This study explores whether the widespread dissemination of Western-type culture and the globalization of food production and consumption that have characterized Italy for decades may have influenced red and processed meat consumption across generations. For the purpose of our study, we constructed a pseudo-panel derived from repeated cross-sections of the annual household survey, “Aspects of Daily Life,” that was part of the Multipurpose Survey carried out by the Italian National Statistical Office (ISTAT) from 1997 to 2012. We adopted an APC  approach that involves age, period, and cohort effects. We followed the experiences of four cohorts: the Silent Generation (born 1926–1945), the Baby Boomer 1 Generation (1946–1955), the Baby Boomer 2 Generation (1956–1965), and Generation X (1966–1980). Our results revealed that increases in disposable income, changes in women's role in society, and urbanization and globalization have had significant effects on consumption patterns. The analysis shows that the older generations have changed their diets more in favor of meat consumption than later generations, with more change in the relatively affluent north of the country compared with the south, while the youngest generations are more likely to adopt more healthful and environmentally sustainable eating patterns. The last century has shown a conspicuous increase in meat consumption, thanks also to economic growth, developments in meat production technology and intensified urbanization. However, meat production and consumption are also subject to criticism for environmental and health-related reasons. The production of meat has become a major concern because of the impact of livestock on global warming and environmental degradation In the food context, reducing the environmental impacts of food consumption requires a shift to the “plant-based” diets that require less land, energy, and other resources than meat-based diets do . One of However, the widespread dissemination of Western-type culture and the globalization of food production and consumption have reduced adherence to the MD in the Southern European countries where it originated . This deThis study explores whether the changes in the technology, culture and social welfare that have characterized Italy for decades may have influenced red and processed meat consumption across generations. We followed the experiences of four cohorts: the Silent Generation (born 1926–1945), the Baby Boomer 1 Generation (1946–1955), the Baby Boomer 2 Generation (1956–1965), and Generation X (1966–1980).The Italian context is similar in many ways to those of other countries in Southern Europe, but Italy underwent a dramatic change in the second half of the last century, passing from an agro-familial society to an industrialized society. This change produced a significant shift in food habits, increasing animal product consumption, particularly meat . Among SThe results revealed that the Silent and Baby Boomer 1 generations shifted from the traditional MD in terms of red meat consumption and that the Baby Boomer 2 generation shifted in terms of processed meat consumption. Our findings also confirm that the youngest generations are the most adherent to the MD, thanks to their higher sensitivity to the environmental and health-related impacts of meat production but also to their concern about the .animal rights and the rearing conditions of the farm animals. Indeed, according to the latest data from the EURISPES  report, The empirical results lead to the need for reflection concerning the oldest generations. Older age is typically associated with worse health, more use of the healthcare system and increased healthcare costs, so the older generations’ high consumption of red and processed meat during early adulthood may present a significant and increasing challenge for today's National Health Service as these generations develop chronic health conditions, including cardiovascular disease and cancer.The remainder of the paper is organized as follows. 22.1An individual's eating regime encompasses more than just food; it is a social marker that, through its symbolic value, constructs social identities . Food chHere, we review the diffusion of red and processed meat in Italy following the experiences of four cohorts: the Silent Generation (born 1926–1945), the Baby Boomer 1 Generation (1946–1955), the Baby Boomer 2 Generation (1956–1965), and Generation X (1966–1980).We contextualized the consumption of red and processed meat according to the economic conditions and the cultural factors that characterized Italy in the decades since 1950. We identified the median age at which women of each birth cohort left their parental homes in the transition into early adulthood. (See Table 1A in the Appendix.) We focused on women because of their traditional role in preparing meals and food management . We consThe Silent Generation entered early adulthood between the end of 1940s and the end of 1960s, a period during which Italy enjoyed intense economic growth. All of the macroeconomic variables -national GDP, GDP per capita, exports/imports, investments, and so on - grew to unprecedented levels and, in parallel, household spending leapt forward in terms of both the quantity and quality of food consumption. The increase in food consumption was significant , a remarkable transformation from the past, as a richer and more varied diet became accessible to classes that had not previously had access to it .The conspicuous decline in the 1950s in the consumption of maize, rye and barley, lard and suet, legumes, and dried fruit, together with the conspicuous increase in the availability of fresh vegetables, fresh fruit, milk, and beef transformed Italy into a “sated” country that began to suffer from the negative health consequences of such a rich and abundant diet, including cardiovascular, endocrine and metabolic diseases .Between 1950 and 1970, food consumption per household more than doubled as the richness of people's diets increased: the consumption of grains flattened out as meat consumption  increased .The result was a European diet that combined a high level of animal proteins with a MD of pasta, fruit and vegetables, of which Italy was among the main European producers, a combination that was, in many respects, unique in Europe. Calorie intake increased from an average of around 2350 calories per person in the early 1950s to 3000 calories in the late 1960s and 3200 in the following decade 35]).We estimated all models using the weighted least squares (WLS) approach, as the cohorts differ in size, and when the number of observations per cell varies substantially, the disturbance term may be heteroskedastic, leading to biased standard errors. By using the WLS estimation and weighting each cell with the square root of the number of observations in each cell, we corrected for heteroskedasticity .To test the robustness of our results, we also re-ran the model by assuming that period effects on the two dependent variables derived from a business cycle effect that operates through economic conditions . The res3Gender and age are confirmed to be significant demographic characteristics related to higher adherence to MD and lower consumption of red and processed meat. Women tend to follow the MD's recommended quantities for red meat and processed meat more than men do. Our results are in accordance with the previous literature, as women have more healthful food habits, while men succumb to the flavor aspects of foods and stand out for their high consumption of meat. Such differences in preferences and values influence the consumption of red and processed meat and the adherence (or lack thereof) to the Mediterranean pyramid recommendations . IncreasAccording to our results, the Silent Generation and the Baby Boomer 1 Generation engaged in a major shift from the traditional MD, particularly in terms of red meat consumption. Italy become more affluent after World War II, even though problems of undernutrition persisted, especially in the less developed areas of Southern Italy. Beef become more easily accessible and represented a symbol of well-being and richness, while the older generations considered the traditional MD, which was rich in plant foods like cereals, legumes, fruits and vegetables, a symbol of deprivation, rather than a healthful life choice .The Baby Boomer 2 Generation adheres more closely to the MD recommendations in terms of red meat consumption, but not in terms of processed meat consumption. This generation entered early adulthood at a time of prosperity and modernization that influenced their food habits. Beef started to loss its appeal as a symbol of wealth and status, and its consumption begin to decline. The period was also characterized by social change that also affected the oldest part of the Baby Boomer 1 Generation): women entering the workforce at increasing rates (according to the ISTAT labour Force Survey (2004)“Rilevazione sulle forze di lavoro” the labor force participation rate of Italian females aged 15–64 increased of about 15% over the years 1980–1990 and of about 32% over the years1980–2000) and changes in household structures, with more single-person households that led individuals to consume more convenience food, such as ready-to-eat meals and processed meat products.Finally, Generation X shows a lower frequency in the consumption of red and processed meat. Generation X entered early adulthood in an era characterized by an overall decline in the consumption of red and processed meat in favor of more sustainable and healthful foods. In 2001, the first domestic BSE case in Italy was also detected, leaving creating a shadow on the safety of beef. These concerns lead to a significant drop in beef consumption in that period an increased lack of confidence in the wisdom of consuming beef products.3.1Italy is characterized by complex regional dietary patterns with significant geographic differences in culinary traditions, as well as in culture, economic development and in climate (with the South with a very warm weather and the North with a cold one for a large portion of the year) that have affected attitudes toward certain foods .To determine the presence of a North-South gradient in the adherence to the MD diet pyramid's recommendations and in the evolution in red and