There was a significant main effect of workload on lane deviation (p < .05), indicating that a longer time on task resulted in greater lane deviation. A significant main effect of day (p < .001) but not time of day for the NASA-TLX, PVT and KSS was found. Time on task has a significant further impact on driving performance and should be considered alongside sleep deprivation and time of day when implementing strategies for long-distance driving.Sleep deprivation and time of day have been shown to play a critical role in decreasing ability to sustain attention, such as when driving long distances. However, a gap in the literature exists regarding external factors, such as workload. One way to examine workload is via modulating time on task. This study investigated the combined effect of sleep deprivation, time of day, and time on task as a workload factor on driving performance. Twenty-one participants  underwent 62 h of sleep deprivation within a controlled laboratory environment. Participants received an 8-h baseline and 9.5-h recovery sleep. Every 8 h, participants completed a Psychomotor Vigilance Task (PVT), Karolinska Sleepiness Scale (KSS), 30-min monotonous driving task and NASA-Task Load Index (TLX). Driving variables examined were lane deviation, number of crashes, speed deviation and time outside the safe zone. Workload was measured by comparing two 15-min loops of the driving track. A mixed model ANOVA revealed significant main effects of day and time of day on all driving performance measures ( The amount of sleep and time of day impair cognitive performance, especially sustained attention. However, little research has specifically examined the role of workload on long sustained attention tasks, such as driving performance. Results showed that workload (time on task) influenced lane deviation, indicating that the longer the participants drove, the more their performance deteriorated. Higher subjective workload scores also tracked poorer driving performance. Future research is required to investigate the impact of other workload factors, such as cognitive load on driving performance, to encapsulate the whole construct.Sleep loss and time of day, impact sustained attention, and performance . These fAlongside these processes, external factors, including workload, impact alertness, and reduce cognitive performance . There iTime on task is a primary factor contributing to workload, as extended time on a task can increase sleepiness and reduce alertness . This maDriving requires continuous sustained attention . MonotonAlong with performance measures of alertness and workload, it is important to concurrently measure subjective perceptions as they help predict behavior , and proThe literature shows that sleep deprivation, time of day, and time on task all individually impact sustained attention. However, little is known about how time on task as a workload factor impacts sustained attention, specifically driving performance, at different times of the day under conditions of sleep deprivation. It is common within Australia for long-haul truck drivers to operate a vehicle between 6 and 14 h with little or no breaks , 23. ThiA priori power analysis was conducted to compute the required sample size using G*Power 3.1 . The speA total of 23 healthy adults , aged 18–34 years old, were recruited to participate in this study. Exclusion criteria consisted of individuals with poor sleep patterns, excessive caffeine use, concerning health, or psychiatric disorders, regular/heavy drug, or alcohol use, and the use of any corticosteroid or anti-inflammatory medications. Refer to Recruitment occurred through posters placed on notice boards throughout the University of South Australia (UniSA). Eligible respondents were contacted for further screening procedures. At the completion of the study, participants received an honorarium of $600. Ethical approval was obtained from the UniSA Human Research Committee (Application ID: 202112).A within-groups, repeated measures experimental design  was emplThe experiment was conducted in the Sleep and Chronobiology Laboratory at UniSA. The highly controlled laboratory has a constant temperature of 22°C, light fixed at 100 lux, no windows, and is soundproof, to ensure no exogenous variables misalign natural circadian rhythms.Interested respondents were initially screened via a telephone interview whereby relevant medical, sleep, and lifestyle disorders were discussed. If deemed eligible, participants visited the Sleep and Chronobiology Laboratory where the aims and expectations of the study were firstly explained, and signed consent was obtained. Participants were then asked to complete screening questionnaires pertaining to sleep quality, morning, or evening preference, depression levels, sleep apnea symptoms and handedness preference.A urine sample was taken to screen for drugs and a full blood test done for general health physiological screening, with specific analyses looking at electrolytes, thyroid stimulating hormone and liver functioning. One week prior to the experiment, participants completed a sleep-wake diary and wore a GENEActive  monitor,A driving simulation was employed to measure sustained attention and the effect of time on task, as a workload factor .A customized 30-min track was developed by York Computer Technologies to measure the effect that time on task has on sustained attention. To examine time on task as a workload factor, two 15-min loops were examined, with the second loop having a cumulative longer time on task. Each loop around the driving track took 15-min (when adhering to speed and driving instructions), making the two loops directly comparable. The track mimicked a monotonous country highway drive, with a mundane scenery of shrubs . There wA steering wheel, accelerator, and brake were installed on the computers in participants bedrooms, to simulate a real driving experience. Participants were instructed to keep both hands at the 10 and 2 position for the duration of the drive, adhere to speed limits (100 km/h on straight roads and 80 km/h at corners), and stay in the center of the left lane. If participants crashed, there was a crash sound followed by instructions for them to promptly restart the drive. The primary outcome variables of this study, derived from this task, were lane deviation, crashes, speed deviation, and safe zone .a = .838. The variables utilized for analysis were the scores from the six subscales, along with the overall average score [The NASA-Task Load Index (TLX) was utilized to measure the perception of workload demands . The NASge score .The PVT was utilized to measure the effect of sleep deprivation and time of day on alertness. The PVT is the current gold-standard measure of alertness and psychomotor vigilance with minor learning and aptitude effects .The 10-min PVT occurred after the driving task. Participants were instructed to respond as quickly as possible to the red stimulus by pressing the button and were warned against false starts (i.e. responding before stimulus appeared). During the task, the reaction time in milliseconds was displayed for 1 s, to serve as performance feedback. The PVT has variable inter-stimulus intervals, between 2 and 10 s, yielding approximately 90 stimuli per trial . The mai“extremely alert” to “extremely sleepy; fighting sleep”.The Karolinska Sleepiness Scale (KSS) was completed at the beginning of every workload test battery as a subjective measure of situational alertness . The KSSThe protocol consisted of a baseline day, three experimental days, and a recovery day . On the The following day participants began the 62 h of sleep deprivation. The rationale for this amount of sleep deprivation was that it allowed for at least two full 24-h circadian cycles of data collection. This was also to account for the vast inter-individual differences in performance that are presented under conditions of sleep deprivation . During When participants were not completing cognitive tasks, they were encouraged to congregate in the living area to engage in non-strenuous activities, such as watching movies. To maintain control, participants received meals based on calorie and macronutrient requirements as calculated by a nutritionist. Participants were not allowed caffeine or other stimulants. After 62 h of sleep deprivation, participants received a 9.5-h recovery sleep opportunity.p < .05. Effect sizes were calculated using Partial Eta Squared. In accordance with Richardson [Statistical analyses were conducted on SPSS . Two parchardson , small, The final sample consisted of 21 healthy participants . Descripp < .001), time of day . Pairwise comparisons revealed that lane deviation differed based on the time of day, with best performance around the circadian peak (17:00), and worst performance around the circadian nadir (09:00). Significant time of day differences were found between 09:00 and 17:00 (p < .001), as well as 09:00 and 01:00 (p = .002). Pairwise comparisons revealed that lane deviation increased from loop 1 to loop 2 (p = .042).Significant main effects of day (p = .004) was found, showing that the time of day effect on lane deviation increased from one day to the next, as participants became more sleep deprived. No significant interaction effects were identified between day and time on task (p = .939), time of day and time on task (p = .602), or day, time of day, and time on task (p = .871).A significant interaction effect of day and time of day (p < .001), and time of day , with more crashes near the circadian nadir (09:00) and less around the circadian peak (17:00).Significant main effects of day (p = .001), demonstrating that the effect of time of day on crashes increased from one day to the next as participants became more sleep deprived. No significant interaction effects were identified between day and time on task (p = .912), time of day and time on task (p = .853), or day, time of day and time on task (p = .612).A significant interaction effect was found between day and time of day (p < .001), and time of day . A significant decrease in speed deviation was demonstrated from 09:00 to 17:00 (p < .001).Significant main effects of day (p = .076), day and time on task (p = .610), time of day and time on task (p = .950), or day, time of day and time on task (p = .958).No significant interaction effects were found between day and time of day (p < .001), and time of day . Reduced time was spent in the safe zone near the circadian nadir (09:00), whilst more time in the safe zone occurred near circadian peaks (17:00).Significant main effects of day (p = .314), day and time on task (p = .835), time of day and time on task (p = .789), or day, time of day and time on task (p = .708).No significant interaction effects were revealed for day and time of day (p < .001), but not time of day (p = .078), were identified for the overall NASA-TLX score (p < .05). No significant interaction effect between day and time of day was found (p = .141).A significant main effect of day (LX score . Pairwisp < .001), but not time of day were identified for the NASA-TLX subscales of mental demand, physical demand, temporal demand, performance, and effort (p < .001). Pairwsie comparisons revealed significant increases in mental demand and physical demand from one day to the next , except between days 2 and 3. Frustration scores significantly decreased from 09:00 to 17:00 (p = .047). There was no significant interaction effect between day and time of day for any of the subscales.A significant main effect of day , but not time of day (p = .073), were found for the PVT RRT (p < .001). There was not a significant day by time of day interaction effect for RRT (p = .063).A significant main effect of day ( PVT RRT . Pairwisp < .001), but not time of day (p = .427), indicating that subjective alertness significantly decreased with sleep deprivation , was found, demonstrating that the effect of time of day on subjective alertness increased as participants became more sleep deprived.A significant day by time of day interaction effect , changed with sleep deprivation. Participants reported decreased alertness and increased workload with sleep deprivation. A recent study by Pesoli and colleagues  similarlTime on task was the only workload factor explored in this study, however multiple interacting factors, including cognitive load, stress, and time pressure, contribute to workload . Future Despite this driving task being sensitive to alterations in sustained attention , 19, theAlthough, the sample consisted of young, healthy individuals, which does limit generalizability of the findings, research demonstrates shift workers who drive through the night are generally younger . Future This study examined the importance of workload in combination with extended sleep deprivation and different times of the day on sustained attention driving performance. The potential impact that other workload factors may have on sustained attention should be investigated in future research. This study has implications for the wellbeing of long-haul driving populations, reinforcing the negative impact long monotonous driving has on driving performance and emphasizing the need to include workload in the messaging about accident risk to overall reduce the likelihood of motor accidents.


