Background: Spinal cord injury (SCI) is a devastating problem for modern society, whether it affects young people in the most productive period of their lives or the elderly. The spinal cord injury is currently without curative treatment and the therapeutic intervention aims to minimize secondary complications and maximize residual function through rehabilitation medicine. The main objective of this scientific paper is to determine whether there is evidence in the literature regarding the importance and/or use of hydrotherapy, as part of the therapeutic management of the SCI patient, in order to decrease the degree of spasticity, of pain symptoms, increase or maintain range of motion, improve respiratory, cardiovascular, and metabolic status, as well as improve function and psychological benefits. Methods: Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) procedures, the following databases were analyzed between 2000 and 2021: Pub Med, Pub Med Central, Science Direct, Scopus, and SpringerLink. Initial keywords: rehabilitation treatment, spinal cord injury. Additional keywords: hydrotherapy, aqua therapy, spasticity, human. For the scientific quality of the included articles, risk of bias was assessed using the Downs and Black Appraisal Modified Scale. Results: Our research used only four publications as per PRISMA protocol, assessed with Downs and Black Scale. The study models used in the individual studies included in the research are the following: two systematic reviews, one experimental non-randomized control, and one individual semi-structured interview. Due to the low number of studies, despite two of them being reviews, there is the necessity for a more standardized methodology to prove the benefits hydrotherapy for SCI patients for the improvement of lower limb functioning. Conclusion: Hydrotherapy is an important component of the treatment of an SCI patient, despite the limited number of scientific studies that support this aspect. Clinical trials in the future are required. Spinal cord injury is a serious pathology that can cause various aspects of a patient’s life to significantly deteriorate. The primary goal of rehabilitation is to improve a patient’s functional level and decrease their secondary morbidity. In this paper, we review various secondary long-term complications that can occur after a spinal cord injury (SCI). Some of these include respiratory, cardiovascular, urinary, and intestinal difficulties, as well as spasticity, pain syndromes, pressure ulcers, and fractures .Most of the time, treating patients with spasticity using drugs can lead to side effects. Hydrotherapy can assist in reducing the amount of medication needed as part of rehabilitation treatment .Spasticity is a major issue for SCI patients, also limiting a patient’s mobility and affecting their ability to perform various activities of daily life. Spasticity represents a significant challenge, both for the patient and for the rehabilitation team .Medical hydrotherapy has been prescribed since Hippocrates revealed the curative virtues of water hundreds of years ago .During the 1800s, Sebastian Kneipp, the ‘founder of hydrotherapy’, wrote extensively about the healing effects of water. His research was immediately recognized by healthcare professionals .Hydrotherapy can relieve pain for patients with various conditions . It can Giesecke defined various aquatic exercise goals, including decreased spasticity, improved respiratory status, increased endurance, and psychological benefits. The temperature of the water is critical because excessively hot or cold temperatures may exacerbate spasticity and can also decrease the effectiveness of certain therapeutic techniques . Warm waUnfortunately, aquatic therapy is not routinely available to patients with a spinal cord injury. Many of them are vulnerable to colostomies and frequent involuntary incontinence due to neurogenic bowel dysfunction .According to Recio and Cabahug, aqua-based therapy could be effective for treating spinal cord-injured patients with suprapubic and Foley indwelling catheters, tracheostomy tubes, and pressure ulcers . The patThe primary goal of this study is to determine the importance of hydrotherapy as a part of the therapeutic management of SCI patients on a global scale and whether there is up-to-date literature to confirm our clinical findings.To conduct the research, the following databases: PubMed, PubMed Central, Science Direct, Scopus, and SpringerLink were analyzed between 2000 and 2021, according to the PRISMA procedures recommendations for systematic reviews . Initial(1)Population ;(2)Intervention (hydrotherapy/aqua therapy).Titles and abstracts were read and evaluated for inclusion using the following criteria:Exclusion criteria included publications from previous time periods, publications about hydrotherapy that have as an aim other pathologies than spinal cord injury and publications that do not use English as the publishing language.The scientifical quality of the studies was evaluated through the modified Downs and Black Scale ,18, whicFor possible addition, one author examined titles and abstracts. Another two separately identified the full text of collected articles, with differences addressed by consensus or arbitration from a third author.The study initially started with a search in the databases mentioned above for a shorter period, namely 2015–2021. Given the small number of articles eligible for a review to demonstrate the importance of hydrotherapy in the therapeutic management of patients with spinal cord injury, the search period was extended to 2000–2021, keeping the same databases. Unfortunately, the number of items identified as eligible did