processed meat consumption across generations, we re-ran the model on two subsamples using geographic dummies for the North and South of Italy. The results are shown in Our findings support the presence of a North-South gradient in the consumption of red meat, as expected, with residents of the North consuming red meat more frequently than those of the South. Our results also revealed standardization in the evolution of red meat consumption across generations in the country's two geographical areas. As for the full sample, the oldest generations (the Silent and Baby Boomer 1 Generations) in the two macro-areas present similar dietary lifestyles that are characterized by greater frequency of red meat consumption and lower scores on the MD pyramid recommendations. The younger generations, again, seem to be more oriented to lower consumption of red meat than the older generations are.The analysis of our results on the evolution of processed meat consumption across the two macro-areas and across generations, however, indicates a more complex pattern with differences that reflect the dissimilar “food culture” and economic conditions that have characterized the Italian regions in the last several decades. The northern regions again consume processed meat more often than the southern ones, and it is the Baby Boomer 1 Generation that has the lowest degree of compliance with the MD diet. In the diffusion process of processed meat, the southern regions appear to lag one generation behind the northern regions, as those in the South who present the lowest adherence to the MD, ceteris paribus, are the Baby Boomer 2 Generation and Generation X.Arguably, the economic and social dualism between the more economically developed northern regions and the less developed southern regions may have interacted with the diffusion of convenience food more than with the diffusion of red meat ,59. BothThe “traditional” pattern that was a peculiar characteristic of the oldest generations of the South was abandoned later by the younger generations in favor of a rise preferences for processed products like processed meat. While Generation X in Northern Italy was more oriented toward sustainable and healthful foods, the same generation in the South became the new “convenience seeker,” with food habits farther from those recommended by the MD pyramid .According to our results, the Silent and Baby Boomer 1 Generations are characterized by a major shift from the traditional MD in terms of red meat consumption, which these generations saw as a symbol of prosperity, while the Baby Boomer 2 Generation, especially in northern Italy, had a tendency to consume more convenience food, such as processed meat, in response to their need for meals that could be prepared quickly.The health, social and environmental concerns that are associated with red and processed meat consumption are part of an ongoing global debate and have led younger generations to adopt more healthful and environmentally sustainable eating patterns. However, despite the increasing shift away from the consumption of red meat products among the youngest generations, our findings echo previous findings regarding older age's association with poor health, as the evolution in the oldest generations diet toward more animal products has increased their risk of developing chronic health conditions in later life, placing an increasing burden on the National Health Service .According to our findings, a country's eating regime is deeply rooted in its history and dietary patterns are shaped by consumers’ culture, context, and socioeconomic status. Therefore, altering individuals' consumption decisions is often challenging. Informational campaigns should consider that, among the oldest generations, health-related reasons for consuming less red and processed meat may be perceived as more convincing than environmental reasons are likely to be .3.2In order to test the robustness of our results, we also re-run the model by assuming that period effects on the red and processed meat consumption could derive from a business cycle effect operating through economic conditions. Indeed, Clark et al. (2010) show that changes in aggregate economic conditions affect subjective well-being, which may also influence the propensity towards red and processed meat consumption .We include in the regression model the GDP growth rate see . Even th4The choice of foods as part of a diet implies a complex mechanism of interactions between social and cultural processes, values and traditions . Our resArguably, more stringent regulation is needed to reduce red and processed meat consumption. These meats could be treated like other carcinogens and foods that raise public health concerns. For instance, informational campaigns could be combined with pricing instruments like “sin” taxes—designed according to the Pigouvian principle—that incorporate the health and environmental costs of meat consumption into the price paid by the consumers, forcing them to take the outcomes of their consumption habits into account when they choose what foods to consume . School-Our study presents a limitation: since it relies on a pseudo-panel approach we cannot take explicit account of individual-specific heterogeneity in red and processed meat consumption since it involves aggregation into prototypes of individuals  identified by characteristics that remain stable over time. Despite this limitation, our approach is particularly suitable to investigate how food consumption habits of different demographic groups change over time or due to aggregate changes in culture, economic conditions, and environmental and health concerns.The interpretation and reporting of the results are the sole responsibility of the authors.All authors contributed to the conception of the study, the design of the study, and writing of the manuscript. All the authors commented on/edited all drafts of the manuscript.All the authors can be identified as the guarantors for the overall content and interpretation of the results.None.The authors report no declarations of interest.The views expressed are those of the authors and do not necessarily reflect opinions of the institutions of affiliation.


Introduction: A deprivation index has become a more popular tool to rank levels of deprivation within different geographic areas. It is extensively used for monitoring health inequalities, evaluating health care services, developing and modifying health policies and programs, and allocating health resources equitably. Our objectives are (1) to explore the relevant literature to describe features of composite deprivation measures; (2) create a list and classification of original deprivation indices. We will develop the classification of indices to systematize knowledge and improve the functional utility of the information. Methods: Any original deprivation index mentioned in peer-reviewed or grey literature documents will be eligible for inclusion if it assesses deprivation at a population level and used in relation to health. The study area will be limited to the geographic areas of North America, Europe, Australia, and New Zealand. Tables and a narrative summary will be used to describe features of deprivation indices. Diagrammatic form will be used to create the classification of deprivation indices. Discussion: Practically, the results of this study could facilitate finding a common language among researchers and specialists who create and use deprivation indices, thus helping the development and implementation of appropriate deprivation indices for different countries. In 1979, Townsend defined “deprivation” as the concept of unmet needs due to an actual or perceived lack of resources required to maintain the quality of life  to which various socioeconomic groups or individuals within those groups have grown accustomed, or are considered to be the accepted norm within the group [Although researchers also utilize individual variables reflecting material, social ,3 and enA number of epidemiological studies have been carried out around the world that examine the effect of deprivation on a wide range of health measures and disparities. Overwhelming evidence shows major negative impacts of deprivation on human health, for instance, type 2 diabetes and obesity in Germany  and SoutThe deprivation indices are commonly used in public health research to quantify social inequalities in health and environmental health inequality, or to assess the effect of some characteristics of areas  on health behaviors and outcomes separately. In addition, local health authorities use these indices to help identify areas where the need for medical care and the demand for medical services are expected to be the highest and then target health policies and programs to the areas in order to achieve the following goals: to improve health outcomes, to allocate financial and technical resources appropriately and to make health services broadly accessible.However, despite their considerable advantages, deprivation indices are unique and country specific. Therefore, in creating a deprivation index, it is important to take into account differences in the social, cultural and economic characteristics, such as income, employment, social supports, community safety and other relevant factors of different countries. In addition, the development of an index depends on technical progress and socio-economic changes in any country. For example, ownership of a color TV is not an indicator of deprivation for high-income countries, as the majority of the population living there has this device, but the variable may be essential to calculate levels of deprivation in low-income countries.Some researchers have imported slightly modified publicly available indices, such as the Townsend index , and theIn the current review, we will examine how, in different countries, deprivation indices were created. This is significant because indices have been used in public health for more than three decades. The first deprivation index was created in the UK in the late 1980s. A stock of knowledge and information about deprivation indices have been accumulated over this period. If in the past they were only used to measure material and/or social deprivation , now they are created from different domains, which also include indicators relating