Toona sinensis in the wild is of great significance to the selection of T. sinensis varieties and the evaluation of relative yield. In this study, UAV hyperspectral imaging technology was used to obtain canopy hyperspectral data of biennial seedlings of different varieties of T. sinensis to distinguish young and old leaves. Five classification models were trained, namely Random Forest (RF), Artificial Neural Network (ANN), Decision Tree (DT), Partial Least Squares Discriminant Analysis (PLSDA), and Support Vector Machine (SVM). Raw spectra and six preprocessing methods were used to fit the best classification model. Satisfactory accuracy was obtained from all the five models using the raw spectra. The SVM model showed good performance on raw spectra and all preprocessing methods, and yielded higher accuracy, sensitivity, precision, and specificity than other models. In the end, the SVM model based on the raw spectra produced the most reliable and robust prediction results . Three important spectral regions of 422.7~503.2, 549.2, and 646.2~687.2 nm were found to be highly correlated with the identification of young leaves of T. sinensis. In this study, a fast and effective method for identifying young leaves of T. sinensis was found, which provided a reference for the rapid identification of young leaves of T. sinensis in the wild.Rapid and accurate distinction between young and old leaves of  T. sinensis, with rapid growth rate, straight trunks and beautiful texture  have been successfully applied to the young leaf identification in some plants, higher spectral fidelity may be required, which can be provided by hyperspectral imaging . Hyperspin situ detection , aerial imaging has gradually become a common method for data acquisition. In recent years, advances in unmanned aerial vehicle (UAV) technology have brought new opportunities for agricultural and forestry monitoring. Compared with satellite remote sensing, UAV remote sensing has the advantages of low cost, flexibility, versatility, and providing dynamic macroscopic observations, making it popular in scientific exploration and commercial applications . Due to etection . At presetection , crop heetection  and foreetection . HoweverAt present, UAV hyperspectral imaging technology has been widely used, but there are some problems . SpectraTraditional discriminant models are based on linear/non-linear statistical regression models that have been developed between vegetation-related parameters and spectral data . In receT. sinensis using UAV hyperspectral imaging technology combined with different preprocessing methods and machine learning algorithms was studied. The objectives of this study were (1) testing NIR hyperspectral combined with random forest (RF), artificial neural network (ANN), decision tree (DT), partial least squares discriminant analysis (PLS-DA) and support vector machine (SVM) ability to establish an optimal model for discriminating young and old leaves of T. sinensis; (2) when establishing RF, ANN, DT, PLSDA and SVM models, finding out the effects of various preprocessing methods on the effects of near-infrared hyperspectral; and (3) identifying the most important wavelengths associated with the classification of young and old leaves of T. sinensis in model calibration.In this study, the classification of young and old leaves of T. sinensis seeds of different varieties from all over China were planted in the experimental field, which covers an area of 3,330 square meters. The test materials were biennial T. sinensis seedlings grown from these seeds. The row spacing of T. sinensis seedlings is 10 × 20 cm. As shown in T. sinensis are all fuchsia, and the young and old leaves can be clearly distinguished by the human eye.The experimental field  is located in Xinsha Island, Fuyang District, Hangzhou City, Zhejiang Province, China. Trials were conducted in September 2021. Image acquisition was performed using a MATRICE600 Pro UAV  equipped with a GaiaSky-Mini2-VN  airborne hyperspectral imager with 1,392 × 1,040 pixels. The GaiaSky-mini2 airborne hyperspectral imager has a spectral range between 400 and 1,000 nm, a total of 176 spectral bands, and a spectral resolution of 3 ± 0.5 nm. The hyperspectral UAV flew at around 12:00 noon, with a flight speed of 5 m/s, and a total flight time of 4 min and 41 s. Images were collected at a flight altitude of 50 m, and the photo-taking interval was set to be equidistant at 20 m. The weather was partly cloudy during the flight. A total of 83 images were acquired.T. sinensis in hyperspectral images. The old leaves obtained 1956 ROIs, and the young leaves obtained 2015 ROIs, with a total of 3,971 samples. 80% of the samples were randomly selected as the training set and 20% of the samples as the test set.In order to reduce the influence of uneven light distribution and dark current, the hyperspectral image should be corrected for black and white . NIR hypThere may be noise in the raw spectral data that can interfere with subsequent data analysis, so it is necessary to use appropriate methods to preprocess the raw spectral data . In thisRF, ANN, DT, PLSDA, and SVM algorithms were used to build models. RF is an ensemble algorithm composed of multiple decision trees proposed by prospect  is a band transformation, which was proposed by The data with NDVI < 0.8 in the captured pictures were excluded. The spectrum extracted from the background-removed image was inverted using the selected model.The Toona sinensis representative spectra were averaged into two groups  plotted in In order to choose the best combination method for preprocessing and model, the original data and the spectral data preprocessed by SNV, Savitzky–Golay, first derivative, second derivative, SNV + first derivative and SNV + second derivative were input into DT, ANN, SVM, PLSDA, and RF models, respectively. The accuracy, sensitivity, precision, and specificity of methods based on different preprocessing methods and five model combinations are plotted in Non-informative variables may affect the accuracy of the modeling. Feature wavelength selection can reduce the dimensionality of raw spectral data, retain useful information and remove redundant information. The important variable values (wavelength) of the original spectrum found by the SVM model are shown in T. sinensis. In conclusion, the vast majority of young and old leaves of T. sinensis can be accurately classified, which indicates that hyperspectral data combined with SVM model is a fast and non-destructive method for identifying young and old leaves.T. sinensis predicted by the SVM model are mostly the same as their real distribution in the original image. The above results show that the SVM model can be used for the identification of young and old leaves of T. sinensis.Two images  were randomly selected from the captured images for prediction. T. sinensis is obvious, distinguishing young leaves from old leaves by human eyes is generally subjective and uncertain. Moreover, evaluating the yield of T. sinensis by picking is not applicable in a large area. Among the spectroscopic studies of T. sinensis, most studies focus on the estimation of leaf biochemistry  and wood chemicals  and raw spectra combined with five common machine learning methods were compared using UAV hyperspectral data  to evaluate their performance in distinguishing young and old leaves of T. sinensis. The results show that the combination of the original spectrum and the SVM model outperforms other combinations in the overall accuracy, providing a high-precision and high-efficiency method for the identification of young and old leaves of T. sinensis. The convincing results of this study show the potential of UAV hyperspectral imaging in distinguishing young and old leaves of T. sinensis.Although the color difference between young and old leaves of Triticum aestivum L.) and three partially waxy wheat from wild-type wheat. It was found that the SVM model based on the original spectral data had the highest classification accuracy (98.51%) for the prediction set. Six preprocessing methods were used in this study, and the models built with raw spectra outperformed those built with other preprocessing methods. Different NIR hyperspectral preprocessing has a great impact on the output performance of the SVM model. Hevea brasiliensis by PLSDA classification, and the established model was robust enough. In the results of this paper, the classification accuracy of PLSDA  is also very high, and it can also be applied to the classification of young and old leaves of T. sinensis. Zea mays L.) seeds by the SVM classification model yielded a high classification accuracy of 96.46% , the green peak centered at 550 nm (549.2 nm), and the red reflectance minimum (646.2 ~ 687.2 nm). The reflection in the visible band is mainly affected by the pigments in the leaves. Previous studies have identified the differences in leaf pigment content among species as an important factor for classification  seeds and the results showed that the classification model using the full spectrum performed better than the classification model using the effective wavelength. Chrysanthemum varieties, all models using full wavelengths achieved better performance than models using characteristic wavelengths  New Variety Breeding (2021C02070-1-1).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Physical restraint (PR) reduction interventions are currently exploring in developed regions with well-established welfare systems, whereas developing countries with fast population aging have not attracted enough attention. This China's pilot study evaluated the effects of a minimized PR program on restraint reduction and nursing assistants' knowledge, attitudes, intention, and practice toward PR and explored nursing assistants' experience of the program.This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A minimized PR program was obtained by summarizing the best evidence and was implemented in one Chinese nursing home with 102 older adults from December 18, 2020, to March 21, 2021. An educational program including three theoretical lectures and one operation training was first conducted for nursing assistants one-month period. The primary outcome was PR rate at 3 months. The secondary outcomes contained duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and antipsychotics use at 3 months. Data on PR use and older adults' characteristics were collected through physical restraints observation forms and older adults' medical records. Nursing assistants' knowledge, attitude, intention, and practice toward PR were measured using the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR at 1 month. A semi-structured interview for two administrative staff and a focus group discussion with 13 nursing assistants were analyzed using content analysis to explore perspectives of intervention implementation at 3 months.P < 0.001). Furthermore, only the rate of correct PR increased and the duration of restraint in the daytime decreased significantly at 3 months (P < 0.05). There were no significant effects on PR rate and other secondary outcomes at follow-up. Qualitatively, nursing assistants demonstrated overtly supportive perspectives and that assistance from the program enhanced their knowledge and practice. They noted several challenges that impeded implementation.There were a significant increase in knowledge, attitude, and practice and a decrease in intention of nursing assistants after 1-month educational intervention (The intervention has acknowledged some benefits and was valued by nursing assistants. Implementation barriers should be addressed before delivering in larger trials. According to an international consensus statement, physical restraint (PR) was defined as “any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to their body by using any method that is attached or adjacent to a person's body and that they cannot control or remove easily” . PR is cOur previous bibliometric analysis  showed tWith the increasing research on multi-component interventions containing education, the effectiveness of these complex interventions in reducing the use of PR has attracted much attention. In 2012, Köpke et al.  developeNursing Practice Standards Physical Restraint in Inpatients issued by the Chinese Nursing Association is applied to registered nurses in various hospitals and other medical institutions that can refer to the implementation  Describe the potential effects of interventions on the use of PR for older adults .