surgeon responses to error and adverse outcomes; many are negative. These need to be understood better in order to protect patients and surgeons in the immediate aftermath and in the potentially prolonged 'recovery time', both for patients and surgeons.Level of evidence: V.

Interplay of miRNA-TF-Gene Through a Novel Six-node Feed-forward Loop Identified Inflammatory Genes as Key Regulators in Type-2 Diabetes

Background: Intricacy in the pathological processes of type 2 diabetes (T2D) invites a need to understand gene regulation at the systems level. However, deciphering the complex gene modulation requires regulatory network construction, Objective: The study aims to construct a six-node feed-forward loop (FFL) to analyze all the diverse inter- and intra- interactions between microRNAs (miRNA) and transcription factors (TF) involved in gene regulation. Methods: The study included 644 genes, 64 TF, and 448 miRNA. A cumulative hypergeometric test was employed to identify the significant miRNA-miRNA and miRNA-TF interaction pairs. In addition, experimentally proven TF-TF pairs were incorporated for the first time in the regulatory network to discern gene regulation. The networks were analyzed to identify crucial genes involved in T2D. Following this, gene ontology was predicted to recognize the biological function that is crucial in T2D. Results: In T2D, the lowest gene regulation for a composite FFL occurs through a four-node FFL variant1 (TF- miRNA-miRNA-Gene, n=14) and the highest regulation via a five-node FFL variant2 (TF-TF-miRNA-Gene, n=353). However, the maximum gene regulation occurs via six-node miRNA FFL (miRNA-miRNA-TF-TF-gene-gene, n=23987). Subnetworks derived from the six-node miRNATF- gene regulatory networks identified interactions among TP53 and NFkB, hsa-miR-125-5p and hsamiR- 155-5p. Conclusion: The core regulation occurs through TP53, NFkB, hsa-miR-125-5p, and hsa-miR-155-5p FFL implicating the association of inflammation in the pathogenesis of T2D, which occurs majorly via six-node miRNA FFL. Thus regulatory network provides broader insights into the pathogenesis of T2D and can be extended to study the inflammatory mechanisms in various infections.

Heat Transfer-Inspired Network for Image Super-Resolution Reconstruction.

Image super-resolution (SR) is a critical image preprocessing task for many applications. How to recover features as accurately as possible is the focus of SR algorithms. Most existing SR methods tend to guide the image reconstruction process with gradient maps, frequency perception modules, etc. and improve the quality of recovered images from the perspective of enhancing edges, but rarely optimize the neural network structure from the system level. In this article, we conduct an in- depth exploration for the inner nature of the SR network structure. In light of the consistency between thermal particles in the thermal field and pixels in the image domain, we propose a novel heat-transfer-inspired network (HTI-Net) for image SR reconstruction based on the theoretical basis of heat transfer. With the finite difference theory, we use a second-order mixed-difference equation to redesign the residual network (ResNet), which can fully integrate multiple information to achieve better feature reuse. In addition, according to the thermal conduction differential equation (TCDE) in the thermal field, the pixel value flow equation (PVFE) in the image domain is derived to mine deep potential feature information. The experimental results on multiple standard databases demonstrate that the proposed HTI-Net has superior edge detail reconstruction effect and parameter performance compared with the existing SR methods. The experimental results on the microscope chip image (MCI) database consisting of realistic low-resolution (LR) and high-resolution (HR) images show that the proposed HTI-Net for image SR reconstruction can improve the effectiveness of the hardware Trojan detection system.

Hybrid Scheduling of Tasks and Messages for TSN-Based Avionics Systems

Time-Sensitive Networking (TSN) has been widely considered as a promising networking candidate for avionics systems due to its capability of deterministic communication. In such TSN-based avionics systems, the network scheduling enables the timely transmission of messages. However, this is insufficient to satisfy the real-time requirements of functions, since functions involve the chain-execution of several tasks where messages only serve for the inter-task communication. In order to enhance the functionality of TSN-based avionics systems, scheduling should be extended from the network level to the system level to coordinate message transmission with task execution. Then, how to efficiently implement the hybrid scheduling of tasks and messages becomes an important issue. In this paper, we construct a novel hybrid scheduling framework for TSN-based avionics systems, which consists of system consistency constraints, in-loop function delay calculation, and two hybrid scheduling algorithms. Consistency constraints restrict the unexpected interaction of messages and tasks for hybrid scheduling to guarantee the system-level determinism. Function delay is the end-to-end delay of the task chain, and its calculation provides the optimization objective for hybrid scheduling indicated by two metrics, namely reaction delay and age delay. Scheduling algorithms improve solving efficiency and functional performance through the incremental strategies of message dynamic ordering and task-message rescheduling. Experimental results verify that, compared with exiting scheduling work which considers the dependency of messages on tasks, our work can complete complex scheduling for large systems even with hundreds of functions, and can reduce function delays by 69% in reaction delay and 37% in age delay.