to environmental deprivation . Furthermore, deprivation indices are included in other composite measures, such as the Health Opportunity Index (HOI)  that covHowever, the scientific community still cannot reach a consensus on selection of appropriate data sources , individual deprivation indicators and geographic areas for creating an index. In this regard, we will create a taxonomy of indices to systematize knowledge and improve the functional utility of the information. Moreover, the classification will provide an organized framework for planning and following through with the process of developing new deprivation measures. Therefore, the findings of the review will serve as a valuable resource material for future studies, programs, plans and projects.In the light of the above, the purpose of this scoping review will be to investigate the nature and characteristics of deprivation indices. The following specific objectives have been pursued: (1) to review the relevant literature to describe features of composite deprivation measures ; (2) create a list and taxonomy of deprivation indices.A preliminary search of PubMed found a recently published scoping review from 2018 by Ichihara et al. on area deprivation measures used in Brazil [The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews . We haveWhich original deprivation indices  exist around the world?What area levels (country/area of country) are the indices operationalized at?What years and data sources are used to create the indices?Which deprivation indicators/domains make up the indices?Which types of deprivation  are considered in the indices?Which weighting methods are used to create the indices?Are updated versions of deprivation indices available?Are separate websites and/or supporting documentation about the indices available?Study selection will be performed based on the inclusion/exclusion criteria. The eligible article should indicate the following: (1) the territory for which an index was created, (2) a list of all the indicators that form the index, (3) the data source from which these indicators were extracted, (4) the weighted method used to assess the importance of the indicators in the index. In addition to information about creating an index, (5) the article should present evaluation of the predictive validity of the index   or evideThe concept of this review is to create a taxonomy of deprivation indices. Therefore, this review will consider studies where researchers created an original deprivation index to examine the effect of deprivation on health. An original deprivation index is defined as “an original deprivation index that includes a combination of deprivation indicators that is unique and not repeated in other indices”.This review will consider the deprivation indices developed for both a whole country  and specific areas of a country ). The study area will be limited to the geographic areas of North America, Europe, Australia, and New Zealand.Observational studies  will be eligible for inclusion.Questionnaire-based individual-level deprivation indices will be excluded , a New Zealand index of socioeconomic deprivation for individuals). Adapted  and updated versions of deprivation indices will be excluded. We define an adapted index as “an index (containing a certain (unique) set of deprivation indicators) that is applied outside the country for which it was created”. An updated index is defined as “an updated index that is already available, but undergoes transformation over time ”.Index creation guidelines, systematic, scoping and other reviews will be excluded. Experimental studies , conference proceedings, editorials, commentaries, and duplicate publications will be excluded.The search strategy will aim to locate only published studies, without publication date limit. Papers published in any language will be included to avoid language bias. On 10 December 2020, an initial limited search of MEDLINE (PubMed) was undertaken to identify articles on the topic. A total of 1040 results were obtained. Bibliographic databases will be searched to find papers that include “deprivation index”, “deprivation indices”, or “deprivation indexes” in the title and/or abstract field. There will be no restriction by publication year. The reference lists of papers included in the review will be screened for additional papers.The databases to be searched include MEDLINE (PubMed). Sources of gray literature to be searched include Google Scholar. For each included deprivation index, we will use a Google search to determine if there is a separate website and/or supporting documentation about the index and its methodology to establish whether it was used outside research projects. In the same way, we will search for updated versions of indices. In our opinion, the parameters  clearly demonstrate the simplicity of use, relevance, and accessibility of the index. If the information is only available via the included study, then the data will be extracted from there. The information source will be recorded as part of the data extraction.Optionally, the search of relevant studies that are already known to the authors will be included in the scoping review.Following the search, all identified records will be collated and uploaded into EndNote X9  and duplicates removed. Following a pilot test, titles and abstracts will then be screened by two independent reviewers (A.Z. and S.M.) for assessment against the inclusion criteria for the review. Potentially relevant papers will be retrieved in full and their citation details imported into the JBI System for the Unified Management, Assessment and Review of Information  . The fulData will be extracted from papers included in the scoping review by two independent reviewers (A.Z. and S.M.) using a data extraction form developed in Microsoft Excel by A.Z. see . The datThe extracted data will be presented in diagrammatic and tabular form in a manner that reflects the objective and scope of this scoping review. A narrative summary will accompany the tabular and/or charted results and will describe how the results relate to the review’s objective and questions. Tables and figures will be used where appropriate.Data on the deprivation indices will be analysed to create a list and taxonomy of indices that will be available to researchers, practitioners, and policymakers. This will include quantitative analysis of the indicators and domains that make up indices, for instance, the percentage of indices measuring particular features . The analysis will also assess the proportion of indices operating in particular geographic scales and the proportion of indices developed using different variable/domain weighting methods.The ambiguous nature of indices makes it difficult to fully recognize their potential in both scientific studies and practical applications. Accordingly, it is important to explore the development of indices in greater depth. Based on a description of features of deprivation measures as well as a methodology and interpretation of indices, we will create their taxonomy. The aim of creating the taxonomy is to systematize information related to the methodology for constructing and using deprivation indices in public health research and practice. Practically, the results of this study could facilitate finding a common language among researchers and specialists who develop and use deprivation indices, thus helping the development and implementation of appropriate deprivation indices for different countries.We hope that the data from the review will stimulate the use of a competent approach and will help researchers and public health specialists in resolving conflicts or inconsistencies that arise during the construction and use of indices.


Atrial fibrillation (AF) and Heart failure (HF) constitute two frequently coexisting cardiovascular diseases, with a great volume of the scientific research referring to strategies and guidelines associated with the best management of patients suffering from either of the two or both of these entities. The common pathophysiological paths, the adverse outcomes, the hospitalization rates, and the mortality rates that occur from various reports and trials indicate that a targeted therapy to the common background of these cardiovascular conditions may reverse the progression of their interrelating development. Among other optimal treatments concerning the prevalence of both AF and HF, the introduction of rhythm and rate control strategies in the guidelines has underlined the importance of sinus rhythm and heart rate control in the prevention of deleterious complications. The use of these strategies in the clinical practice has led to a debate about the superiority of rhythm versus rate control. The current guidelines as well as the published randomized trials and studies have not proved that rhythm control is more beneficial than the rate control treatments in the terms of survival, all-cause mortality, hospitalization rates, and quality of life. Therefore, the current therapeutic strategy is based on the therapy guidelines and the clinical judgment and experience. The aim of this review was to elucidate the endpoints of pharmacologic randomized clinical trials and the clinical data of each antiarrhythmic or rate-limiting medication, so as to promote their effective, individualized, evidence-based clinical use. Atrial fibrillation (AF) and heart failure (HF) are evolving as new cardiovascular epidemics over the last decade . AF is tResearch has been done in the aspects of HF and AF, although the approaches that will offer the best clinical outcomes still remain unclear. The suggested common pathophysiological pathways that these two entities share, introduce combined therapeutic strategies in order to eliminate the prevalence of adverse outcomes resulting from their concomitant existence. Rate and rhythm control medication are considered to be primary choices in the treatment of patients with coexisting HF and AF . The effThe aim of this comprehensive review was to demonstrate the interdependent pathophysiological mechanisms of HF and AF and further analyze the landmark clinical trials of current rate and rhythm control pharmacotherapies, reflecting their challenges in daily clinical practice. In addition, we discuss extensively the pharmacologic randomized clinical