(b) Identify the impacts of training on a minimized PR program on nursing assistants' KAP toward PR use.(c) Explore nursing assistants' experiences and perceptions of intervention implementation processes after program completion.This was a one-group, pretest, and posttest pilot trial with a nested qualitative descriptive study. A qualitative descriptive study was performed to describe the nursing assistants' perspectives of the program . A three* Power 3.1 software was performed to calculate the sample size  who were absent in the nursing home on the day of data collection, (b) who were told to be not allowed to observe because of serious and special illnesses, and (c) with involuntary movement. A single-group rate difference test prior to power analysis in the Gple size . The reqple size , 27, theThe minimized PR program of this study was developed in three steps . First, The primary outcome of this study was to assess the PR rate among older adults in the facility. The secondary outcome contained (a) duration of restraints, types of restraints, the rate of correct PR use, the incidence of falls and/or fall-related injuries, and the use of antipsychotics at the older adults level and (b) knowledge, attitudes, intention, and practice toward PR, experience, and perspectives of intervention implementation processes at the level of nursing assistants.The PR rate was defined as the ratio of the number of older adults who were restrained at least once on the day of data collection to the total number of older adults. The use of PR was collected by direct observation, which was reported to be the most reliable method for collecting data on PR use . Two traAnother three restraint-related outcomes were measured by observers. First, the duration of restraint in 24 h was the sum of restrained time of four observation intervals. Standardized interviews with the direct nursing assistants of older adults were adopted, and the nursing assistants were asked for how long older adults were restrained during the interval between each observation. Second, all types of restraint used with older adults were recorded by observers. Third, the rate of correct PR use indicated the ratio of older adults who were restrained correctly to all restrained older adults. Situations of improper use of PR were as follows: (a) not meeting the restraint indications, (b) being too loose, (c) being too tight, (d) violating the functional position of older adults, (e) fixing on the bed rail, (f) observing restraint-related complications, and (g) other occasions of improper use. Additionally, data on falls and fall-related injuries and use of antipsychotics for 3 months before intervention and a 3-month intervention period were collected from medical health records. The above outcomes related to older adults were measured at the pre- and post-intervention time. All these data were collected using a customized data collection form.The Chinese version of the Staff Knowledge, Attitudes, and Practices Questionnaire regarding PR was performed to assess KAP toward PR of nursing assistants. The questionnaire was developed by Janelli et al.  and valiData regarding the older adults' characteristics including gender, age, length of residence, number of chronic diseases, cognitive function, degree of care dependency, mobility, fall risk, and tube indwelling tube were obtained from the older adults' health records and their ability assessment data. Cognitive function was derived from the Mini-Mental Status Examination (MMSE) . The degExperience and perspectives of intervention implementation processes for nursing assistants were obtained from a qualitative descriptive study conducted after the 3-month intervention. The qualitative study was comprised of (a) focus group interviews with 13 nursing assistants who participated in PR training and the implementation of the minimized PR program and (b) a semi-structured interview with two administrators of a nursing home . Of 24 nursing assistants in the nursing home who attended the training, five nursing assistants always cared for restraint-free older adults and did not directly practice the program, four were not willing to participate in interviews, and two requested leave to return home during data collection. Thus, a total of 13 nursing assistants attended the focus group interviews. Focus groups are often used to develop research hypotheses or interventions, find out problems encountered in research practice, etc. This method can collect a large amount of interactive data in a short period of time, making up for the insufficiency of traditional questionnaires. In addition, two administrators provided organizational support and leadership during the practice of the program. Therefore, through semi-structured interviews with these two administrators, we can understand the impact of the program from the perspective of managers. Due to no beginning conceptual or theoretical framework to guide and focus the initial interview questions, organizing scheme of concepts developed from the literature and group discussion helped in guiding our data collection . Major aM) and standard deviation (SD) for continuous variables with a normal distribution, and median and interquartile range (IQR) for skewed data. The knowledge, attitude, intention, and practice scores of nursing assistants conformed to the normal distribution, and the paired t-test was used for comparison. The duration of restraint was examined using the Wilcoxon signed-rank test because of the non-normality of the data. The count data were compared using the chi-square test or Fisher's exact test. P < 0.05 was set for statistical significance. As data on the semi-structured interview were obtained from only two managers, it is difficult to extract the themes independently with limited information. Considering that the focus group and semi-structured interview involved similar interview questions, we integrated data for analysis. The audio-recorded interviews were transcribed verbatim within 48 h, and the transcription was checked against the audio records by two researchers to ensure their accuracy. Content analysis was performed to analyze the words and phrases of the interview data . Ten nursing assistants received middle school education, and 14 were educated in primary school and below. The working years in the nursing home ranged from 1 to 6 years, with an average of 4.00 (SD = 1.41). They were responsible for 5.29 (SD = 1.04) older adults and paid 3,000 to 4,000 RMB per month.A total of 24 nursing assistants including eight males and 16 females were engaged in the educational program, aged from 48 to 62 years, with a mean age of 54.58 years (P = 0.479). The duration of restraint in 24 h, daytime, and nighttime of older adults was not following the normal distribution, and the Wilcoxon signed-rank test was used for pre- and post-intervention comparison. The duration of restraint in the daytime decreased rank significantly from baseline to follow-up (P = 0.030), whereas the duration of restraint in 24 h and nighttime had no significance (P > 0.05). The rate of correct PR use of 73.53% (25/34) after the 3-month intervention was significantly higher than that at baseline with a correct rate of 35.14% (13/37). The number of older adults with at least one fall or fall-related injury, as well as antipsychotics use, did not differ statistically significantly before and after the intervention (P > 0.05). A comparison of baseline and 3-month types of incorrect restraint use for restrained older adults is illustrated in P = 0.005), no significant difference in other types of incorrect restraint use was displayed before and after the intervention (P > 0.05). Thirteen older adults were restrained using informal restraint tools at baseline, such as hemp rope, work gloves, and socks, which were eliminated after the 3-month intervention (P < 0.001) (A comparison of baseline and 3-month outcomes for older adults is displayed in < 0.001) .t-test findings (P < 0.001). Additionally, the total score of intention toward PR decreased significantly compared with baseline, indicating nursing assistants less intend to use PR on older adults (P < 0.001).The knowledge, attitude, intention, and practice toward PR of nursing assistants conformed to the normal distribution. The paired findings  showed tSD = 4.18). Five nursing assistants received an education level of primary school and below, and eight educated in middle school. They worked in the nursing home for over 3 years. A semi-structured interview was conducted with two managers. One was the dean of the nursing home, male, aged 53 years, and educated for undergraduate, and one was the nursing manager, female, aged 32 years, educated for undergraduate, and working for 8 years.A total of 13 nursing assistants including six males and seven females participated in the focus group interview, all aged from 48 to 62 years, with a mean age of 52.92 years . The patients/participants provided their written informed consent to participate in this study.JW, MX, and QZ performed substantial contributions to conception and design, interpretation of data, manuscript drafting, and manuscript revising. WL, XL, LL, and JT were involved in data collection and literature review. All authors have read and critically revised the manuscript for its intellectual content and approved the final version.This study was funded by the National Key Research and Development Program of China (2020YFC2005900), Postgraduate Research and Innovation Project of Chongqing Province (CYS19202), and Key Project of Chongqing Science and Technology Commission (cstc2018jscx-mszd0030).The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.