Influence of phase diffusion on atomic grating in a three-level ladder-type system in lower-level microwave-driven scheme

In this paper, we consider a scheme for electromagnetically induced grating (EIG) in a three-level ladder-type system. A microwave field of finite bandwidth making a standing-wave pattern is applied on lower levels. In addition, we have also introduced an indirect pump in our system. A weak probe field is then applied to study the effects of phase diffusion associated with the microwave control field on EIG. It is found that phase diffusion associated with the strong microwave control field strongly affect the diffraction. We have incorporated the effect of different system parameters such as the strength of the microwave field, indirect pumping mechanism, interaction length, and detuning in the weak probe field. Interestingly, the stronger microwave control field retrieves the loss in diffraction intensity caused by the phase diffusion. Our results show that the introduction of detuning in the optical probe field results in the enhancement of the phase grating effect. Furthermore, our results show that an optimized indirect pump field can slightly improve the first-order diffraction intensities both in the absence and presence of phase diffusion.

Electronic Properties of F, Cl and H Atoms Adsorbed on CsPbI3(110) Surface

The electronic properties of the CsPbI3 surface are calculated by using first-principles calculations. Through calculating adsorption energy of CsPbI3 passivated by Cl, F and H atoms, it is found that adsorption energy values of CsPbI3 (110) surface passivated by H atoms fluctuate less, they are less sensitive to the adsorption position, and the adsorption is stable. Through calculating surface states of passivation system, it is found that F and H atoms have quite good passivation effect, and the Fermi level of passivation system increases and enters the forbidden band, indicating that the passivation effect is relatively ideal. Passivation effect of Cl atoms are poor, a new shallow acceptor defect states appeared at the bottom of the conduction band. This defect level could trap carriers and weaken the carrier migration ability, which is a disadvantage of Cl passivation system. Through the charge density difference and Bader charges, it is found that the F and H atoms get more electrons from the I atom, which is beneficial to the passivation of the surface states.

Подходы к оценке защищённости информационных систем с криптографическим преобразованием объектов

The file system is one of the components of an information system, especially vulnerable to attacks by intruders. Consequently, it is impossible to increase the security level of an information system without ensuring a sufficient level of protection for file system objects, attacks on which affect, among other things, the interests of users of information systems. In order to make decisions on the use of certain mechanisms for protecting file system objects, a regular assessment of their current level of security is necessary. The purpose of the study. Building a model for assessing the security of an information system with cryptographic transformation of file system objects in the context of an attacker using a wide range of attacks on the file system. Materials and methods. The analysis of scientific publications on the problem of assessing the security of information systems allowed us to propose a methodology for assessing the security of information system assets. The methodology is based on a combination of a probabilistic approach to the analysis of possible scenarios for the implementation of threats in information systems for file system objects, expert assessments of basic attack events and representations in the form of attack trees. The threat implementation representation in the form of attack trees is used to simulate the actions of an attacker. Results. A structural model of an information system with cryptographic transformation of objects has been developed. Its valuable assets have been allocated. The list of the main threats to information security relevant for such systems is defined. Possible variants of the ways of implementing attacks and possible scenarios of the development of events in the processes of transferring file system objects with cryptographic transformation are modeled. A set of measures for the protection of information system objects with cryptographic transformation of objects is proposed. The calculation of the probabilities of attacks on an asset along the path determined by the attack tree, the possibility of implementing an attack, the degree of effectiveness of the proposed countermeasures is proposed. Conclusion. The presented methodology for assessing the security of an information system with cryptographic transformation of objects makes it possible to use well-known approaches in a comprehensive manner, and will be useful to developers and researchers in practical and scientific activities to ensure information security.

Compliance of Adolescent Friendly Health Clinics with National and International Standards: Quantitative findings from the i-Saathiya study

ObjectiveIndian adolescents experience several health challenges requiring acceptable, equitable, appropriate and effective healthcare services. Our objective was to assess the compliance of Adolescent Friendly Health Clinics (AFHCs) in two of...