trials, elucidating the endpoints, strengths, and potential limitations of either strategy and also the clinical data of each antiarrhythmic or rate-limiting medication separately, so as to promote their effective, individualized evidence-based clinical use. Recent trials of catheter ablation are promising in this subgroup of patients; however, the scope of this review was to focus on pharmacologic guideline-directed rhythm and rate-control strategies.The pathophysiological relationship between these two entities is not entirely clear and still remains a matter of research, but their coexistence in a great percentage of the population is beyond doubt . This caAF may coexist not only in HF with a reduced ejection fraction (HFrEF), but also in HF with preserved ejection fraction (HFpEF), with the same risk factors contributing to this coexistence. Interestingly, research has focused on AF occurring on HFrEF, basically including persistent and long-standing AF, according to the population studied ,7.2 DS2VaSc risk assessment score. All subtypes of AF must be treated with anticoagulants if CHA2 DS2VaSc is greater than 2 points in men and three points in women, and they should be treated with anticoagulants if CHA2 DS2VaSc is one point in men and two points in women. The selection of the type of anticoagulant is based in patients’ clinical characteristics and personal wishes.Managing AF in the HF patients is linked with several therapeutic challenges. There are several contraindications to medications that are usually administrated in AF and the patients’ response to the used treatment for AF may not be the desired one. Additionally, the association between AF and acute HF may not be so easily clarified, whereas the therapeutic goals in patients where the two conditions are coexisting are not clear yet . The majClinical characteristics are also the main factor for the clinician’s decision to treat AF with rate or rhythm control. Multiple factors can affect this decision such as patient’s age, duration of AF, echocardiographic characteristics of the left atrium, medical comorbidities, and of course the presence of symptoms. Rhythm control can be achieved using Class I or Class III antiarrhythmics. Class Ic medicines should be avoided in patients with ventricular dysfunction, or patients with a history of coronary disease due to their proarrhythmic effect. On the other hand, Class III antiarrhythmics can be used safely in these patients but with the risk of non-cardiac complications. If one chooses rate control, then beta blockade is the cornerstone of this therapy. Several studies and sub-analysis have been conducted in order to determine the best case scenario between pharmacologic rate versus rhythm control on AF in HF patients. Yet, there is not a clear answer. Rate control is not without challenges . There aRapid ventricular rate, irregular ventricular response, and loss of atrial contraction are all associated with adverse hemodynamic events and a further worse prognosis in patients with AF ,18,19,20In the management of a patient with AF and HF, the administration of an initial treatment strategy with a subsequent alternative planning is essential. A rhythm control strategy targets the restoration and maintenance of sinus rhythm (SR) and the control of the ventricular response rate in the case of recurrent AF. A ratecontrol strategy targets mainly the control of the ventricular response rate . While rIn the following sub-sections, we present in detail the landmark randomized clinical trials comparing pharmacologic rhythm versus rate strategies, referring to enrolled patient characteristics, pharmaceutical agents used to achieve rhythm/rate control and/or potential adverse effects, primary and secondary endpoints regarding cardiovascular morbidity, mortality, QoL, HF hospitalizations/symptomatic improvement, thromboembolic, and bleeding complications.The RACE study included 522 patients with persistent AF observed from 1 June 1998, until 1 July 2001.In a sub-study on AF patients with mild to moderate chronic heart failure (CHF) with NYHA functional Classes II and III, 261 individuals were analyzed, while 130 and 131 patients were randomized to rate and rhythm control groups, respectively . In thisThe results in the group of patients with AF and mild CHF showed that the occurrence of cardiovascular morbidity and mortality and QoL is equal between those treated with rate control and those treated with rhythm control. Between the two groups, however, there were important differences in the end points. In the rate control group, a higher mortality and morbidity, thromboembolic complications, and major fatal and nonfatal bleedings were observed. In the rhythm control group, a successful maintenance of sinus rhythm was associated with excellent survival whereas there was no improvement in the progression of CHF . In anotThe administration of prophylactic antiarrhythmic drugs had significant effects on the end points in the rhythm control arm and not in the rate control arm. Although, one patient in sotalol treatment died suddenly, there were no reported severe adverse effects during this treatment. During treatment with Class Ic drugs, life-threatening adverse events were reported in four patients, in one patient during the institution of the drug in the hospital and additionally two patients died suddenly while being in Class Ic drugs treatment. Cardiovascular mortality in patients not treated with Class Ic antiarrhythmics was reported equally among the whole study population, with more events reported in the rate control group . AmiodarThe AF-CHF study included 90 cardiology centers throughout Canada, the United States, South America, and Europe. The recruitment started in May 2001, the randomization was concluded in June 2005, and the follow-up period ended on 30June 2007 .The patients enrolled had a left ventricular ejection fraction of 35% or less, as well as a history of congestive heart failure and atrial fibrillation and a required long-term therapy in either of the two study groups where the patients were randomly assigned, either to the rhythm control group or the rate control group . Rhythm During the AFFIRM trial, 4060 patients with AF and HF were analyzed . The enrIn an intention-to-treat analysis by Guglin et al. , the patPatients in the rate control arm were more frequently in AF, while patients in the rhythm control arm were in SR about 11 times more frequently than in AF. The two groups with the lowest frequency of SR were associated with much worse functional status: rate control and rhythm-to-rate crossovers . PatientThe AFFIRM trial indicated that there is no survival benefit from the rhythm control strategy when compared to the rate control strategy . A subanIn conclusion, according to the AFFIRM study, symptomatic HF was more common in the rate control than in the rhythm control arm, without introducing however a more beneficial profile of either strategy. In general, AF is shown to be associated with poorer NYHA functional class, more symptomatic HF, as well as with greater requirements for ACE inhibitors and diuretics, in all subgroups of the AFFIRM trial except for those patients who crossed over from rhythm to rate control, while the highest rate of symptomatic HF patients was reported among patients who changed strategy between rate and rhythm control more than once. This group of patients may represent a primary target for other treatment strategies such as ablation because of the greater benefit for them being in stable SR . AdditioThis randomized controlled study aimed to determine whether restoration and maintenance of SR were beneficial for patients with HF and persistent AF. The study included patients aged >18 years of age with persistent AF and chronic symptomatic HF (NYHA > Class II symptoms) with echocardiographic evidence of systolic dysfunction. No patients presenting contraindications in oral anticoagulants were included in the study. Patients were randomized to either a rate control or rhythm control strategy. Between follow-up visits the patients’ symptoms were recorded and additionally their quality of life (QoL) was assessed by specific questionnaires . DigoxinThe results of the study showed that a rhythm control strategy can improve QoL and left ventricular function in comparison with rate control strategy alone. For the patients whose SR was maintained at 1 year follow-up, they presented with the greatest improvement . HF patiThe How to Treat Chronic Atrial Fibrillation (HOT CAFE) study described the comparison between the use of either the strategy of SR restoration and maintenance and the strategy of ventricular rate control and chronic thromboembolic prophylaxis in patients with persistent AF . The recThe results of the HOT CAFΕ study showed that the rate control of persistent AF is equivalent to rhythm control in terms of the primary endpoints of the study, supporting the results of other trials despite the rather younger population or the longer persistence of AF (for up to 2 years) .The ventricular response control was in both groups easily accomplished, resulting in a good management of symptoms and exercise tolerance, emphasizing the importance of the ventricular rate restoration in AF patients. A better rate control and a significant decrease in mean heart rate during follow-up was achieved in the patients of the rhythm control group, while in the rate control group the ventricular response was satisfactory with no significant changes during follow-up. While at baseline there were no significant differences, patients in the rhythm control arm had a higher maximal workload and longer exercise tolerance than patients in the rate control arm at the end of follow-up . The rhyPIAF trial is an open, randomized pilot study aiming to compare two different treatment strategies in patients with persistent and symptomatic AF lasting between 7 days and 360 days . The patThe results of the study showed that neither of the two therapeutic strategies is more beneficial in the improvement of AF-associated symptoms. In PIAF, amiodarone led to restoration of SR in 23% of patients, while the remaining majority underwent at least one direct current cardioversion and as it has been shown, in 56% of patients who were successfully cardioverted, that SR could be maintained on a low-dose