Background: Laparoscopic (LP) and robot-assisted pyeloplasty (RAP) are minimally invasive techniques for correcting uretero-pelvic junction obstruction (UPJO). We retrospectively compared the clinical outcomes of all adults who underwent RAP (n = 41) to those who underwent LP (n = 24) for UPJO at our institution between 2003–2022. Methods: Age, sex, body mass index, surgical side, past abdominal/endoscopic surgeries, pre- and postoperative renal scans, pre- and postoperative serum creatinine levels, operative time (OT), presence of crossing vessels, estimated blood loss, postoperative complications, length of hospital stay, time to JJ stent removal, follow-up length, and postoperative hydronephrosis were analyzed. Results: The groups were demographically comparable. The mean total and skin-to-skin OTs (minutes) were significantly longer in the RAP group than in the LP group . Hospital stay (days) was shorter in the RAP group (3.3 ± 2.1 vs. 7.3 ± 2.5 p < 0.001). Postoperative complication rates were identical for both groups. The LP group had a significantly longer follow-up period (85.2 ± 73 vs. 19 ± 14 months p < 0.001). The success rates for the LP and RAP groups were 87.5% and 90.6% (p = 0.708). Conclusions: RAP achieves equivalent results to LP, in adult patients. A longer OT may be expected with the robotic system since it can handle more complicated cases. Congenital or acquired uretero-pelvic junction obstruction (UPJO) is a result of obstructive stenosis between the renal pelvis and the proximal ureter. The obstruction interrupts urinary flow from the renal pelvis into the ureter, the renal pelvis becomes dilated, the renal parenchyma is lost, and kidney function deteriorates . The cauAn open retroperitoneal approach (pyeloplasty) was first described by Trendelenburg in 1886, and the first successful surgery was performed by Kuster 5 years later [In 1949, Anderson and Hynes presented the principles of an open retroperitoneal approach pyeloplasty . Those pLaparoscopic pyeloplasty (LP), which was performed according to the Anderson–Hynes principles, was first described in 1993 by Schuessler et al. , who repFollowing the introduction of the da Vinci robotic surgical system in late 2000, an increasing number of surgeons have been taking advantage of three-dimensional imaging, six degrees of freedom, and the elimination of tremor provided by the system for enhanced performance of complicated surgeries.In 2002, Gettman et al.  were theThe high costs of implementing the robotic system, however, have been of major concern among some medical centers, raising the question of economic viability. For example, the average cost of laparoscopic surgery at our medical center as of 2021 was 1550 USD, while the average cost of robotic surgery was 3800 USD.The English literature is replete with studies that sought to compare the outcomes of RAP to those of LP or to an open approach. Unfortunately, the vast majority of those studies are either low-quality, missing data, or combine pediatric and adult populations in their statistical analysis. In the present study, we aimed to compare the clinical outcomes of RAP to those of LP performed solely in an adult population at a single medical center.Interventionary studies involving animals or humans, and other studies that require ethical approval, must list the authority that provided approval and the corresponding ethical approval code. Following approval by the Chaim Sheba Medical Center Institutional Review Board (#SMC-20-7759), we retrospectively collected the data of all adult patients (≥18 years of age) who had undergone either first-time LP or RAP for UPJO at our institution between 2003–2022. Specifically, LP had been performed between 2003–2008 by one surgeon, while RAP had been performed from 2015 onward by another surgeon. Both surgeons had at least 5 years of experience in laparoscopic and robotic surgeries, respectively, at the date of first recording for each. Only a few of those surgeries took place between 2008 and 2015 due to human resource issues, and those that were performed had been carried out in an open retroperitoneal approach and by various surgeons.The indications for pyeloplasty in the adult population were as follows: persistent pain, obstruction displayed on renal scintigraphy, and recurrent urinary tract infection, all in association with hydronephrosis due to UPJO as demonstrated by computerized tomography.Both LP and RAP were performed in a transperitoneal approach and as previously described by others . RAP surData on the following parameters were recorded and analyzed: age, sex, body mass index, surgical side, previous abdominal surgeries, previous endoscopic surgeries , preoperative renal scintigraphy findings, serum creatinine level, total and skin-to-skin operative times, the presence of a crossing vessel, estimated blood loss, postoperative complications, length of hospital stay, time to JJ stent removal, follow-up length, the presence of hydronephrosis, post-operative renal scintigraphy findings, and the creatinine level at the last follow-up. Short-term postoperative complications were classified according to the Clavien–Dindo classification system .We defined total operative time as the time that had elapsed between the patient’s entering the operating theatre until transfer to the recovery room. Similarly, skin-to-skin operative time was calculated as the time since the first skin incision to the closure of the last incision.Surgical success was defined by not needing a second surgery due to re-stenosis or if there had been an improvement in the extent of hydronephrosis as seen on images performed during the follow-up period.T-tests were used to examine differences in means of continuous variables. p values <0.05 were considered significant. Statistical analyses were performed with IBM SPSS software, version 26.0 .Continuous variables were presented as mean ± standard deviation (SD), and categorical variables were presented as the number and percentage of individuals in each group. Categorical variables were compared by the Chi-squared test, while A total of 24 patients underwent LP, and 41 patients underwent RAP for UPJO during the study period. Their demographic, surgical, and postoperative data are detailed in The two groups did not differ demographically. While the skin-to-skin operative time was significantly longer for the RAP group compared to the LP group, both the length of stay and the follow-up duration were significantly shorter.Four patients who underwent LP had previously undergone abdominal surgeries consisting of endoscopic procedures for stone fragmentation, and two of them (8.3%) underwent UPJO treatment .Eleven patients in the RAP group had undergone previous abdominal surgeries that included endoscopic procedures in five (12.1%) of them. Four patients from the LP group (16.6%) and seven patients from the RAP group (17%) also underwent pyelolithotomy during the index surgery. One LP patient (4.1%) underwent conversion to open surgery due to difficult anastomosis.There were no significant differences in the early (up to 1 month) postoperative complications sustained by both surgical groups .Complete stone retrieval failed in two patients who underwent LP, and a second stone fragmentation procedure was later required for both.Three patients in the LP group (12.5%) required a second surgery due to re-stenosis and persistent hydronephrosis. One patient in the RAP group (2.4%) underwent diagnostic ureteroscopy 4 months following the index surgery due to persistent pain and evidence of hydronephrosis and retained stone on sonographic images. A 3 mm stone retrieval was performed in that case.p = 0.708).Of the 32 RAP patients for whom long-term follow-up was available, 19 (59.4%) had evidence of hydronephrosis on imaging; however, the postoperative extent of hydronephrosis improved compared to the preoperative level in 16 of them. We do not have information on the long-term follow-up hydronephrosis status in the other three patients. The overall estimated success rate for each technique was calculated at 87.5% for the LP group (21 out of 24) and 90.6% for the RAP group (29 out of 32)  and that compared LP and RAP approaches ,11,12,13Our current patients’ demographic data resemble those presented in the other case series: they were in their 4th–5th decades of life, they had no laterality dominance, the rate of the estimated blood loss during their surgeries was low, and the overall complication rate was low as well. An interesting finding in all of the five adult case series, including the present one, is the relatively high incidence of a crossing vessel to the renal lower pole in the UPJO cases (~50%) compared to the general population (~30%) . It has Krajewski et al. found no pathological histology in many patients with a crossing vessel to the lower pole and observed that crossing vessels only created mechanical obstruction . In otheThe findings of the present study differ from earlier ones in three parameters: (1) the longer length of stay of the LP cases, (2) the longer total and skin-to-skin operative time in the RAP group compared to the LP group, and (3) the longer overall follow-up time in general and in the LP group in particular. The first finding can be explained by the very stringent protocol that has been followed in our department during the laparoscopic era. Longer catheter and drainage times were the standard of care due to uncertainty about the suturing quality. Later on, with the establishment of high success rates, this draconian protocol was abandoned.Similar to Link et al. , we haveThe main limitation of the present study is its retrospective design. While the study groups are relatively small, pyeloplasty in the adult population is not a common surgical procedure and is one that is indicated in very selected cases compared to the pediatric population. The main advantages of our study are its 20-year perspective design (2003–2022) and its relatively long postoperative follow-up period, which is not available in other studies.We consider that the continuous presence of hydronephrosis observed in adults during long-term follow-up is not necessarily a surgical failure but rather that it reflects a chronic state that is not associated with persistent obstruction. This notion is supported by our patients’ postoperative renal nuclear scans, which were not obstructive in most cases. Moreover, we believe that RAP is as good as LP, and that the decision regarding technique selection should be in accordance with the surgeon’s discretion and skills. Notwithstanding, the advantages of better visualization and the precision of movement that significantly reduce the level of complexity and that are made possible by the da Vinci robotic surgical system are highly attractive to a tech-savvy surgeon.RAP achieves the same results as LP among adults with UPJO, but it is superior to LP because it provides the surgeon with an overall better surgical experience. More complicated cases can be carried out with the da Vinci robotic system than with both open surgery and LP, but some lengthening in operative time may be expected.