Climate Change Education, Globalisation and the Nation State: A Commentary on Ghana’s Science Curriculum

AbstractIn this paper, we offer a commentary on the climate change content in Ghana’s primary and junior high school science curriculum. Since 2019, the government of Ghana has mandated climate change education at multiple levels of the school system. However, there is very little analysis of these curricula. This paper fills an important gap by critically reviewing the climate change content in the science curriculum in a country with a complex and tenuous past regarding capitalist and colonialist expansion and exploitation. We note that while the curriculum attends to technical details of greenhouse gas emissions and climate impacts, it elides the larger global context that has led to the rise in carbon emissions and anthropogenic climate change. We make the case for a climate change curriculum that integrates culture, language and histories, and tackles the complexities of globalisation.

Gut Microbiota Dysbiosis and Inflammation Dysfunction in Late-Life Depression: An Observational Cross-Sectional Analysis.

There are some challenges to diagnosis in the context of similar diagnostic criteria for late-life depression (LLD) and adult depression due to cognitive impairment and other clinical manifestations. The association between gut microbiota and inflammation remains unclear in LLD. We analyzed gut microbiota characteristics and serum inflammatory cytokines in individuals with LLD to explore the combined role of these two factors in potential biomarkers of LLD. This was an observational cross-sectional study. Fecal samples and peripheral blood from 29 patients and 33 sex- and age-matched healthy controls (HCs) were collected to detect gut microbiota and 12 inflammatory factors. We analyzed differences in diversity and composition of gut microbiota and evaluated relations among gut microbiota, inflammatory factors, and neuropsychological scales. We extracted potential biomarkers using receiver-operating characteristic curve analysis to predict LLD utilizing the combination of the microbiota and inflammatory cytokines. Elevated systemic inflammatory cytokine levels and gut microbiota dysbiosis were found in LLD patients. Relative abundance of Verrucomicrobia at the phylum level and Megamonas, Citrobacter, and Akkermansia at the genus level among LLD patients was lower than HCs. Abundance of Coprococcus, Lachnobacterium, Oscillospira, and Sutterella was higher in LLD patients. Notably, IL6, IFNγ, Verrucomicrobia, and Akkermansia levels were correlated with depression severity. Our study identified IL6, Akkermansia, and Sutterella as predictors of LLD, and their combination achieved an area under the curve of 0.962 in distinguishing LLD patients from HCs. This research offers evidence of changes within gut microbiota and systemic inflammation in LLD. These findings possibly help elucidate functions of gut microbiota and systemic inflammation in LLD development and offer fresh ideas on biomarkers for clinical practise in the context of LLD.

Still water run deep: Therapeutic TP effect of ucMSC-Ex via regulating mTOR to enhance autophagy.

Our previous study confirmed that umbilical cord mesenchymal stem cells-exosomes (ucMSC-Ex) inhibit apoptosis of pancreatic acinar cells to exert protective effects. However, the relationship between apoptosis and autophagy in traumatic pancreatitis (TP) has rarely been reported. We dissected the transcriptomics after pancreatic trauma and ucMSC-Ex therapy by high-throughput sequencing. Additionally, we used rapamycin and MHY1485 to regulate mTOR. HE, inflammatory factors and pancreatic enzymatic assays were used to comprehensively determine the local versus systemic injury level, fluorescence staining and electron microscopy were used to detect the effect of autophagy, and observe the expression levels of autophagy-related markers at the gene and protein levels. High-throughput sequencing identified that autophagy played a crucial role in the pathophysiological process of TP and ucMSC-Ex therapy. The results of electron microscopy, immunofluorescence staining, polymerase chain reaction and western blot suggested that therapeutic effect of ucMSC-Ex was mediated by activation of autophagy in pancreatic acinar cells through inhibition of mTOR. ucMSC-Ex can attenuate pancreas injury by inhibiting mTOR to regulate acinar cell autophagy after TP. Future studies will build on the comprehensive sequencing of RNA carried by ucMSC-Ex to predict and verify specific non-coding RNA.