amiodarone treatment over the observation period, although the percentage occurring from the observations was smaller than what was initially expected, which was 70% . PatientThe purpose of this study was to determine whether a restoration and maintenance of SR will improve survival and exercise tolerance among patients with nonischemic cardiomyopathy and AF . The patAccording to the results of the study, patients with chronic AF and nonischemic left ventricular systolic dysfunction may present with improved rates of mortality and exercise capacity after SR is restored and maintained . All of the strokes were reported after the discontinuation of warfarin in the rhythm control group, suggesting that patients with HF should continue receiving anticoagulation even after the restoration of SR  60]..60].The STAF study compared the strategies of rhythm and rate control in patients with persistent AF regarding mortality, QoL, adverse events of the disease, and therapy side effects. From January 1997 to August 1999, 200 patients were recruited in an interim analysis, with a minimum follow-up of 12 months or a primary end point . PatientThere was no difference in the primary and secondary end points between the two treatment strategies, except for the hospitalizations for cardiovascular reasons. Hospitalizations, basically concerning repeated cardioversions and initiation of antiarrhythmic treatment, were more frequent in the rhythmcontrol group. Additionally, there was an equal improvement in the QoL in both treatment groups although it was still lower than that of the healthy control group. It was also reported that rhythm control therapy showed no superiority in the maintenance of SR in a long term basis (23% in three years) when compared with rate control, although the number of patients observed was small . It was The CASTLE-AF trial compared catheter ablation and pharmacological therapy for patients with AF and HF . Over 30In this subpopulation of the CASTLE-AF study, it was reported that pharmacological rhythm control strategies using AADs in patients with advanced HF was not superior to a pharmacological rate control strategy in the primary outcome of the study, and additionally the prevalence of ventricular arrhythmias was comparable between different treatment strategies . A propoA trial which was conducted on data collected from the Duke Cardiovascular Disease Database targeted the determination of whether a rhythm or a rate control strategy for patients with AF and diastolic heart failure affected survival . For thiThis study indicated that there was no statistical difference on survival between the rate and rhythm control strategies. Although there are not enough data describing the optimal management of AF in diastolic HF, there was a tendency of restoring and maintaining SR in such patients. It is assumed that SR benefits those patients because left ventricular filling in diastolic heart failure occurs primarily in late diastole and is dependent, unlike what happens in healthy hearts, on atrial contraction, which is not preserved in AF. Based on the data occurring from this study, there was no advantage of a rate over a rhythm control strategy for AF in patients with diastolic HF. Statistical adjustments though resulted in a better survival profile in patients with AF and HF with preserved ejection fraction, when it was managed with rhythm control  65]..65].A 2019 analysis on the Get with The Guidelines–Heart Failure (GWTG–HF) registry along with Medicare claims data from 2008 to 2014 described the treatments for rate versus rhythm control and the subsequent effects in patients with HFpEF and AF . There wIn this population it was observed that rhythm control was associated with 1-year lower mortality when compared with the rate control treatment, even after risk adjustment. This result suggests that there might be an opportunity to improve outcomes in patients with HFpEF and AF, therefore future studies need to investigate this beneficial effect . A numbeThe decision for the administration of a rhythm control treatment is often based on the objectives of controlling symptoms and reducing the need for hospitalization. AF is effectively controlled if recurrences are infrequent, well tolerated, self-terminating, and do not require hospitalization. An unsuccessful treatment is associated with the frequent development of symptoms, poor tolerance of the recurrent episodes of AF, and AF-related hospitalizations . AccordiAmiodarone is the most commonly used AAD in the treatment of congestive HF, cardiac dysfunction and the first choice among AADs for the treatment of the combined AF and HF. The safety of amiodarone in HF has already been demonstrated ,73, as wRecent antiarrhythmic drugs may be more beneficial and have less adverse effects in AF treatment of CHF patients . The PerDofetilide is an alternative AAD for rhythm control in patients with HF. Its safety has been demonstrated in the Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) trial, designed to demonstrate the effect of dofetilide on the mortality in patients with HF and left ventricular systolic dysfunction with or without AF . In a suThe double-blind Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T) compared sotalol and amiodarone in the terms of the restoration and maintenance of SR in patients with AF and mostly normal LVEF . A totalThe Rate Versus Catheter Ablation Rhythm Control in Patients with Heart Failure and High Burden Atrial Fibrillation (RAFT-AF) trial currently aims to determine whether the treatment of AF by catheter ablation, with or without antiarrhythmic drugs reduces all-cause mortality and hospitalizations for HF, in comparison with a rate control strategy in patients with HF and AF. A sample of 600 patients with NYHA functional Class II–III HF (HFrEF< 35%) or HFpEF) and a high burden of AF are included in the trial, randomized to either rate control or rhythm control in a 1:1 ratio . The theRhythm control may be preferred as a treatment strategy in selected patients based on their clinical profile. For instance, patients with new-onset AF and new-onset systolic HF may be significantly benefited by a rhythm-control strategy and, by the maintenance of SR, the underlying cardiomyopathy could be reversed . In patiIn patients with chronic HF, a rhythm control strategy, either pharmacological or electrical, has not been proven to be superior to a rate control strategy in reducing mortality or morbidity . In clinIf a patient presents with recurrent symptomatic AF despite the AAD treatment, a transition to rate control is optimal. If the rate control is ineffective in the alleviation of the AF symptoms, then repeated cardioversions with AAD dose adjustments may be attempted . If no one of the applied treatments is effective, AF ablation is still a potential option .There is clinical evidence that slower heart rates in SR are associated with long-term survival. The Systolic Heart failure treatment with the If inhibitor Ivabradine (SHIFT) Trial was designed to define the effect of ivabradine in regards to guideline-based treatment on cardiovascular outcomes, symptoms, and QoL in patients with CHF and systolic dysfunction . A numbeAn evaluation of ventricular rate control from the radial pulse is not optimal, especially in HF patients, as the ventricular response does not always generate a palpable pulse. An electrocardiographic documentation of rate control is necessary; a wearable device used for routine monitoring, however, has not yet been established. The 2016 ESC HF guidelines proposed the optimal ventricular rate at rest in patients with AF and HF should be established between 60 and 100 bpm ,38,98,99B-blockers appear safe and efficient as a first-line rate control treatment, although it is not clear whether they reduce morbidity and mortality in patients with AF . The varDigitalis has been long used in the treatment of patients with HF. The Digitalis Investigation Group (DIG) trial studied the effect of digoxin on mortality and hospitalizations in patients with HF. The trial demonstrated reduced hospitalizations in patients with reduced LVEF and SR but no reduction in mortality was confirmed . When adB-blockers combined with digoxin may also be used in the control of the ventricular rate . Khand eAmiodarone has been reported to be included in the rate control therapy; in acute decompensated HF it is better tolerated than b-blockers as an agent and is more effective than digitalis. Amiodarone would be more helpful in patients with new-onset AF <48 h, while the embolism risk assessment is the same as previously mentioned in the rhythm control strategy. According to the ANDROMEDA and PALLAS trials, dronedarone should also be avoided in patients with HF and permanent AF ,83. DespPatients treated with a non-strict rate-control strategy that remain symptomatic, with a lower heart rate at rest, could be pursued, and with persistent symptoms at an optimal resting heart rate, rate control during exertion may also be optimized. Alternatively, a rhythm control therapy may be considered, if it has not already been attempted . FrequenA great effort has been directed to the improvements in the management of AF and HF as separate disease entities, and despite the gradual progress in the determination of the pathophysiology and the interrelated mechanisms of their coexistence, this has provided the clinical practice only with a few randomized trials and data concerning the optimal therapeutic strategy in the concomitant of AF and HF. Neither the rhythm nor rate control strategy has been proven so far to be superior in the management of such patients, although many trials adjusting their analyses according to the characteristics of the patients have demonstrated a more beneficial role of either of the two strategies in certain endpoints. Therefore, the ideal therapeutic strategy is applied based on the approved guidelines and the results of large, randomized trials, along with the clinical experience and the medical judgment of the treating team. Further trials and studies are required to clarify the interaction between the rate and rhythm control strategy in AF and HF and the optimal combination of the existing therapies in order to achieve the greatest improvement in cardiovascular outcomes, hospitalization, QoL, and survival.