This systematic review describes and discusses three commercially available integrated systems for forensic DNA analysis, i.e., ParaDNA, RapidHIT, and ANDE. A variety of aspects, such as performance, time-to-result, ease-of-use, portability, and costs  of these three (modified) rapid DNA analysis systems, are considered. Despite their advantages and developmental progress, major steps still have to be made before rapid systems can be broadly applied at crime scenes for full DNA profiling. Aspects in particular that need (further) improvement are portability, performance, the possibility to analyze a (wider) variety of (complex) forensic samples, and (cartridge) costs. Moreover, steps forward regarding ease-of-use and time-to-result will benefit the broader use of commercial rapid DNA systems. In fact, it would be a profit if rapid DNA systems could be used for full DNA profile generation as well as indicative analyses that can give direction to forensic investigators which will speed up investigations. Sampling and securing traces at a crime scene are crucial steps in the investigation process, which in the Netherlands is generally carried out by the police. Information obtained at this stage immediately gives direction to an investigation once the results are available. Nowadays, with commonly applied methods, it might take weeks to obtain from evidence collection to a report provided by a forensic laboratory . ForensiThe generation of STR profiles currently requires highly skilled geneticists and dedicated laboratories . HoweverForensic DNA analysis, as performed in the Netherlands, can be divided into several sequential operations. Firstly, the evidence must be collected at the crime scene, which is typically done by using a (moistened) cotton swab handled by a forensic investigator. The sample on the swab is sealed in the tube and then sent to the forensic laboratory ). The next step is the sample work-up, where cells are eluted and lysed. Subsequently, DNA is extracted from these cells using commercially available kits. Before amplification, a quantification step is usually included within conventional STR profiling since the best results are obtained by the use of a specific amount of input DNA. Quantification ensures maximum efficiency of the amplification reaction and prevents (repetitive) analysis of over-amplified samples. Forensic samples are known for their low amount of DNA, as one cell only contains about 6 pg of DNA. Therefore, it is necessary to perform an amplification reaction to increase the amount of DNA, which ensures detection and further analysis  can take place ,10.Electrophoresis in glass capillaries was already demonstrated in 1981 , and theThe MiDAS  is another integrated system reported in the literature. However, as described by Hopwood et al., further development of this system was discontinued after the closure of the Forensic Science Service in the UK ,15,16. TMore recently, Zhu et al. developed a droplet PCR combined with multiplex STR for forensics . In theiDespite all academic efforts to develop  integrated portable systems for forensic DNA analysis, only a few systems became commercially available for integrated forensic DNA analysis to be used in the field. The ParaDNA, RapidHIT, and ANDE systems are discussed in this systematic review, as well as also some promising devices that never truly became commercially available. A systematic review is carried out to analyze the performance of these systems which are accredited to be used by a forensic investigator on the scene. In the discussion, the technical performance of the analyzed systems is compared, and some critical notes are made about costs and ease-of-use, among other things. Moreover, a critical reflection is given on the use of these systems at the scene, as well as additional societal and organizational challenges.For clarity and to support readers’ understanding, some words/terms used in this work are explained here. An allelic drop-out is a failure to determine an allele within a sample. This occurs when one or both allelic copies are not amplified during PCR.PCR inhibitors are chemical or physical obstacles that block amplification and, as such, ultimately fail the PCR reaction.‘Rapid DNA analysis’ is defined as using a rapid DNA instrument without human intervention, whereas ‘modified rapid DNA analysis’ is defined as using a rapid DNA instrument in combination with human interpretation of the DNA analyses results ,29,30,31Rapid DNA systems are fully integrated platforms that can generate STR profiles from (reference) samples within two hours .For the systematic review, a search for articles was carried out in the PubMed database without language or date restrictions. The following keywords were used: (ParaDNA) OR (RapidHIT) OR ((ANDE) AND (DNA)). The articles that were included ‘ad hoc’ were found via Google Scholar or used as a reference in one of the articles from the systematic review.A ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ (PRISMA) flow diagram is used to summarize the screening process of the scientific literature . It makeThe results of the literature search, as described in Subsequently, the articles were screened by title and abstract. For ParaDNA, seven articles were excluded since they did not involve STR analysis/DNA profiling but described ParaDNA Body Fluid ID Test (see for more information In the next phase (the eligibility phase), the articles were fully read. In total, four studies were excluded: one manuscript was not peer-reviewed (yet), one article described an old system  because the exact time depends on, e.g., the type of sample (teeth and bone require longer extraction times) and laboratory protocols. When DNA quantification is included, another two hours of thermal cycling is needed, thus leading to a time-to-result in the range of 3.5 to 5.5 h or even more . A fullyIn January 2013, an article was published in ‘Biometric Technology Today’ about the use of rapid DNA technology, i.e., full DNA analysis within 2 h. At that time, two systems were available for commercial use: RapidHIT 200 and ANDE 4C. The FBI and the US Army started trials and evaluations . In the following sections, the rapid DNA systems—ParaDNA, RapidHIT 200, its successor RapidHIT ID, and the ANDE system—that made it to market are reviewed.The ParaDNA Intelligence Test System has been developed by LGC . ParaDNA screens five STR loci  and the sex marker Amelogenin . The timThe ParaDNA system is a so-called ‘Level 1 DNA Screening Solution’, which implies that it meets the following criteria: (1) the test must be a DNA test, (2) it should provide the police with a more robust and reliable decision making tool, (3) should speed up early intelligence, (4) is easy-to-use by non-scientific personnel, and (5) the test result must be interpretable by minimally trained personnel .Li et al. validated the ParaDNA test with mock evidence samples, according to the Scientific Working Group on DNA Analysis Methods (SWGDAM) guidelines. They used blood on glass, on Flinders Technology Association (FTA) cards and on denim, saliva on glass, buccal swabs, drink bottles, smoked cigarettes, semen on glass and carpet, and touch DNA on clothing and on a mobile phone. Both the blood and saliva samples had a success rate of 100%. When using saliva on swabs, the success rate dropped to 80%. Semen samples and touch DNA had a success rate of 60–75%  and 14%, respectively .Tribble et al. tested the ParaDNA Screening System with seminal samples, which profiles D16S539, TH01, and Amelogenin loci. They tested serial dilutions of semen, and at 2 nL of semen in each well, the assay showed a drop in Amelogenin. At 0.2 nL, the presence of DNA was no longer detected . DonachiDawnay et al. report results with the ParaDNA screening system as obtained during the UK Police pilots’ phases III and IV . A profile was defined as successful when 14 or more alleles were determined. For blood, the success rate was 100% in both phases. When using saliva as a sample the success rates were 88.9% and 82% for phases III and IV, respectively. Touch samples scored relatively low, viz. 33.3% in phase III and 65.2% in phase IV . They deUsing 4 ng of more DNA (corresponding to 1 ng per well), Blackman et al. showed that more than 65% of the samples provided a full profile. A ‘usable’  profile could be generated with 250 pg of DNA in more than 80% of the samples by using the ParaDNA system .In conclusion, the ParaDNA Screening System can be used for samples that contain a relatively high amount of DNA, such as blood, saliva, and semen ,39,40,43Later on, the so-called ParaDNA Body Fluid ID Test became available. This test also uses of HyBeacon probes and is an RNA-based test to determine the type of body fluid  ,47,48,49The RapidHIT ID (launched in 2013), a system from IntegenX (which is part of Thermo Fisher Scientific as of 2018), is a cartridge-based system and can create a full STR profile within 90 min . The GloThe ACE cartridge is used for the analysis of a single swab , and the EXT cartridge is for the analysis of DNA extracts (evidence profile) . Later oRapidHIT systems are evaluated extensively in the literature. Articles that describe which system is used are discussed in the corresponding A sensitivity level of 176 ng saliva DNA was reported by Jovanovich et al. for full concordant profiles and using 16 ng of DNA (on a swab), 57% of the alleles could still be detected. A 100% success rate was achieved for the positive controls (37 samples). Out of 250 buccal samples, 219 samples were fully in concordance with the PowerPlex 16 profile on the first pass .Hennessy et al. assessed the sensitivity, accuracy, and genotype concordance of this RapidHIT system. Full profiles were obtained till 500 pg when DNA was added to the vials; down to 25 pg, 65% of the alleles were detected. In case DNA was added to swabs, a sensitivity of 100 ng was found. Moreover, when 5 ng DNA was loaded into the swabs, 52% of the alleles were detected. It has to be noted that all standards tested were in 100% concordance with the certified reference profiles. For 150 buccal swab samples, a 100% genotype concordance was obtained; the 13 Combined DNA Index System (CODIS) core loci were present on 94.7% of the samples .Buscaino et al. could obtain complete profiles with 75 pg/µL for GlobalFiler Express and 50 pg/µL for AmpFlSTR NGM SElect Express and a total amount of input DNA (depending on the sample input volume) less than 250 pg. Five samples were run in triplicate, producing complete and concordant STR profiles, thus showing good reproducibility. The AmpFlSTR NGM SElect kit showed full concordance for all tested mock crime scene samples, while the GlobalFiler Express kit, 5/7 samples did not result in full concordance .Martin et al. investigated the use of rapid DNA analysis on touch DNA samples. Samples such as cable ties, fabric, matchstick, and ziplock bags were analyzed. The cable ties and matchsticks were directly placed into the cartridge of the RapidHIT. Together with tape-lifted fabric, these samples