not increase significantly.The International Committee of Medical Journal Editors suggested, in 1993, that articles submitted to biomedical journals should follow the same set of guidelines.We chose articles published in 2000 and after because we supported that during that period the International Committee of Medical Journal Editors’ suggestion had been embraced by relevant researchers and had increased the quality of reports .As per p < 0.01 and p < 0.02, respectively).The first study selected was a study published in 2004 by Kesictas N. et al., where researchers evaluated the effectiveness of aquatic therapy on patients with spinal cord injuries. Twenty-four participants were divided into two groups. The first group received standard aquatic exercise twice a day and the other group received oral baclofen. The participants were also assessed for their muscle spasms and the effects of the treatment on their breathing and movement. The researchers also used the Ashworth scales to measure their progress. The hydrotherapeutic intervention successfully reduced spasticity. There was a statistical improvement in Ashworth scores for both study and control groups (p < 0.02). The control group’s spasm severity was 1.4, and the hydrotherapy group’s was 0.7 .The participants in the hydrotherapy group exhibited a significant increase in their Functional Independence Measurement (FIM) scores. They also showed a decrease in oral baclofen consumption. Regarding spasm severity, the hydrotherapy group showed a significant decrease in spasm severity  and forced expiratory flow rate. A similar study conducted on a 3-year program showed that combining swimming and physiotherapy sessions helped improve participants’ cardiorespiratory efficiency [The third paper that met the criteria for selection in our review was a review published in 2018 by Terry J. et al. focused on the effects of aquatic exercise on patients with spinal cord injuries. The study analyzed the effects of different types of aquatic exercise on different aspects of health. It was theorized that the effects of buoyancy and hydrostatic pressure on the patients’ lumbopelvic hip complex and force closure improved their underwater walking. Additionally, the effects of buoyancy on the hip swing were proven to counteract the gravity-based effects of walking. The researchers also noted that the energy expenditure of patients decreased during underwater walking sessions . The 199The fourth study we selected was a 2019 study made by Andresa R et al. that discussed the use of aquatic therapy by rehabilitation professionals for patients with spinal cord injuries. The researchers stated that aquatic therapy is a useful tool for improving the adherence of patients to their treatment. It does not require a standard technique or design .Due to the low number of studies supporting the effectiveness of aquatic therapy for patients with spinal cord injuries, further studies are needed to establish a standard procedure for conducting follow-up studies.In our research, we were able to use only four publications, assessed with Downs and Black Scale as shown in The use of hydrotherapy in the treatment of the SCI patient decreases spasticity, increase underwater functioning of the lower limbs and gait kinematics, increase cardiorespiratory and thermoregulatory status, significant complications that can create a varying degree of disabilities. This therapy has a different mechanism of action on these complications through all the properties that therapeutic water can present: physical, chemical, and mechanical properties ,20,24.As it appears in the data from the specialized literature, spasticity can develop months or years after the acute spine cord injury and lead to severe function loss and hospitalization . AccordiRisk factors for cardiovascular diseases are increased in SCI patients . SCI patThe possible effect of increasing underwater functioning of the lower limbs and gait kinematics is an important element that supports the need for future scientific studies on the role of hydrotherapy in the SCI patient.Design and intervention methods are required for a successful study. They play an essential role in improving the quality of the study and its results.A significant number of clinical case reports were discovered in the context of the research articles included. Although clinical case reports are not considered objective sources of information, they still play a vital role in the development and dissemination of medical knowledge.The importance of clinical trials is often neglected. Although they may seem simple, they are conducted through a rigorous process that is governed by ethical principles.Randomized controlled trials are often used to evaluate the effectiveness of interventions and have been acknowledged as the gold standard because they are considered one of the most powerful types of evidence for use in the development of evidence-based clinical therapeutical programs . HoweverIt is essential to find solutions for implementing randomized controlled trials in medical rehabilitation units, to support the use and effectiveness of balneal factors in the treatment of various orthopedic and neurologic diseases , and manThe fact that when the PRISMA algorithm was applied the number of articles that could be included in the study in the current review was minimal compared to the vast number of patients with neurological pathology studied is of importance in medical rehabilitation as well as a treatment methodology, and arguments were sought for this aspect. One of the hypotheses is that there is an actual development of other treatments, such as robotic, computerized, or immersion in virtual