Preventing Chronic Disease (PCD). Can I edit this? At the midpoint of 2022 we already have many achievements to recognize and celebrate. Last year we crossed a high bar: in 2021 PCD received the biggest jump in impact factor in its history, from 2.144 to 2.803, making it fourth of 27 open-access US public health journals. We are pleased to report that the latest SJR: Scientific Journal Rankings release shows a sustained upward trend, with a new impact factor of 4.354, a 55% increase. Additionally, Scimago Journal Rank recently placed PCD fourth out of 30 US journals and 76th out of 585 journals worldwide in the category of Public Health, Environmental, and Occupational Health open access journals. The journal was also ranked in the top 10% of more than 27,000 journals evaluated by Scimago in 2021. This has been an extremely productive year for PCD continues its focus on ensuring the highest level of scientific quality and rigor in its content by expanding our expert resources. For our upcoming collection on combating racism, we brought together the journal’s first guest editorial board, whose members bring expertise in areas that intersect issues of racism and public health. We are excited to be working with such a distinguished group. We have also expanded the breadth and depth of representation in our team of associate editors and in our Editorial Board and Statistics Review Committee. We will need the experience and knowledge that all these new experts bring to the journal, in anticipation of another record number of submissions. So far this year we have published 2 collections and have two more scheduled. In this column I will share details of these collections and a new collection podcast, as well as our upcoming calls for papers. And finally, I will provide an update on our efforts to advance best practices in diversity, equity, and inclusion (DEI) in our operations and our plans to provide authors with updated guidance on reporting race and ethnicity.PCD has appointed 5 new members to serve on the journal’s Editorial Board. The board is made up of volunteers who advise the journal on its policies and identify appropriate and timely topics for publication. Attention to the latest and most pressing public health topics requires that the journal expand to include the necessary expertise in its Editorial Board. We are pleased to have secured expertise in public health data systems, which will position the journal to disseminate information on how the public health field can use and leverage timely, relevant, and actionable data to generate public health responses  Zhao, PhD, Health Scientist in CDC’s Division of Population Health; and Mario Sims, PhD, MS, FAHA, Professor of Medicine in the Department of Medicine at the University of Mississippi Medical Center and Chief Science Officer of the Jackson Heart Study.PCD continues to identify emerging areas of research, evaluation, and public health practice of interest to the journal’s readership. We currently have 7 active calls for papers (see Announcements at https://www.cdc.gov/pcd/announcements.htm) and encourage interested authors to submit manuscripts for consideration in the following areas:Global Responses to Prevent, Manage, and Control Cardiovascular Disease . Heart disease and stroke continue to be leading causes of death and disability worldwide, exceeding even the recent impact of the COVID-19 pandemic . According to Healthy People 2020, achieving health equity requires valuing everyone equally with focused and ongoing societal efforts to address avoidable inequities, historic and contemporary injustices, and the elimination of health and health care disparities . In April 2021, CDC declared racism a public health threat, identifying it as one of the fundamental drivers of health inequities . Sleep is an essential daily behavior that supports physical, emotional, and psychological well-being . Health behaviors are shaped not only by individual choices but also by the environments in which they occur . Assessing the impact of public health interventions is important for several reasons. Typically, fiscal resources are used to support public health interventions, so it is imperative to determine whether the return on those investments supports changes in how these interventions are delivered or whether the interventions should be discontinued altogether . The nation’s health data systems are often antiquated, resulting in a myriad of negative effects on chronic disease prevention and health promotion efforts. In addition, antiquated data management systems often become difficult to support, maintain, scale, or integrate into new platforms  Diversity, Equity, and Inclusion Committee. The purpose of this committee is to ensure that CSE reflects the best, most earned, most equitable, and fair representation of both the profession and the work published in scholarly communications . CSE is PCD’s ScholarOne manuscript submission system. Users of the system will be prompted upon login to address incomplete profile information, including providing additional demographic details. To protect users’ privacy, responses are voluntary and will be viewable only in the aggregate by PCD and ScholarOne staff. Initial questions will address gender identity, race, and ethnicity to help us better understand the diverse representation of our contributors and reviewers and guide our future efforts. We hope to include additional questions in future phases. PCD readers will also receive updates on the journal’s guidance to authors regarding the reporting of race and ethnicity in our articles. Specifically, the journal seeks to provide the best guidance on how the Methods section of manuscripts submitted to PCD in original research articles and briefs should explain who identified the participant race or ethnicity and the source of the classifications used. In addition, PCD will require authors to provide a rationale as to why race and ethnicity categories were collected for a study and to report the race and ethnicity of study populations in the Results section.Over the coming months, we expect to begin collecting demographic data from users of PCD already has an impressive list of accomplishments, thanks to the combined expertise and commitment of our volunteers, authors, and peer reviewers and our excellent staff. As pleased as we are with our progress, we are even more excited about the plans ahead. Until the next update, we ask for your continued support in sharing with your colleagues the many calls for papers presented in this column. If you find one or more of the topics interesting, please think about submitting your work to PCD for consideration. As always, we thank the journal’s increasing number of volunteers who serve as associate editors, Editorial Board members, Statistics Review Committee members, and peer reviewers for positioning the journal to experience continued success.At this midpoint of the year,


This paper reviews some of the existing methods for charging electric vehicles, generating renewable energy, and storing it. Plans of practical implementation in the city of Brno are compared with the situation in Glasgow. Moreover, it is essential to pay attention to integrated solutions in order to increase efficiency. Energy harvesting and charging systems are combined with an air quality measurement system and integrated into LED street lights. The collected data are sent to a central server for evaluation. The use of smart solutions is a modern approach to saving energy and reducing CO Within the context of the RUGGEDISED project, this paper examines the use cases of Glasgow, which is a Lighthouse city in the project, and Brno, a Fellow city. Among the solutions that Brno and Glasgow are currently working on, we will focus on supporting electromobility by installing electric vehicle (EV) chargers within additional technologies and in different city environments. For instance, saving energy is realized by using renewable energy sources. In particular, photovoltaic panels (PVs) will be installed on the roofs and walls of parking houses and industrial or residential buildings.Renewable energy is an inevitable trend and an essential part of a sustainable lifestyle in the coming years. As shown in Several papers ,3,4 focuEV chargers could be integrated into lampposts which will also contain sensors for measuring air pollution . The majMonitoring air quality benefits citizens living in large cities. The sensors situated on the lamppost could measure pollutants such as dust particles , ozone  [A map of solar irradiance in the territory of the city of Brno is available at the web portal st 2022) ,29 whereWith the total area of the building being 432 mA is the area of PV panels, and From the gathered solar irradiance data it is possible to estimate the production of electric energy per year. There is a continuous increase in the efficiency of PV panels ,31, but The European Commission provides a web application, the Photovoltaic Geographical Information System (PVGIS) , where iA total of 292 charge points have been installed across 151 units in Glasgow as of April 2022 . In collThe majority of current EV chargers are fast or rapid, which can charge most vehicles to 80% in about 30 min . Table 2There are 13 air quality monitoring stations in Brno. Five stations are operated by Brno, six are owned by Czech Hydrometeorological Institute (CHMI), and two are by Public Health Institute. Several harmful substances, including NO effects . PM10 duects [μm  and theyects [μm ,42. A grA study such as this one suggests that air monitoring could be useful and that having more data would be beneficial for a healthy population. In addition, there is no need for new stands to integrate sensors into street LED lights. This approach is applied in Glasgow city, which could be replicated in Brno .Smart cities are open domains for not only civil applications, but also for military purposes. With more than 56% of the world’s population and almost 75% of Europe’s population living in urban areas in 2020, the future potential importance of smart cities is on the rise . TherefoIn general, an army’s operation requires extensive logistics. Currently, opportunities to cover part of its energy consumption using local sources are being investigated. This could decrease the vulnerability of logistics and potential losses of troops and equipment. Local production of electric energy without fuel delivery requirements is generally accomplished by photovoltaic or wind power sources. These sources are weather dependent and the energy gained is usually insufficient to fully satisfy the army’s needs. However, with a connection to battery systems or fuel cell technology, these sources can offer a solution