showed the best results .The RapidHIT was extensively evaluated by LaRue et al. Among other things, they tested the variability, sensitivity, concordance, and reliability, and they performed a contamination study. The success rate using reference buccal swabs was comparable to standard methods. Full profiles were obtained with an input of 200 ng of DNA, while with 10 ng, more than 10% allelic drop-out was observed, resulting in partial profiles .Thong et al. compared the performance of the RapidHIT 200 System  with the standard protocol. They tested swabs with blood, semen, and buccal samples, blood-stained FTA punches, tissues, bone marrow, fingernails, and cigarette butts. Overall, the RapidHIT 200 System performed well compared to standard laboratory protocols. It was recommended by Thong et al. to perform more experiments with more challenging DNA samples, such as degraded samples, samples containing inhibitors, mixtures, and samples with a small amount of DNA .Shackleton et al. investigated the performance of the RapidHIT200 with crime stain type samples on the RapidHIT 200, which contain various  input amounts of DNA. Extending the sample work-up time (DNA bead binding time or lysis time) had a positive effect on the results, but this negatively affected the time-to-result: i.e., up to 30–60 min extra time was needed . ShackleThe RapidHIT 200/GlobalFiler Express system (with RH200/GFE cartridge kits) was evaluated by Date-Chong et al. The built-in quality flags in the software appeared, among others, in cases of intra-locus imbalance and inconclusive homozygote allele. Of all reference buccal samples, 50% passed the criteria of generating a full profile without raising any quality flag, which would require manual editing. With manual data review, the success rate is increased to 91% for obtaining a full genotype at each locus .Holland et al. also evaluated RapidHIT 200 for automated human identification of single source samples. A total of 85 buccal swabs were analyzed, and 100% concordance was obtained with known DNA profile information. When using the software of the instrument for data analysis, 95.8% provided full profiles in the reproducibility study .The RapidHIT 200 was explored by Verheij et al. with different types of samples. They concluded that the system is very suitable for buccal swabs. Moreover, saliva, semen, skin, and hair samples were tested, but profiling success rates were variable, and with lower input samples, profiling artifacts were present. The blood samples tested presumably contained inhibitors since no profile could be obtained .Only 74% of the buccal swab samples that were tested by Mogensen et al. on a RapidHIT 200 resulted in a correct STR profile. The working ranges in order to generate full profiles were found to be 900–1200 ng. Lower and higher amounts of DNA resulted in allelic drop-out .Shackleton et al. used the AmpFlSTR1 NGMSElect Express STR kit with single source reference samples. Prior to testing the performance of the RapidHIT ID, the instrument protocol was optimized by adjusting, among others, the lysis temperature, the thermal cycling parameters, and the injection time for CE. The repeatability, reproducibility, and sensitivity were found to be sufficient for buccal swabs (obtaining a reference profile) .Amick et al. validated the ACE and evaluated the EXT cartridges according to the Quality Assurance Standards from the FBI. Among other things, they investigated the reproducibility, precisions, and sensitivity and performed a contamination assessment. The RapidHIT ID, using ACE cartridges, showed reproducibility and precision within a ±0.5 bp window. According to Amick et al., the ACE cartridges showed acceptable results for buccal swabs. The sensitivity test of the EXT cartridge revealed allelic drop-out for input of 2500 pg DNA and lower. The main drawback of the EXT cartridge is that an evidence sample must first be extracted and quantified before analysis on the RapidHIT .The use of blood samples in combination with the RapidINTEL cartridge and the RapidHIT ID System was investigated by Chen et al. They also concluded that FTA cards are the preferred method for storage. Urea and melanin cause inhibition resulting in signal decrease and allelic drop-outs. Using 0.5 µL of blood or 7 ng of genomic DNA resulted in a concordance rate of 100% .Murakami et al. evaluated the performance of the RapidHIT ID (with ACE and INTEL cartridges) with samples from postmortem bodies at different stages of decomposition. Moreover, nail clipping samples were collected and analyzed. A detection rate of 100% was obtained with the latter, even after 10 years of storage, as long as the nail clippings were pretreated with dithiothreitol and TNE  buffer. For blood stains, the recommended storage method is using filter paper at room temperature .A success rate of 72% was reported by Wiley et al. upon testing the RapidHIT ID . After manual interpretation of first-pass inconclusive results, the success rate could be increased up to 90%. While coffee, smoking tobacco, and chewing tobacco did not influence the result, the swab type used is of importance since it can affect the typing success rate .The RapidHIT system was used by Gangano et al. to demonstrate the usability of the system with blood and saliva samples. They concluded that 88% of the samples  generated DNA profiles that were classified as qualitatively sufficient enough to be able to search against a database. Moreover, a reanalysis study was performed where the swabs were recovered from the cartridge after analysis on the RapidHIT. Reanalysis of these samples on the RapidHIT demonstrated that conserving these samples is possible with an average of 92% of the original full loci calls .Upon use of the GlobalFiler Express kit, Salceda et al. found a sensitivity of 12,500–200,000 cells/swab, while for 6250 cells, only 51.6% of the alleles could be detected. Five control samples were tested with three RapidHIT ID machines, and all 15 profiles were complete and concordant. The authors claim that this system showed 100% concordance in comparison with conventional methods .Ward et al. used the RapidHIT ID system and RapidINTEL sample cartridges to evaluate the performance with mixtures and touch DNA samples. The mixtures were artificially constructed from raw DNA as well as from body fluids. While the profiles from the simulated DNA mixtures on the RapidHIT showed the expected mixture proportions, the peak heights were lower compared to results when using a standard laboratory workflow. For the mock casework, mixtures, blood, saliva, or both blood and saliva were used. A combination of saliva and blood led to low levels in the profile of the saliva contributor. The sensitivity of the RapidHIT is lower than a standard laboratory workflow, which affects the results when touch samples are analyzed. Many of the analyzed touch DNA samples produced very low-level DNA profiles .Cihlar et al. validated the RapidHIT ID system with the ACE GlobalFiler Express sample cartridges in combination with reference buccal swabs. Among others, they performed a concordance, contamination, sensitivity, reprocessing, and mixture study. The data generated showed that the workflow of RapidHIT generates reliable and reproducible DNA profiles. A first-pass success rate of 92% was obtained with the reference buccal swabs. However, Cihlar et al. also advise using a trained forensic analyst to increase the pass rate success .In conclusion, the RapidHIT 200 provides good results in the case of single-source reference samples, especially when manual evaluation is performed ,71. A liBefore the ANDE systems became commercially available in their current format, it was developed and tested by NetBio, which was published as a research report in 2009 . In 2013In 2012, DNAScan was the first system released by ANDE (‘Accelerated Nuclear DNA Equipment’), which was later renamed to ANDE 4C (4-color). However, the ANDE system was originally developed by NetBio . The sysIn addition to DVI, trafficking in persons is also a situation in which rapid DNA results are crucial. Palmbach et al. investigated whether the ANDE system (at that time still part of NetBio) was suitable for this purpose. A success rate of 95% was obtained for the reference profiles; the other 5% resulted in partial profiles. The other samples consisted of various objects, such as cigarette butts, condoms, plastic bottles, and straws. Overall, a success rate of 71% was obtained, consisting of 23%, 42%, and 6% for full profiles, partial profiles, and mixed profiles, respectively .Moreno et al. evaluated the first version, the DNAscan, which generated a profile from CODIS 13 loci. Without human review, an overall success rate of 75% was achieved from reference buccal swabs .The developmental validation of the DNAscan/ANDE system was carried out by Della Manna et al. using a BioChipSet Cassette. Over 2000 buccal swabs were analyzed, which resulted in over 99.998% concordant alleles .The California wildfires in 2018 were the motivation for Gin et al. to use rapid DNA for victim identification. Among others, blood, as well as liver, brain, and muscle tissue, were used for DNA profiling. In 90% of the cases, the ANDE (no type mentioned) led to the identification and was even the primary identification modality .The ANDE (probably 4C) system was used by Hinton et al. for the analysis of reference samples , samples from a controlled setting, and from an uncontrolled environment. In combination with the A-Chip, 19 of the 22 buccal swabs resulted in a complete profile. For the controlled setting, the I-Chip was used, which provided a full profile for 7 of the 12 samples. The I-Chip was also used within military exercise, i.e., the uncontrolled environment. Only 7 out of 44 samples could generate a full profile from a single contributor. The other samples resulted in no DNA profile (25), partial DNA profile (9), and DNA mixtures (3) .Ragazzo et al. validated the ANDE 6C according to the ISO/IEC 17,025 standard. A total of 104 buccal swabs were analyzed with the ANDE system and with the traditional laboratory method. Of these 104 samples, three swabs gave no interpretable signals. A concordance rate of 99.96% was obtained by comparison of 2800 genotypes. With these results, the aforementioned standard was met [While the ANDE 6C was originally designed for reference samples , Manzella et al. tested the performance of this system with calcified and soft tissue samples. The success rate was 0%, 11%, and 50% for muscle tissue, ribs, and teeth, respectively . Turingan et al. analyzed 1705 casework samples to analyze the performance of the ANDE 6C with the I-Chip to address the FBI’s Quality Assurance Standards. Among other things, they investigated specificity, sensitivity (including a limit of detection), reproducibility, mixtures, and a wide variety of sample types , and saliva). Their main conclusion was that the limit of detection is influenced by the type of sample, the condition (aging and degradation), and the substrate . Six forensic and