reality.The exoskeleton systems represent a new therapeutic approach in the rehabilitation program of these patients and can be successfully used for gait re-education, proposing kinetic models of the exoskeleton with permanent control over the angle, and angular velocity at the level of each joint, as well as over the parameter muscles (muscle parameters), offering the patient continuous passive movement ,35. ThisAnother therapeutic class used in the treatment of spasticity in patients with spinal cord injury in current medical rehabilitation is botulinum toxin. There are standardized schemes that can also be customized for the individual patient’s treatment situation and the patient’s target muscles, and the treatment is more effective in the first 6 months ,37,38.The strength of the study is as follows: The number of patients with neurological pathology in the field of spinal cord injury is very high, and the disability resulting from this pathology has a significant impact on the quality of life of both the patient and his family. For this reason, it is necessary to investigate all the therapeutic possibilities used to increase independence and maintain the existing functional remainder. Hydrokinetotherapy is part of the therapeutic rehabilitation management of these pathologies, with a therapeutic impact on several systems, as discussed in the The limitations of the study are as follows: The small number of studies in specialized literature regarding the impact of hydrokinetotherapy on patients with spinal cord injury makes it impossible to carry out a meta-analysis on this subject and very difficult to carry out a review that respects all the stages imposed by the PRISMA algorithm. The fact that the review was not pre-registered in an international prospective register of systematic reviews, such as PROSPERO, and a funnel plot was not made are also a limitation of this review. In addition to the limited number of existing scientific studies, there are other drawbacks, such as heterogeneous methodologies, disparate study populations, and different training programs, which must be overcome in future studies.Due to the low quality of the controlled studies and the lack of sufficient follow-up randomized controlled trials, there is not enough evidence supporting the importance of hydrotherapy for the functional rehabilitation of patients with spinal cord injury. Hydrotherapy’s physiologic effects in orthopedic recovery and neurological disease must be investigated further. Financial support for such studies and the required clinical trials are still an issue. Despite its significant therapeutic benefits, aquatic exercise and balneal rehabilitation are underutilized.Rehabilitation techniques must represent the main purpose of multiple and important qualitative scientific studies because medical rehabilitation represents a key role in spinal disorders such as SCI.


Community engagement and involvement have been increasingly recognized as an ethical and valuable component of health science research over the past two decades. Progress has been accompanied by emerging standards that emphasize participation, two-way communication, inclusion, empowerment, and ownership. Although these are important and noble benchmarks, they can represent a challenge for research conducted in marginalized contexts. This community case study reports on the methods, outcomes, constraints and learning from an NGO-led community engagement project called Bucket Loads of Health, implemented in the Western Cape province of South Africa. The independent project team used multiple participatory visual methods to foster two-way communication between members of two disenfranchised communities, Enkanini and Delft, and a group of water microbiologists at Stellenbosch University who were conducting research in Enkanini. The project was carried out during the 2018 Western Cape water crisis, under the growing threat of “Day Zero”. The resulting visual outputs illustrated the negative impacts of water shortage on health and wellbeing in these community settings and showcased scientific endeavors seeking to address them. Engagement included knowledge exchange combining body maps, role play performances and films created by the community members, with hand maps, posters and presentations produced by the scientists. Whereas these engagement tools enabled reciprocal listening between all groups, their ability to respond to the issues raised was hindered by constraints in resources and capacity beyond their control. An additional core objective of the project was to bring the impacts of water shortage in participating communities, and the work of the research team, to the attention of local government. The case study demonstrates the challenges that politically ambitious community engagement faces in being acknowledged by government representatives. We further the argument that research institutions and funders need to match professed commitments to engagement with training and resources to support researchers and community members in responding to the needs and aspirations surfaced through engagement processes. We introduce the concept of engagement integrity to capture the gap between recommended standards of community engagement and what is realistically achievable in projects that are constrained by funding, time, and political interest. Fieldwork for health-related scientific exploration is largely done in settings where the health challenge under investigation has a direct impact. The intention is to improve the health and wellbeing of people experiencing that impact, plus others who reside in similar settings and face the same challenges. Historically, health