Exploring the associations between physical activity level, cognitive performance, and response to computerized cognitive training among chronic stroke patients

AbstractBackgroundPost‐stroke attentional and working memory deficits are common and represent relevant predictors of long‐term functional recovery and outcome. The individual responses to cognitive rehabilitation and interventions vary between patients and are influenced by multiple factors. Recently, a link between the level of engagement in physical activities and cognitive rehabilitation has been suggested. However, few previous studies have tested the predictive value of physical activity on cognitive performance and response to cognitive training among chronic stroke patients. There is also a lack of knowledge concerning the prognostic value of index stroke characteristics on physical activity in chronic phase.MethodIn this cross‐sectional and longitudinal study, including stroke survivors suffering mild‐to‐moderate strokes (n = 52, mean age = 70 years), we used Bayesian regression to test the association between cognitive performance and response to a 3‐week intervention with a commonly used computerized cognitive training (CCT) system and baseline physical activity level measured with International Physical Activity Questionnaire. We also tested the association between physical activity level in chronic phase and stroke characteristics, including stroke severity (National Institutes of Health Stroke Scale), ischemic stroke etiology (Trial of Org 10172 in Acute Stroke Treatment), and stroke location (n = 66, mean age = 68 years). For descriptive purposes, we included 104 sex‐ and age‐matched healthy controls (mean age = 69 years).ResultsThe analyses revealed anecdotal evidence of a positive association between overall cognitive performance and daily minutes of sedentary behavior, indicating that better cognitive performance was associated with more daily hours of sitting still. We found no support for an association between cognitive performance and response to CCT with activity level. In addition, the analysis showed group differences in sedentary behavior between patients with small‐vessel disease (n = 20) and cardioembolism (n = 7), indicating more sedentary behavior in patients with small‐vessel disease. There was no further support for a predictive value of index stroke characteristics on physical activity level.ConclusionThe results do not support that baseline physical activity level is a relevant predictor of the overall performance or response to CCT in this sample of chronic stroke patients. Similarly, the analyses revealed little evidence for an association between index stroke characteristics and future activity level in patients surviving mild‐to‐moderate stroke.

Abstract A013: Cell-extrinsic mechanisms of accelerated therapy resistance mediated by altered pharmacokinetics

Abstract Background: Targeted therapies directed against oncogenic signaling addictions, including one resulting from EML4-ALK fusions, can induce strong and durable clinical responses. However, some tumors do not respond (intrinsic resistance), while the initially responsive advanced cancers eventually relapse (acquired resistance). Our earlier studies with experimental models of ALK+ lung cancer revealed that acquired resistance to ALK inhibitors represents a gradual, multifactorial adaptation that progresses through multiple intermediate stages. These evolutionary intermediates can display unique collateral sensitivities to pharmacological inhibitors, including high sensitivity to a KDM histone demethylase inhibitor JIB-04. Results: To explore the utility of using JIB04 to suppress the evolution of resistance in vivo, we examined its ability to enhance responses to clinical ALKi alectinib and lorlatinib in mouse xenograft models. Surprisingly, JIB04 blunted the in vivo tumor responses and accelerated their relapse. The discrepancy between the in vitro and in vivo effects of JIB04 implied environmental mediation. Therefore, we examined the potential involvement of several mechanisms of environment-mediated resistance. We found that rather than directly decreasing cell-intrinsic therapy sensitivity, JIB04 altered ALKi pharmacokinetics. Using mass spectrometry measurements, we found a strong reduction in systemic and intratumor levels of the ALKi. This reduction is attributable to an accelerated metabolic conversion and excretion of metabolites. Our ongoing and planned efforts focus on the elucidation of mechanistic details and the exploration of clinical correlation. Significance: Both intrinsic and acquired resistance are assumed to reflect reduced sensitivities of tumor cells due to mutational, plasticity-related, and microenvironmental mechanisms. Pharmacokinetics studies are the essential component of drug development and clinical trial pipelines. However, after clinical approval, drug concentrations are not routinely examined in clinics. Whereas JIB04 is not used in clinics, its effects are mediated by mechanisms that might be triggered by more relevant dietary or pharmacological factors. Our results highlight the potential danger of blind spots in consideration of causes of therapy resistance and warrant the inclusion of pharmacokinetics analyses in diagnosing/treating therapy resistance. Citation Format: Pragya Kumar, Robert Vander Velde, Virginia Turati, Andriy Marusyk. Cell-extrinsic mechanisms of accelerated therapy resistance mediated by altered pharmacokinetics [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Cancer Evolution and Data Science: The Next Frontier; 2023 Dec 3-6; Boston, Massachusetts. Philadelphia (PA): AACR; Cancer Res 2024;84(3 Suppl_2):Abstract nr A013.