research laboratories worldwide took part in the validation study of the ANDE 6C of Carney et al. Over 99.99% concordant alleles were generated with the over 2000 analyzed samples , without human review of the results .Also, Grover et al. evaluated the ANDE 6C system and the A-Chip, using only buccal swab samples. Among others, they tested sensitivity, reproducibility, species specificity, and stability. Overall, they concluded that the system performs well and that the automated analysis results in accurate and concordant DNA profiles .Manzella et al. used the ANDE 6C system to investigate the difference between the ANDE swab and a conventional cotton swab as a sampling method. Using both swabs for buccal samples resulted in a success rate of 33% and 88% for the conventional cotton swab and the ANDE swab, respectively .Turringan et al. used the ANDE 6C to identify human remains. They used several tissue types, such as the buccal, brain, liver, and muscle. Up to 11 days of exposure, buccal swabs are the sample of choice. Moreover, bone and tooth samples provided good results for up to 1 year (which was the duration of the study). When the remains are refrigerated, all tissue types yield good results .In conclusion, the ANDE systems (4C and 6C) work very well when buccal swabs are used as input, even without human intervention  . While bNEC developed a portable DNA analyzer that can perform DNA analysis within 25 min, with 5, 15, and 5 min for DNA extraction, PCR, and CE, respectively. The disposable cartridge contains 5 mm wells that are used as test tubes. The channels for fluid transfer serve as pipettes. The system weighs 32 kg and can analyze 16 loci. It must be noted, however, that the most recent publication using the NEC system dates from 2012 .As already mentioned in the introduction, MiDAS is a microfluidic system for rapid forensic DNA analysis. In contrast to other rapid DNA analysis systems with all reagents present in the cartridge, MiDAS requires manual preloading of all reagents onto the cartridge. Moreover, other manual steps are required in the operation of the system, such as the installation of the CE chip. The system consists of a total of five interdependent modules: (1) swab lysis, (2) DNA extraction, (3) PCR, (4) PCR product transfer, and (5) CE separation, including optical readout . Each moIn this section, various aspects of commercial systems are discussed, among others, their performance, portability, and costs. For comparison (and overview) purposes, Besides technical challenges, there are quite some societal and organizational hurdles to overcome upon using (modified) rapid DNA directly at the crime scene. Jurisdiction and legislation are important parameters that influence the successful use as well as utilization of rapid DNA techniques. In the Netherlands, the forensic investigator arrives at the crime scene to investigate what has happened, how it happened, and especially who did it. To find out the latter and to match a DNA profile to a suspect, the taken samples are normally sent to a forensic laboratory such as the NFI. This process takes up much precious time. The forensic investigator is not aware of whether the collected samples contain (enough and non-degraded) DNA and if the sample is from the perpetrator(s) or victim(s). In the meantime, a tactical investigator would like to have evidence to connect a suspect to a crime scene. In order to obtain a more efficient coupling between forensic and tactical investigators, fast results are essential, which could be accomplished by means of using (modified) rapid DNA technology for generating full DNA profiles as well as for screening samples.Rapid DNA techniques show good performance when single source reference samples  are used. Moreover, in the case of blood and saliva (samples with a relatively high DNA content), a full DNA profile can be expected. However, it is known that rapid DNA techniques are less sensitive than conventional laboratory DNA analysis processes. This is caused by the conventional process having more sample work-up steps  and using more sensitive machines ,66. AddiA few publications compared the RapidHIT and the ANDE systems. The RapidHIT ID System and the ANDE 6C Rapid DNA System were compared by Watherston et al. for DVI simulations . MoreoveNail and quadriceps tissue turned out to be the best sample types for DNA profiling in the case of DVI. Nail samples were also found to be an appropriate type of sample. Overall, both systems were suitable for identification at the (crime) scene. While the ANDE 6C system is more robust in terms of resistance to shocks upon transport (to a crime scene), the RapidHIT can generate more DNA profiles that are usable .Romsos et al. concluded that modified rapid DNA analysis is needed for both RapidHIT systems ,29. The The National Police in the Netherlands has purchased a RapidHIT for research purposes, as described by de Roo et al. This RapidHIT is placed in a dedicated advanced bus to facilitate an environment that matches the applicable quality requirements for DNA research . AlthougAnother important parameter for being a truly rapid method is the time-to-result (in combination with throughput). The RapidHIT ID is the fastest system, with a time-to-result of 90 min, although the ANDE 6C, in combination with the A-Chip, is not much slower, with 94 min. While this is truly a record in terms of time needed for generating a profile from a swab as input, the limited throughput of 1 and 5 samples per run for the RapidHIT ID and the ANDE 6C, respectively, is a bottleneck for analysis at a (complex) crime scene such as DVI situations.The sensitivity  varies between the different systems . The repAccording to Watherston et al., a sample run on the ANDE and RapidHIT costs 387 and 247 Australian Dollars (~€250 and ~€169), respectively . The RapAlthough the use of commercially available systems for DNA analysis is growing, there are (still) various practical challenges to overcome.In general, non-expert users are able to run a rapid DNA system . However, for more complex samples, due to, e.g., inhibition or degradation, expert review is required. Additionally, rapid DNA analysis is less sensitive and shows more allelic drop-out compared to conventional DNA analysis due to the limited sample work-up, resulting in limited removal of dirt or soil and the presence of inhibitors, among others ,55.Watherston et al. mentioned that the RapidINTEL cartridges for the RapidHIT required refrigeration  near the testing area, while the I-Chip for the ANDE could be stored at room temperature . As can be seen in Using rapid DNA systems at a crime scene involves some jurisdictive hurdles. According to Dutch law, DNA analysis can only be conducted by an accredited laboratory, and only a forensic expert is allowed to perform the interpretation of DNA profiles . In ordeIn the USA, the law was adopted somewhat earlier since the Rapid DNA Act was already signed in 2017. The aim was to reduce the DNA analysis backlog in the USA and to reduce violent crime. Because of this adaptation, it is allowed to perform DNA profiling with rapid DNA systems of arrestees in booking station environments . Wilson-Wilde et al. mention the legislative hurdle that plays in Australia. Within the law enforcement context, there are only three locations at which rapid DNA systems can use in Australia. Besides, within the existing forensic laboratories , it is also possible to analyze crime scene samples within Police crime scene units (with a possible backlink to a forensic laboratory) and within police stations. In the latter case, only reference samples are allowed .The ParaDNA system cannot generate a complete DNA profile, only 6 STRs . This maThe use of (modified) rapid DNA systems on the crime scene involves a trade-off between speed and performance. In general, rapid DNA systems are not as sensitive as conventional laboratory methods. While the speed and portability are extremely useful for, e.g., DVI cases, their performance  has to be (further) improved to actually use these techniques on crime scenes. The discussed systems work well when using single-source buccal swabs , but for more complex samples, the success rate  is too low. Below, conclusions regarding currently available commercial systems for rapid DNA analysis are provided by focusing on multiple aspects/requirements , especially for the RapidHIT.Use of disposable cartridges for single use: All (modified) rapid DNA systems make use of sample cartridges that are single-use cartridges.Time-to-result: although it is not (yet) possible to generate a DNA profile within the targeted 60 min, obtaining a DNA profile in ~90 min is possible.Portability: With a weight of at least 29 kg and the present dimensions, current rapid DNA systems are not really ‘briefcase’ sized systems. When loaded into a bus or van, such systems become mobile but not portable.An enclosed system (no operator manipulation possible to avoid contamination): All rapid DNA systems fulfill this requirement.Robustness: The rapid DNA systems are robust in terms of being transportable. They can withstand, e.g., shocks while being transported from one location to another in a car or van.Possibility to analyze a variety of forensic samples: The RapidHIT works well with buccal swab samples, but for other types of samples, the success rate drops. While the ANDE performs somewhat better with real case samples, reference samples  are the preferred sample type.Performance (sensitivity and selectivity): Even though the selectivity of the rapid DNA systems is not widely reported, no incidents were mentioned. Their sensitivity, on the other hand, is still substantially lower than conventional laboratory methods. It has to be mentioned that a trade-off exists between sensitivity and speed: in general, a higher analysis speed negatively influences the sensitivity that can be obtained with a system.Costs: About €200 per cartridge run makes the use of rapid DNA systems quite costly, especially with the low throughput/amount of sample per cartridge taken into account.Both systems, the ANDE and the RapidHIT (ID) suffer from poor sensitivity compared to conventional DNA analysis in a forensic laboratory. In order to save time, work-up steps such as extraction and/or purification are skipped. When taking all the mentioned parameters into account, the ANDE system performs slightly better than the RapidHIT ID system. Although the ANDE system is somewhat heavier, it has a better sensitivity range. It can run more samples at the same time. The analysis time of both systems is comparable. Overall, impressive developments have taken place. Nevertheless, there is still no portable device containing all the required steps available for fast analysis (under 1 h for a full STR profile) of real ‘dirty’ samples directly at the crime scene. It would also be ideal to have a multi-compartment chip, which makes it possible to perform fast and reliable analyses directly at the crime scene, as well as on-chip storage of samples for (further) laboratory analyses.