science research has been designed and implemented by scientists, with minimal engagement or involvement of those who live in the communities where their fieldwork is conducted, other than enrolling them as research participants. Over the past two decades, community engagement and involvement (CEI) has been increasingly recognized as an ethical and valuable component of health research , 2. ReseUNICEF and others have proposed that core standards of engagement should include community participation, empowerment and ownership, inclusion, two-way communication, adaptability and localization, and should also build on local capacity , 4. ThesGood two-way communication requires those who are involved to participate in a process of listening and responding that is open, balanced and reciprocal . This suParticipatory visual methods (PVM) provide ways to generate materials that foster good two-way communication and can strengthen co-learning in research engagement initiatives . In a PVThis community case study reports on the methods, outcomes, constraints and learning from a project called Bucket Loads of Health (BLH) which aimed to promote community engagement in water microbiology research in the Western Cape province of South Africa. BLH was implemented in 2018 while the province was experiencing its worst drought in over 100 years, raising the prospect of a “Day Zero” when piped water supplies would be shut off . ExtremeThe BLH project was conceptualized and led by a representative of the Sustainable Livelihoods Foundation (SLF)in-situ solar pasteurization and solar disinfection of rainwater harvested from the roofs of shacks in informal settlements  implemented extreme water-saving measures including a ration of 50 L per person per days, enforced in some cases by automatic shutoffs at the level of household water meters; reduced flow to entire neighborhoods; and increased tariffs for higher usage. This made a minimal difference in informal settlements, where the need to carry water from communal standpipes had in many cases already limited residents to around 50 L per days .In Enkanini, a community leader who lived in the settlement and had previously worked as a community-based researcher for the WRL was chosen by the microbiology team to mobilize the group of Enkanini participants for the BLH project. In Delft, participant mobilization was done by a community leader who lived in the township and had taken part as a research participant in earlier research projects run by SLF. These community leaders were both given an outline of the goals, methods and timeline of the BLH project and asked to identify up to 15 males and females in their respective communities who were over the age of 18, available and interested to take part according to the project outline provided.The Enkanini focus group comprised 12 residents, all first-language isiXhosa speakers originally from the Eastern Cape. There were 8 women ranging in age from 18 to 44 and 4 men ranging in age from 23 to 35. The length of time spent living in Enkanini differed among the participants. However, they had all lived in the settlement for over 12 months, having moved there from other informal settlement contexts. The maximum level of formal education among the group was matriculation from high school. None of the Enkanini participants were in sustained employment at the time of the project; their incomes came from government grants and occasional piece work, for example as domestic workers or unskilled laborers. Three participants had previously worked as co-researchers on Stellenbosch University projects conducted in their community, and two had worked with the microbiology team to facilitate stakeholder engagement.The Delft focus group comprised 15 residents of the township, including three isiXhosa participants originally from the Eastern Cape and 12 participants whose first language was Afrikaans. There were 10 women ranging in age from 23 to 64 and 5 men ranging in age from 27 to 58. Amongst the participant group, the length of time spent living in Delft ranged from 10 to 20 years. As with the Enkanini participants, the maximum level of formal education among the Delft group was matriculation from high school. Some members of the group had part time employment through schools, non-governmental or community-based organizations, though the majority were unemployed and depended on government grants for income. Two members of the group had an existing relationship with SLF through involvement in previous research projects.The research partners included the group leader, Professor Wesaal Khan, and four members of her research laboratory, including one post-doctoral fellow, two PhD students and a Masters student.The participants in both community settings, and the microbiology team, committed to the project throughout its one-year duration. The Delft and Enkanini groups functioned independently and did not meet.The key programmatic elements of the BLH project incorporated three main phases: workshops, knowledge exchange days and public exhibition events. The key content of these phases is outlined below. Workshop and meeting agendas were flexible and provided opportunities for reflection and adjustment, with the intention that participants should have substantial control of the project outcomes. The engagement team was conscious of several barriers to effective two-way communication, including differences in race, multiple first languages, and vast differentials in income, formal education, expertise, experience in public speaking, and power. All activities and events were designed with these differences in mind and were facilitated by the engagement team. In Delft, the