to fulfill at least part of the army’s energy consumption. The second advantage of this approach, especially with photovoltaics, is their silent operation.The military’s electricity consumption ranges from supplying bases to vehicles to equipping soldiers. Wearable and portable soldier equipment contains various gear such as a GPS, personal radio, and mini-UAVs. For example, for a 72 h mission, a soldier in Afghanistan in 2012 required 618 Wh of energy and 7 kg of batteries . The abiThe next area of energy consumption is electromobility. Electromobility, in particular EVs, is slowly becoming part of civil transportation. The military, however, has higher requirements on their vehicles , which lFueling military equipment and vehicles with electric energy would decrease the number of fuel types. Electric energy can be produced from different types of primary energy sources, thus decreasing the logistic complexity, which is usually available from an electric grid outside of the disaster area or in the background of the combat area. In a disaster or combat area, the production of electric energy can be secured by classic generators or by renewable sources, as electric energy delivered through the electric grid is usually vulnerable to the effects of the disaster or military operations. A similar approach can be taken with smart cities outside of disaster or war-affected zones. A combination of renewables and an electrical grid can be used, which can also improve the reliability of the energy supply in times of crisis. In the disaster/combat zone, a certain amount of energy should be able to be produced by renewable sources that operate as independent microgrids . It could provide at least some energy for soldiers and civilians, although it would depend on the weather or intensity of combat operations. For a short time, the battery systems or electric vehicles in V2G (vehicle-to-grid), V2H (vehicle-to-home), or V2L (vehicle-to-load) modes could be used as an energy source as well.The infrastructure of smart cities can be considered as dual-use technology (civil and military) and should be able to help in times of disaster, security incidents, warfare activity , or situations when the city is in a combat area. Additionally, the infrastructure could provide better conditions for civilians and for military or security forces in times of crisis by providing independent energy sources and information flow from the area, which can assist in improving surveillance.The article investigated the current state of the EV market and the latest trends. Data show a positive increase in the number of electric vehicles registered in the Czech Republic, as well as in the city of Brno. Approximately 19 times more electric vehicles are registered in the United Kingdom than in the Czech Republic; however, the larger population and territory in the UK must be taken into account. Using electric vehicles effectively meets the population’s transportation needs without adversely affecting air quality. Combined with renewable energy sources, they hold a significant influence when it comes to charging infrastructure and accommodating the demands of EVs. In particular, photovoltaic panels appear promising, and scientific advancements ensure increased efficiency in energy conversion. The possibility of calculating electricity production by PV panels for a given location is outlined. A detailed analysis of the city of Brno regarding the availability of EV chargers was carried out, evaluated, and compared with Glasgow. Moreover, the possibility of air quality monitoring in Brno was described, and selected locations were presented and compared.The military’s perspective on smart cities and electromobility has also been reviewed and discussed. Due to the possibility of silent operation and ease of fuel distribution, EVs are an appealing approach for a military area. Although a smart city can utilize its sensors to improve its military’s knowledge of the situation, there is a risk that an enemy can use this information for their own benefit. As a result, smart cities with sensor systems have potential benefits and drawbacks that must be considered in developing them.


To improve the cognition and understanding capabilities of artificial intelligence (AI) technology, it is a tendency to explore the human brain learning processing and integrate brain mechanisms or knowledge into neural networks for inspiration and assistance. This paper concentrates on the application of AI technology in advanced driving assistance system. In this field, millimeter-wave radar is essential for elaborate environment perception due to its robustness to adverse conditions. However, it is still challenging for radar object classification in the complex traffic environment. In this paper, a knowledge-assisted neural network (KANN) is proposed for radar object classification. Inspired by the human brain cognition mechanism and algorithms based on human expertise, two kinds of prior knowledge are injected into the neural network to guide its training and improve its classification accuracy. Specifically, image knowledge provides spatial information about samples. It is integrated into an attention mechanism in the early stage of the network to help reassign attention precisely. In the late stage, object knowledge is combined with the deep features extracted from the network. It contains discriminant semantic information about samples. An attention-based injection method is proposed to adaptively allocate weights to the knowledge and deep features, generating more comprehensive and discriminative features. Experimental results on measured data demonstrate that KANN is superior to current methods and the performance is improved with knowledge assistance. Thanks to the complex structure and mechanisms of the brain, humans have the capability to continuously learn new knowledge, perceive complex environments, and make precise decisions . With thThis paper mainly focuses on the application of AI technology in advanced driving assistance system (ADAS), which has proved its effectiveness in safe driving and its evolution is in full swing. To elaborately capture the surroundings, multiple sensors are equipped on vehicles, such as cameras, LiDAR and millimeter-wave (MMW) radar. Cameras provide high-resolution optical images that are in line with human visual cognition and are widely applied in object detection  and tracCompared with cameras and LiDAR, MMW radar is more reliable and robust in harsh environments. It is widely used in many practical scenarios, such as remote sensing target detection and classification  and inteTypical feature-based approaches  extract Recent advances in deep learning have promoted the development of automatic object classification. By learning and optimizing details from pure input data, neural networks can accomplish various specific tasks. A convolutional neural network (CNN) has been established to extract valuable features for automotive radar object classification . RecentlIn order to promote the intelligence of radar object classification and achieve more accurate and stable performance, it is a trend to introduce prior knowledge generated from human brains and experience into neural networks for assistance and guidance. Recently, similar ideas and methods have been studied in many fields. Reference  presenteFollowing the idea, a knowledge-assisted neural network (KANN) using RD map sequence for automotive MMW radar object classification is proposed. The primary intention is to inject knowledge into the neural network to supplement the network with physical information and to improve the classification performance. The network imitates the structure of neural mechanisms in human brains, however, it achieves learning tasks through brute force optimization of input data and lacks perception of the practical physical world. While knowledge is generated based on how and what the human brain thinks when accomplishing complex tasks. It conforms to human brain cognition and is an objective and physical description of the objects in the practical world. By fusing the knowledge and high dimensional data fitting, the network will have some physical cognition capability and be more similar to the way the human brain perceives, which will improve the network performance in practical driving assistance applications.Specifically, in the method, the RD map sequence is served as input, which consists of several frames of region-of-interest (RoI) about an object based on CFAR algorithm. To improve the performance of the network, two kinds of prior knowledge of RD maps based on human expertise are extracted and hierarchically integrated into the network for assistance. The first one is image knowledge which describes the explicit spatial information of the RD map. It is obtained from the algorithms consistent with the human brain visual mechanism and applied to the attention mechanism to help the network more accurately concentrate on object regions. The second one is object knowledge which represents the semantic attribute information of objects. It includes the ranges, velocities, azimuths, and RD map extension features, which are important when humans are classifying objects. Additionally, RD maps of the same object may vary with different ranges, velocities, etc. Therefore, object knowledge is injected into the network to assist its training and classification. It is combined with the deep features extracted from the network adaptively through an attention-based injection method to provide more comprehensive and discriminative features. Experimental results on measured data of four kinds of objects demonstrate that KANN can achieve advanced performance and the assistance of knowledge is helpful.The architecture of KANN is shown in MMW radar dominantly transmits continuous chirps and receives the reflected echoes from objects. The workflow of RD map sequence generation is shown in avg_eK) and undulation feature (unduK) which delineate the exact spatial information and distinguish the target and background clutter. Given a pixel sij whose location is  in an RoI, we consider the pixels in the surrounding region with the size of 3 × 3 to calculate the features:Since an object only occupies a small region in the RD map, KAM establishes an attention mechanism that is inspired by the visual attention mechanism of human brains . It genen = 9 and where avg_eK and unduK can represent the spatial information consistent with the visual cognition of the human brain. Concretely, avg_eK describes the average energy of the region and highlights the target regions, while unduK describes the amplitude undulation information.F. Then, a max pooling layer and an average pooling layer are