An integrative cognitive function improvement program was administered to the CN and MCI groups for six weeks. To measure cognitive function, electroencephalogram (EEG) and cerebral blood flow (CBF) were evaluated, and to measure oral health, the O’Leary index, Löe & Silness index, tongue coating, unstimulated saliva flow rate, and oral muscle strength were measured. To measure mental health status, mental health, happiness and social support were measured. The CN and MCI groups showed a significant change in EEG-based indices for awareness level and physical stress. Regarding oral health, the O’Leary and the Löe & Silness index score decreased significantly in the CN and MCI groups. Saliva flow rate increased significantly in the CN and MCI groups. In regards to mental health, the happiness score increased post-intervention in the CN and MCI groups. In conclusion, the integrative cognitive function improvement program was effective in improving cognitive function, oral health, and mental health of elder people.We aimed to investigate the effects of an integrative cognitive function improvement program that combined existing cognitive, emotional, and physical therapies on cognitive function, oral health, and mental health in elder participants. Participants were classified into one of the following groups: cognitively normal (CN;  In general, the elder population can perform cognitive activities at the same level as younger people, as long as they do not have serious illness. However, brain function deteriorates and memory decreases gradually with increasing age. Approximately 25% of people between the ages of 60 and 69 show mild cognitive impairment and 54.6% of people ages 85 and above show moderate cognitive impairment ,2. DemenCognitive therapy is closely related to psychological, social, and physical functioning, and its focus is to improve various cognitive functions such as attention, computation, memory, language, and visuospatial discrimination . In addiEmotional therapy can offer a positive change in the quality of life and vitalizes elder people faced with perceptual or physical function loss . DepressPhysical therapy prevents cognitive impairment due to frontal lobe degeneration by improving cardiovascular function through physical activity and increasing CBF . Of variIndividual differences exist in cognitive impairment in old age, and they manifest themselves in conjunction with other complex factors. Hence, compared to stand-alone therapies, an integrative program was found to be more effective in helping individuals with diverse symptoms  by increasing participants’ interest and promoting active participation ,19. HoweAccordingly, this study was conducted to develop an integrative program composed of cognitive, emotional, and physical components to improve cognitive function in cognitively normal and mildly impaired elder participants and examine this program’s effects on cognitive function, oral health, and mental health.n = 48 under the assumptions of a significance level of 0.05, an effect size of 0.25, and a power of 0.85. In this study, a total of 60 participants were enrolled in anticipation of drop-outs [Study participants were people aged 65 or higher who were members of a senior center in the Gyeonggi Province. The inclusion criteria for the participants included the following: (1) understanding of study purposes and voluntary consent for participation, (2) no problem in communicating with others, (3) being ambulatory, (4) undergoing no pharmacological therapy to improve cognitive function, and (5) no history of participating in other cognitive intervention programs. The minimal sample size required to test the mean differences was estimated using G * Power 3.1.9.2 for Windows  and estimated to be rop-outs . n = 20) and experimental groups (n = 40). The Korean version of the Mini-Mental Status Examination (MMSE-K) was used to classify participants in the experimental group into cognitively normal (CN) and mildly cognitively impaired (MCI) groups. Participants with a score of 24 or higher were classified into the CN group and those with a score between 18 and 23 were classified into the MCI group [Participants were randomly allocated to control n =  and expeThe integrative cognitive function improvement program for the elder participants was developed in several phases. In the first phase, the literature was reviewed—studies in which cognitive function improvement programs were administered to elders in general or elders with mild cognitive impairment in the last 10 years were searched, and the relevant data were collected. In the second phase, program contents  were determined based on the literature review. In the third phase, an expert group consisting of a dentist, two dental hygienists, and three professors of dental hygiene were consulted to evaluate the program’s adequacy. Based on their recommendations, parts of the program were revised. In the fourth phase, a pilot study was conducted with five people aged 65 or older who were members of a senior center in Uigeongbu City to estimate the length of time needed to administer the survey and intervention, perform a dental exam, and review the results. The pilot study revealed that the survey and dental exam were not time effective. Thus, they were not included in the time allocated to administer the program and instead, pre- and post-intervention tests were planned before the program began and after it was completed. In the fifth phase, based on the pilot study, the second round of revisions was made to finalize the program. The finalized program was designed as an integrative program consisting of cognitive, emotional, and physical activities in a group learning setting.The cognitive activities consisted of oral health education and a post-education workbook developed in a previous study . For oraEmotional activities consisted of music and laughter activities, performed for 30 min per session. In music therapy, familiar, simple, and repetitive songs have been used in previous studies to stimulate long- and short-term memories and to maintain focus and attention . LaughtePhysical activities included whole-body exercise to stimulate the cranial nerves and cognitive function by using the hand and facial muscles and mouth exercise to promote oral health. Participants performed the exercises for 30 min per session . The phyIntegrative cognitive function improvement program was administered to participants in the experimental groups in May and June 2022. In consideration of the executability and the duration for participants to maintain focus, two 90-min sessions were planned per week, for a total of six weeks. The participants learned the recommended cognitive, emotional, and physical activities by watching the researcher and instructor team repetitively demonstrate each of the activities. The control group did not undergo the integrative cognitive function improvement program during the study period. For ethical reasons, however, the program was administered for six weeks to the control group upon completion of the study in June 2022.A week before the intervention began, the researcher and a trained research assistant administered a pre-intervention test to participants in all three groups over two days (2 and 3 May 2022). Participants filled out a self-report survey, received a dental exam, and underwent an electroencephalogram (EEG) study performed by an expert. A post-intervention test  was performed using the same criteria a week after completion of the program. The EEG measurements were recorded a total of three times . Four participants in the CN group visited a designated hospital to participate in a CBF study a total of three times .To test group homogeneity, data regarding demographics, cognitive function, activities of daily living (ADL), and quality of life with respect to oral health were collected by administering a self-report survey. To assess cognitive function, the MMSE-K was used . AdditioTo examine cognitive function, EEG and CBF studies were conducted. EEG was measured with Neuro brain , an EEG device developed by the Korea Institute of Brain Science . Two eleCBF measures the volume of blood flow to the brain and is an indirect method to evaluate cognitive improvement. In this study, after consultation with experts, transcranial Doppler ultrasound (TCD) was selected from several CBF measurement approaches because it was relatively affordable, and the participants were more accepting of the approach . The parTo examine oral health status, the O’Leary index  , Löe & STo evaluate mental health status, mental health in old age, happiness in old age, and social support were assessed. Mental health in old age was assessed with the Korean General Health Questionnaire (KGHQ), which was developed based on Goldberg’s General Health Questionnaire . Happinep value < 0.05. To compare participant groups on demographic characteristics, the Chi-square test, Fisher’s exact test, and analysis of variance (ANOVA) were performed. To test for homogeneity between the groups, ANOVA was performed. To test the changes in time in EEG, two-way repeated measures ANOVA was performed. Lastly, a paired sample T-test was performed to compare outcome measures before and after the intervention for oral and mental health, and repeated measures ANOVA was performed to test differences between the groups.The data were analyzed using IBM SPSS Statistics . Statistical significance was determined if a The three groups did not differ from one another at a statistically significant level in the demographic variables, except for the MMSE-K. In all groups, the proportion of females was greater when compared to the proportion of males, and the proportion of the age group of 75–84 was greater than any other age group. Regarding education level, high school graduation was the most common, and regarding socioeconomic status, middle class was the most common .p < 0.01 and p < 0.05 respectively). The post hoc test revealed that the AL significantly improved after the intervention in the CN (p < 0.01) and MCI group (p < 0.001) compared to pre-intervention. Post-intervention PT values were significantly improved than those measured after the first session (p < 0.05) in the CN group (p < 0.05) and those measured at pre-intervention in the MCI group (p < 0.05). There were no significant MD differences in the post hoc test , and the Löe & Silness index score (gingivitis) decreased by 0.47 and 0.48 in the CN and MCI groups, respectively (p < 0.01). Saliva flow rate increased by 0.13 g/min in the CN group and by 0.15 g/min in the MCI group (p < 0.05). Additionally, both the O’Leary and Löe & Silness indices showed significant differences across the measurement times (p < 0.01) and in group × measurement time interaction (p < 0.05). The saliva flow rate showed a significant difference across the measurement times (p < 0.01).The mean O’Leary index score  decreased by 0.42 and 0.40 points in the CN and MCI groups, respectively (p < 0.05), and the score was significantly different across the measurement times (p < 0.01)  .The current study was conducted to evaluate the effects of the integrative cognitive function improvement program on cognitive function and oral and mental health in cognitively normal and mildly impaired elderly people.The prefrontal lobe is the area of the cerebral cortex most affected by aging, and cognitive function, which is strongly linked to the prefrontal lobe, can rapidly deteriorate due to aging . In thisMean blood flow velocity is least influenced by physical changes and best reflects CBF status . It is aOral health is reported to greatly influence quality of life in old age . In the Depression is the most common mental health issue causing personal and social problems in old age . PreventBased on the study findings, the following suggestions for future studies and policy have been made in order to develop further specialized integrative programs for cognitive function improvement and actively treat the elder population. First, the current program showed equivalent outcomes in both the CN and MCI groups. However, responses to a program for elders may differ depending on the participants’ cognitive and health status. Accordingly, when an integrative program is designed and applied in the field, the status of target elders should be accurately identified and reflected in the program contents and operation. Second, the integrative program developed in the study could be utilized in a variety of settings, such as convalescent facilities and dementia prevention centers. Hence, local autonomous and central governments should establish funding and support systems for integrative programs to be aggressively utilized. Third, no previous studies, inside or outside of Korea, have ever conducted an experiment to test the effects of an integrative cognitive function improvement program by performing EEG and CBF studies; thus, the current study findings cannot be directly compared to any previous studies. Additionally, the study findings should be interpreted with caution because the level of cognitive function was not considered in selecting the control group. Further limitations are the small sample size and the inability to investigate related variables such as oral health status and oral care behavior of the participants. In future studies, positive intervention effects should be replicated by expanding the sample size and performing longitudinal research to investigate the long-term effects of integrative intervention programs.In this study, cognitive, emotional, and physical activities were combined into an integrative cognitive function improvement program for the elder participants. Our findings showed that the program was found to be effective in improving AL and PT, increasing CBF in the PCA, reducing the extent of tongue coating and gingivitis, increasing saliva production, and enhancing happiness in old age in both the CN and MCI groups. It is hoped that integrative cognitive function improvement programs will be widely utilized to prevent the deterioration of oral and mental health and thereby improve the quality of life in the elder population.