existing relationships between SLF and community organizations also helped to mitigate these barriers.Separate workshops were held with the focus groups from the two participating communities and the microbiology team.In both Enkanini and Delft, the engagement process began with a one-day inception workshop. This allowed for introductions, a more-in-depth explanation of the goals, methods, and timeline of the project by the engagement team and an opportunity for attendees to ask questions. The inception workshops included a session to review the hopes, fears, and expectations of the potential participants with the intention of managing expectations around the possibilities and limitations of the BLH project. Expectations of project outcomes were revisited and discussed throughout the different phases and activities of the engagement process. Those who wished to participate in the project were asked to give their written consent. Most of the community members who attended the inception workshops in both settings consented to participate in the entire project.In Enkanini, participants expressed their interest in BLH as wanting to know more about the water research that they could see taking place in their settlement and to understand any direct benefits for the wider community from this research. In Delft, participants said that they were interested to take part in the project because they wanted to be informed about research that was being done to address a household problem that was severely affecting them and their community. In both settings the focus group members expressed enthusiasm for sharing their lived experience of water shortage with researchers and other stakeholders as they had not previously been given an opportunity to do this.Due to poor standards of education and limited employment opportunities for those living in marginalized settings, it was expected that participants from Enkanini and Delft might face difficulty with reading and writing. Differences in first language between the community participants, the microbiologists and the engagement team also brought about a barrier to effective engagement. As reported elsewhere,  visual fEarly in each workshop, the whole group worked together to create a color-coded water typology, describing the forms in which they encountered water in their daily lives. This included clean tap water, stormwater, sewerage, wastewater from washing, rivers, and streams, puddles and industrial runoff. Small groups then created hand-drawn community maps, highlighting places of importance to them and places where they encountered water in its various forms. This exercise surfaced stories and experiences that were later incorporated into body maps.Body mapping was first described as a research method in a comparison of women's identity and the concept of the reproductive system in rural Jamaica and the UK . In 2002In the BLH body mapping process participants were asked to create life-size images reflecting their individual embodied experiences of water shortage . The bodMusic-making activities were woven throughout the five-day creative process. This included listening to water sounds and discussing responses, rhythm play with formal and improvised percussion instruments, singing and song-making. The music facilitator recorded all these activities and used the recordings to build new compositions, which were later used as soundtracks for the videos emerging from the workshops.Both creative workshops also included a role-playing component, in which small groups developed short dramas about issues that had emerged regarding research and researchers. In Enkanini, these dramas focussed on community experiences of working with researchers in the settlement.The video-making phase of the creative workshops took different forms with the two focus groups. In Enkanini, filmed body map presentations evolved into a collaborative film, Our Water Challenges, about the problems of dirty water and waste, and the need for collective action.In Delft, the filmed body map presentations became the basis of four short videos grouped around themes identified by the engagement team that reflected the diverse impacts of the water crisis: Children, Water and Recreation; Community Spirit; Health, Stress and Sanitation; and Water and LossThree planning workshops were held with each of the focus groups, during which they rehearsed the presentation of their visual materials and helped to design the engagement and exhibition events.The engagement team led a one-day workshop at the SLF campus to help the microbiologists prepare for the knowledge exchange days and to develop research presentations that would be accessible to the community focus groups. The research team also created hand maps  as visuaTwo knowledge exchange days were held in Stellenbosch, one with each community focus group.via their hand maps and delivered presentations covering the basics of water science and their own research. They also took each focus group on a guided tour of their research department and laboratory . Through the CEI project the microbiologists also recognized that alternative water sources may not be a high priority for Enkanini community members, whereas greywater treatment strategies were urgently required.The project enabled the microbiology team to see the significance of their research in a new light and to acknowledge the value and ethical obligation of in-depth community engagement. After the conclusion of the project, the microbiology team leader decided to withdraw WRL activities from Enkanini. This was an unforeseen response and an unintended consequence of the engagement process. The research team did not retreat