Salmonella-mediated methionine deprivation drives immune activation and enhances immune checkpoint blockade therapy in melanoma

BackgroundAlthough immune checkpoint inhibitor (ICI)-based therapy is advantageous for patients with advanced melanoma, resistance and relapse are frequent. Thus, it is crucial to identify effective drug combinations and develop new...

External Urethral Sphincter Botulinum Toxin Injection to Treat Pseudodysynergia in Patients With Cerebral Palsy

To evaluate urinary outcomes following cystoscopic external urinary sphincter onabotulinumtoxinA (BTX) injections in patients with cerebral palsy (CP). Adults with CP can suffer from bladder outlet obstruction and urinary retention due to a spastic external urethral sphincter ("pseudodysynergia"). We have used BTX injections into the sphincter to relieve the obstruction and allow patients to maintain spontaneous voiding rather than intermittent catheterization. Patients were included in this retrospective cohort study if they had a diagnosis of CP, were at least 18 years of age, and underwent a urethral external sphincter BTX injection between 2016-2023. The procedure included 100u or 200u of BTX mixed in 4cc of saline. Primary outcomes were subjective, patient or caregiver reported changes in retention, lower urinary tract symptoms (LUTS), frequency of recurrent urinary tract infections (UTIs), and hydronephrosis or bladder stones/debris on ultrasound. Fifty patients were included; the majority were male (60%), lived at home with assistance (58%), and had a Gross Motor Function Classification System level of V (50%; ie, severe CP). The most common indications for BTX were retention (96%), LUTS (48%), hydronephrosis (18%), and recurrent UTIs (22%). Post-BTX improvement was seen in 67% of those with LUTS, 65% with retention, 67% with hydronephrosis, and 73% with recurrent UTIs. Most patients underwent repeat injections (60%). There were no significant complications associated with injections. External urethral sphincter BTX is a safe, effective option for treating pseudodysynergia in adults with CP.

“Just as curry is needed to eat rice, antibiotics are needed to cure fever”—a qualitative study of individual, community and health system-level influences on community antibiotic practices in rural West Bengal, India

ObjectivesTo understand community antibiotic practices and their drivers, comprehensively and in contextually sensitive ways, we explored the individual, community and health system-level factors influencing community antibiotic practices in rural West...

Variability in guideline-directed medical therapy across sites and operators and long-term mortality and amputation outcomes risk in patients undergoing peripheral vascular interventions

The use of guideline-directed medical therapy (GDMT) in patients undergoing peripheral vascular interventions (PVIs) decreases the risk of death and amputation and may decrease hospital readmissions. The variability of GDMT prescription across sites and operators and the proportionality of risk is not well understood. We aimed to study the association between variability of GDMT prescription at the site and operator level and outcomes (including 90-day readmissions and 24-month all-cause mortality and major amputation). We examined GDMT discharge rates in PVIs performed between 2017 and 2018 using Medicare-linked Vascular Quality Initiative registry. GDMT included a statin, antiplatelet therapy, and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACE-i/ARB) if hypertensive. Quartiles (Q1-4) of GDMT rates were documented by operators and sites and variability was quantified using median odds ratios (MOR) and intraclass correlation (ICC). The association between lower GDMT rates (per 10%) by sites and operators with 90-day readmission were calculated using logistic regression, and with 24-month mortality and major amputation using parametric survival model. Models were adjusted for patient-level factors and included sites and operators nested within sites as 2 random effects. GDMT rates for 17,147 patients across 223 sites and 1,263 operators ranged from 0% to 38% (Q1, MOR 1.43, 95%CI 1.39-1.47, P ≤ .001) to 57%-100% (Q4, MOR 1.48, 95%CI 1.44-1.51, P ≤ .001). Four percent of variance in GDMT use was explained by sites (ICC 3.9, 95%CI 2.9-5.3) and operators (ICC 4.1, 95%CI 3.1-5.4). A dose-response relationship was noted between lower GDMT rates and increased risk of 90-day readmission risk by sites (P = .021) and operators (P < .001). Lower GDMT prescription by site was associated with higher risk of 24-month mortality (HR = 1.07, 95%CI 1.02-1.13) and major amputation (HR = 1.08, 95%CI 1.01-1.15). Similar associations were found for GDMT use by provider (mortality HR = 1.05, 95%CI 1.02-1.08 and amputation HR = 1.04, 95%CI 1.00-1.08). Both at the operator and health system level, there was significant variability in GDMT prescription following PVI, proportionally translating into risk for readmission, mortality, and major amputation. Targeted quality efforts should prioritize both operator and site levels to improve GDMT use and outcomes for patients undergoing PVI.