applied to down-sampled F in two aspects to capture spatial information autonomously. The size of the layers is configured to 5 × 1 × 1 to obtain compact spatial information. At this time, image knowledge is introduced to concatenated with the pooling results in channel dimension to generate the weight matrix M:In this module, given an RD map sequence, it is first processed with a convolutional layer whose kernel size is 3 × 3 to obtain the feature map f represents the convolution operation, MaxPool (⋅) and AvgPool (⋅) denote the max pooling and average pooling operation respectively. Next, according to M, the redefined feature map F′ can be obtained:where σ denotes the “relu” activation function, where ⊗ denotes Hadamard product.Compared with most existing attention mechanisms, KAM improves the physical perception ability of the network and can explore more accurate attention distribution by embedding image knowledge which is obtained from human expertise and contains precise spatial information of samples.Pr), and velocity profile (Pv) of the object in each RoI. These five kinds of information not only offer real-world information about the objects, but also have the capability of classification , vs, ev, and Δv denote the similar meanings in velocity dimension.where The structure of KIM is given in Fd and FOBK, are connected in channel dimension and Fc can be acquired. After that, the global pooling operation is utilized to squeeze Fc, and two FC layers are adopted to learn the attention weight vector a containing two elements:Then, object knowledge is combined with deep features. Considering that there is a gap between the two features and the same feature may have different contributions in different classification tasks, inspired by squeeze-and-excitation networks , we adopadeep and aOBK are the weights of the deep features and object knowledge, respectively, δ and σ are “sigmoid” and “relu” activation functions, W2 and W1 are parameter matrices, AvgPool (⋅) denotes the average pooling operation. Subsequently, object knowledge and the deep features are redefined by multiplying with the corresponding weights. Next, Fd and FOBK are added to their redefined results to preserve original information from different sources. Finally, the concatenated features are used for classification:where In this module, by injecting object knowledge, the network trains with sufficient information about samples, which improves its learning capability and classification performance.In this section, to evaluate the performance of KANN, we conduct a variety of experiments based on a measured dataset. The dataset is first introduced in detail. Then, the classification performance of KANN is assessed by comparative experiments. Additionally, we analyze the influence of the knowledge assistance and network structure on the performance of KANN through experiments.The measured dataset is collected by an automotive MMW multiple-input multiple-output (MIMO) radar with 4 Tx and 8 Rx producing a total of 32 virtual antennas. It uses the Frequency Modulated Continuous Waveform (FMCW) which is widely used in automotive radar . The speThe radar sensor is assembled and mounted on the front of the car as shown in After collecting the original radar echoes, we perform the sequence generation method and knowledge extraction algorithms to obtain the RD map sequences and two kinds of knowledge. It should be noted that in the experiments we stack the RoIs of the same object in the RD maps of five continuous frames to construct an RD map sequence, and the RoIs in different RD map sequences are completely different. There are some samples given in Moreover, the implementation details are shown. The experiments are conducted on a server cluster with a 64-bit Linux operating system. In the training phase, the batch size is set to 64, the learning rate is 0.01, and the network is optimized with adaptive moment estimation (Adam) algorithm.In order to evaluate the performance of different methods, the average accuracy (AA) of all classes is applied. This metric takes into account the imbalance of the data and can provide a more objective assessment of performance. It can be calculated by:C is the number of classes, NTP is the number of samples classified correctly in class c, and Nc is the total number of samples in class c.where In this part, we assess the performance of KANN based on the measured dataset. Additionally, six methods that have been studied in this field are served as comparisons. Two of them are feature-based methods that extract the features contained in object knowledge and then utilize SVM  and randThe per-class accuracy and AA of different methods are shown in In order to assess the performance of KANN in practical application, the runtime of different methods is analyzed, and the results are listed in To investigate the advantage of knowledge assistance, we conduct the ablation experiment. The basic network of KANN without knowledge assistance is regarded as the baseline. Then, image knowledge and object knowledge, are separately added to the baseline for assistance. KANN is compared with these three models. Moreover, to assess the structure of KANN, we exchange the positions of KAM and KIM to conduct the experiments. Besides, considering that the spatial information can also be obtained by convolutional operation, in KANN, we remove the image knowledge and apply two convolution kernels with randomly initialized parameters to extract spatial information to compare the effect of artificial image knowledge and the automatically obtained spatial information. The results are listed in It is shown that the baseline performs worst. When one kind of knowledge is added, the accuracy improves. The integration of image knowledge increases AA by 3.63%, and object knowledge makes the network achieve an 8.06% increase in AA. KANN with image knowledge and object knowledge achieves the best performance, whose AA is more than 10% higher than the baseline. Additionally, we can observe that when KIM lies in the front, AA drops by about 3%. As for the comparison of artificial image knowledge and spatial information from convolution operation, it can be seen that the AA of the model with artificial image knowledge is approximately 5% higher than the model with learnable spatial information. It can be inferred that though the network can automatically extract the information, the artificial features can supplement the network with physical and discriminative information which the network lacks.From the results, we can conclude that with the knowledge assistance, the network is inspired to learn sample information no longer solely by optimizing data. It can explore information in a way more like the human brain. Although an attention mechanism is built to help the network focus on the object regions first, it is trained by the network learning mechanism. Image knowledge contains sample spatial information, which is acquired based on human brain wisdom and logic. By introducing image knowledge into the attention mechanism, the network can assign attention not only based on the network learning results, but also according to the visual cognition of the human brain. As a result, the network concentrates more precisely on the object region and achieves more accurate classification performance. As for object knowledge, it provides semantic information about objects in the real world, which is in line with the human brain perception when classifying objects. Adding this information supplements more information for the network and can improve the accuracy. Besides, by contrast, object knowledge plays a more significant role in KANN. It can be inferred that object knowledge offers the semantic information which the network lacks, while image knowledge modifies the attention weight matrix. On the other hand, from the module location experiment, it can be inferred that the network can achieve better performance by focusing on the object regions in the early stage and delicately combining object knowledge and deep features through the attention-based method just before classification.In this part, to evaluate the performance of the attention-based combination method in KIM, different combination methods are applied to the fusion of object knowledge and deep features, and the results are discussed. Two common approaches, including concatenation and element-wise addition are served as the comparison methods. The results are listed in In this paper, we propose a knowledge-assisted network KANN based on RD map sequence for automotive MMW radar object classification. We introduce two kinds of prior knowledge to help the network learn information from samples in a way more similar to the human brain. In this way, the neural network can generate more discriminative features for semantic classification tasks. Specifically, image knowledge helps the network more accurately focus on the object regions. Object knowledge is fused with the deep feature from the network to provide more comprehensive information for classification. To effectively combine the two aspects of information, an attention-based injection method is employed to achieve the adaptive combination. Experiments based on measured data of four classes of objects verify the effectiveness of KANN and demonstrate that knowledge assistance can improve the performance of the network. Our research is continuing, and the data in more complex traffic scenarios, e.g., the crowded situation and strong interference conditions, is still being collected and processed. Since some researches show that introducing knowledge into the network can mitigate the network data size dependence , in futuzhangliang@bit.edu.cn.The datasets presented in this article are not readily available because the dataset is part of ongoing work. Requests to access the datasets should be directed to LZ, YW first proposed the idea that introducing prior knowledge into neural networks for assistance, participated in the construction of KANN, analyzed the effectiveness of KANN, and wrote the original manuscript. CH established the network, carried out the experiments based on the measured dataset, and participated in the writing of the original manuscript. LZ organized a study in the field of automotive MMW radar object classification based on knowledge assistance, proposed the detailed framework of KANN, investigated the feasibility of the method, and reviewed the manuscript and made valuable suggestions. JL constructed the measured dataset, arranged the data collection experiments, and reviewed the manuscript. QA and FY conducted the automotive MMW radar data collection experiments. All authors contributed to the article and approved the submitted version.