because they were dissatisfied with the BLH project. They did so because BLH had revealed to them that residents of the informal settlement were aggrieved about the lack of community benefits arising from research in Enkanini  to the exhibition event in Delft. The department did send a junior officer who arrived after the community members had presented their body maps. The officer delivered a promotion of the municipal water-saving campaign which was inappropriate following the emotional presentations given by the focus group. Although taken to task by members of the audience, the government representative did not have the power to escalate the group's complaints about the challenges of enforced water restrictions to decision-makers in his department. The project was purposively carried out during the 2018 Western Cape water crisis and at that time, the CoCT DWS was under extreme pressure to respond to unprecedented drought conditions. It is likely that senior representatives of this department were therefore unavailable to attend events that did not directly address the crisis situation. Whereas, SLF did not have an established link with the DWS, the Foundation was connected with several other CoCT departments. Although it may have been possible to better draw upon these existing connections to link to senior officials in the DWS and organize meetings beyond the exhibition event  the circIt has previously been shown that using participatory visual methods to explore connections with water and water governance can surface emotional responses , 34. TheThe project also confronted the research team members with their incapacity to make a difference in immediate and tangible ways. In most instances, research groups do not have the scope, training, or funding to be responsive to local populations' needs, conditions, and concerns, especially when these are largely structural in nature. This powerlessness can leave researchers feeling conflicted, ethically concerned, and unable to do what they feel is right  and may The BLH project has shown how the participatory creation of personal and collective visual materials, by both researchers and community members, can foster effective CEI and increase engagement integrity. Materials such as community maps, body maps, hand maps and tailored scientific presentations provided effective platforms for reciprocal listening and co-learning. Roleplay performance by community members helped to surface important points of tension and stimulate valuable and needed conversations. Visits to the Water Resource Laboratory were appreciated and enjoyed by the Enkanini and Delft participant groups, and further strengthened interaction and learning. The entire engagement process catalyzed verbal and active responses by the researchers and focus group members. However, further outcomes desired by participants were constrained for multiple reasons, including the limited timeframe and resources of the project and factors that were beyond the control of the community participants, the microbiologists and the engagement team. Policy engagement was almost entirely obstructed by a lack of acknowledgment from local government.The project has shown that building engagement integrity through participatory visual methods requires a substantial initial investment of time and preparation, especially when engaging with marginalized communities. This can detract from the time available for knowledge exchange and public engagement. The case study also highlights the need for CEI to be reflexive and open to going in unforeseen directions.The core standards recommended for CEI by global organizations , 4 carryThe raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.Ethical review and approval was not required for the study on human participants in accordance with the Local Legislation and Institutional Requirements. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article.The community case study was conceived and led by GB and PS contributed to the study design and facilitated the participatory workshops and engagement events. GB wrote the first draft of the manuscript. PS wrote sections of the manuscript. Both authors contributed to manuscript revisions, read, and approved the submitted version.This community case study was supported by the Wellcome Public Engagement Fund (Grant No. 209586_Z_17_Z).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.


Herd immunity is largely affected by the frequency of vaccination and the type of vaccine. Currently, the low vaccine protection rate is mostly attributed to a) there is no vaccine for children under 6 months, and exemption of partial population with neurologic disorder and anaphylactic disease and immunocompromised patients from receiving the vaccine, and b) the emergence of variant strains across the world has greatly reduced the protection of the vaccine. In addition, a significant factor may be neglected: the influence of immunosuppressive parasite infection.According to the current epidemic trend, herd immunity can be achieved As of August 2022. 343.0624 million COVID-19 vaccines have been vaccinated across China (Toxoplasma gondii (T. gondii), where oocysts, the infective stage, can be discharged, causing environmental contamination and widespread infection. According to statistics, the seroprevalence of T. gondii varies from less than 10-60% in the world’s nations  and Guangdong Provincial Forestry Department's Provincial Financial Special Fund for Ecological Forestry Construction-Wildlife Conservation.We sincerely thank the support of Yasser Mahmmod for his overview and precious suggestion on the article.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.