Control System Level Intrusion Detection on J1939 Heavy-Duty Vehicle Buses

As the security vulnerabilities of Controller Area Networks (CAN) become well known, heavy-duty vehicles implementing the SAE J1939 specification layer on this bus are immediate targets. Recently released standards provide clear cybersecurity requirements, but the exact methods to be implemented are not specified and remain up to the manufacturers. In this work we address adversary actions and countermeasures at the control system level for a heavy-duty vehicle J1939 CAN bus. This low level approach allows us to complement regular attacks with more knowledgeable attacks that may evade detection and discuss realistic countermeasures. Indeed, as we also show by experiments, traditional approaches based on machine learning algorithms will largely fail to detect such attacks. We present experiments based on a model that links between the Simulink environment, an extension of the MATLAB platform for the simulation of in-vehicle control systems, with the CANoe environment, which facilitates the simulation of in-vehicle networks.

Development and initial validation of a screening tool for visual ability/performance of people with polyhandicap

BackgroundVisual impairments are common in people with polyhandicap although they are poorly assessed. However, evaluation of the visual abilities of these people is critical to determining treatment for impairments. ObjectivesTo develop and validate an easy-to-use visual-behavioural scale for assessing the visual abilities of people with polyhandicap. MethodsThe development of the Visual Assessment for People with Polyhandicap (VA-PLH) involved 2 steps: i) construction of the scale and ii) field validation. Participant selection criteria were aged > 3 years, age at onset of cerebral lesion < 3 years, a combination of motor impairment and profound intellectual impairment associated with restricted mobility (Gross Motor Function Classification System levels [GMFCS] III, IV or V), and everyday life dependence (Functional Independency Measure [FIM] <55). Vision assessment by both an orthoptist and an ophthalmologist was the reference against which were analysed the items of the scale completed by local health care workers. Acceptability, validity, and reliability were analysed. ResultsAmongst the 232 participants included, 217 had a complete assessment, and 33% were < 18 years of age. Ocular abnormalities were reported in 83% of participants. Visual ability was altered or insufficient in 60% of participants. The final version of the VA-PLH included 3 items related to visual reaction (Area Under Curve Receiver Operating Characteristic = 0.83). Participants were considered at-risk if they had at ≥ 1 of 3 signs present (sensitivity 83% and specificity 73%). The scale's reliability was satisfactory ConclusionThe VA-PLH scale provides an easy-to-use, reliable and valid measure of visual status for people with polyhandicap and may be used both in clinical practice and clinical research. In addition, this study provides an overview of the diversity of visual impairments in a large population of people with polyhandicap, showing that most experience visual challenges.

Training intensity of robot-assisted gait training in children with cerebral palsy.

We compared three different intensities of robot-assisted gait training (RAGT) for achieving favourable outcomes in children with cerebral palsy (CP). This study was conducted using a randomized controlled, single-blind design. Thirty children (19 males and 11 females; mean age 6 years 1 month, SD 2 years) with CP classified in Gross Motor Function Classification System levels II and III were assigned to three different RAGT intensity groups: high-intensity (fastest walking speed and lowest body weight support [BWS]), low-intensity (slowest speed and highest BWS), and comfortable intensity (intermediate speed and intermediate BWS). The RAGT intervention was performed three times a week for 6 weeks. Outcome measures included the 88-item Gross Motor Function Measure, stability index, spatiotemporal parameters of gait analysis, paediatric functional independence measure, and the Canadian Occupational Performance Measure. The 88-item Gross Motor Function Measure was significantly improved after training in the high-intensity (D Δ8.3 ± 15.6; E Δ3.8 ± 4.1) and comfortable intensity (D Δ2.9 ± 3.1; E Δ1.2 ± 2.0) groups, whereas gait speed was improved in the comfortable intensity group, without statistically significant group differences. Only the low-intensity group showed improvement on the stability index (Δ -0.6 ± 0.9, p = 0.05). Everyday functional performance significantly improved in all three groups, with the comfortable intensity group showing the greatest improvement. Different training intensities produced improvement in different areas; individualized RAGT intensity adjustment is therefore needed based on the rehabilitation goal.