Any developed port plays a dominant role both in domestic and international trade reflecting economic prosperity of the port and nearby regions in terms of its cargo throughput and port construction. An attempt is made in this study to use long-and short-term memory (LSTM) artificial neural network method to construct the port cargo throughput prediction model. Three ports namely, Tianjin Port, Dalian Port, and Tangshan Port from China's Bohai Rim region are selected as research objects. The historical cargo throughput of each port for nearly ten years was used as the input index data for joint prediction. The cargo throughput of Bohai Port provides another way to improve the accuracy of port cargo throughput prediction. The prediction results show that the LSTM model can effectively predict the port cargo throughput; the cargo throughput forecasts between the three Bohai Rim ports have both an interactive relationship and differences. The port is a vital transit point for domestic and foreign trade. A well planned port logistics shortens the transportation time and distance of various trades, boosts trade exchanges, and plays an important role in improving national economy. Developed countries in the world generally have their own coastlines and well-functioning ports, and the large ports become gateways for foreign trade. On the 5,800-kilometer coastline of China's Bohai Sea, there are more than 60 large and small ports competing among themselves namely, competition between different port groups; competition between different ports of the same port group; competition between different enterprises in the same port. How a port is in a dominant position in the process of port integration is particularly important for accurate port planning and construction. The port construction involves a wide range of issues, which are related to the construction of railways, highways, pipeline layouts, and agricultural and industrial production development of a city or region. The construction of the port requires a long gestation period and huge infrastructure investment. The problem of underconstruction or overconstruction results either in congestion and delay or waste of space, time, and decline in expected income, respectively.Port cargo throughput is an important indicator of the port's operational capacity . There aIn the past, the forecasting of port cargo throughput was usually based on the target port's throughput indicator, the target port hinterland economic indicator, and the neighboring port's throughput indicator as input indicators to predict a target port. This study believes that port cargo throughput may be affected by the fluctuation of cargo throughput in the adjacent port, in addition to the operations of its own port and the economic development of the port hinterland. To this end, the present study selected three ports around the Bohai Sea namely, Tianjin Port, Dalian Port, and Tangshan Port as the research objects, and established a cooperative prediction model of port cargo throughput based on the LSTM deep learning method. Firstly, by considering the correlation of cargo throughput between ports in the same region, 12 forecasting schemes were designed to predict port cargo throughput. Secondly, most of the raw data was used to train the LSTM model to get the best parameters. In addition, a small portion of the raw data is entered into the optimal LSTM model to obtain predictions and errors. Finally, the analysis of experimental results was used to verify the interactions between the three ports.Port economy and development-related issues have been a popular topic of research among scholars, most of whom only focus on the ports themselves, while demand forecasting and related research on port-related indicators are less. In this paper, the research on the current situation and the degree of future synergistic development of port clusters is innovative in terms of application practice. In this paper, LSTM is used as an experimental model to treat the Bohai Sea port cluster as a whole system for prediction experiments. The main contributions and innovations are as follows: (1) This paper applies the LSTM model to port-related research by constructing an LSTM model to predict the nonlinear time-series data of port-related characteristic indicators. (2) By dividing the ports into subgroups by administrative divisions, the paper provides new ideas for the prediction of port cargo throughput by cross-predicting the historical data of different ports. (3) The LSTM model prediction results are compared with those of other models, and it is determined that the LSTM model is applicable to port research.Demand forecasting is already a mature research topic in many areas such as port throughput, air passengers, energy consumption, and air quality. Several prediction methods and models have been proposed in literature which can be divided into three categories, namely econometric models, artificial intelligence models, and hybrid models.Econometrics models are applied to time series analysis by extracting meaningful data features and statistics to observe future values based on past observations. When predicting univariate time series data, simple methods such as naive model and exponential smoothing model can be used to represent the random process of time series. The naive model uses the latest value as a prediction for the next period, while the exponential smoothing model uses a recursive calculation method that updates each new input observation as it is predicted. Merkuryeva et al.  used SMAThe artificial intelligence model is a kind of intelligent activity that recognizes, classifies, memorizes, associates, predicts, etc., through computer simulation of human thinking process. It has self-learning, self-organization, and self-adaptive ability, and can fit arbitrary functions, especially nonlinear functions. In general, econometric models and time series are influenced by the stability of historical data and economic structures, while artificial intelligence focuses on the size and quality of training data. Artificial neural network (ANN), minimum models such as two-square support vector regression (LSSVR), and support vector machine (SVM) provide a more effective solution for nonlinear prediction problems. Takashi Tanizaki et al.  proposedRecurrent neural network (RNN) is a deep network structure that utilizes sequence information . RNN selectively processes data elements by passing information across time steps, a feature that is important for requirement forecasting. Embedded structures in time series data convey useful contextual information in requirement forecasting. Matyjaszek et al.  studied LSTM is an extension of RNN. As an effective and scalable model, LSTM has been widely used in speech recognition, handwriting recognition, image analysis , documenAt present, the deep learning algorithm is less applied in port cargo throughput forecasting. The port throughput is affected by many factors, showing nonlinearity and large volatility, which is closely related to the world economy and the surrounding port competition environment. Using the LSTM algorithm to predict the monthly cargo throughput of the Bohai Rim port can improve the accuracy of predicting port cargo throughput.2 concentration, and the effectiveness of the method was verified by actual data.Collaborative prediction is a common method used to improve prediction accuracy. Cheikhrouhou et al.  proposedThe predecessors have two main aspects of port research, one is the study of the relationship between economic activities and port operations; on the other hand, the demand forecast of port cargo throughput. Kim et al.  considerCargo throughput is one of the important factors affecting the economic development of the port. Accurate forecasting of cargo throughput not only improves the efficiency of port operations but also provides a reference for planning port development. Based on the analysis of the location advantage of Ningbo–Zhoushan Port, Li Zengwei and Ye Jun used the three-exponential smoothing method to analyze the port cargo throughput in the next five years. Patil GR and Sahu P K used multiple regression models and time series models to predict shipments from Mumbai, India, between 2014-15 and 2017-18, with the former being more accurate than the latter. Seabrooke et al. used regression analysis to predict the growth and development of freight in Hong Kong ports. C Zhang and L Huang used the combined model of grey forecasting model and logistics growth curve model for port cargo throughput forecasting and applied the model to an actual port in China, verifying the validity of the joint model, and the model has no geographical restrictions on external conditions such as culture. Mo et al.  construcIn the past, the forecasting of port cargo throughput was usually based on the throughput index of the target port and the economic indicators of the target port hinterland as input indicators to predict the throughput of the target port. At present, there are few studies on collaborative prediction between multiple ports. This study believes that port cargo throughput may be affected by the fluctuation of cargo throughput in the adjacent ports, in addition to the operations of its own port and the economic development of the port hinterland.The long short-term memory (LSTM) is a special recurrent neural network first proposed by Sepp Hochreiter and Jurgen Schmidhuber in 1997. Compared with the traditional cyclic neural network RNN, it is also based on time series data, through the cyclical connection between neurons, to find the relationship between time series data and modeling time series data. Different from RNN, LSTM solves the problem which the gradient of RNN often faces in the actual application process. The LSTM neural network model is similar to RNN with a hidden layer, but the nodes in each common hidden layer are replaced by storage units. Its core idea is a special neuron structure - “memory unit,” which can maintain its state over time. The nonlinear gating unit can adjust the flow of information into and out of the unit, as shown in t, the input, output, and state of a memory unit module are xt, ht, and Ct, Then, the input gate, the forgetting gate, the input conversion, the unit state update, and the hidden layer output formula of the memory unit module are respectively shown in equations it=xt and ht−1, input transformation generates new information xt and ht−1, and outputs values from 0 to 1 through the sigmoid function ; multiply this by the amount of information xt and ht−1, outputs the values from 0 to 1 through sigmoid function , and multiplicate them with the state of the moment on the memory unit to determine the retention and abandonment of the original information in the memory unit. The new information is then added to the retained original information to update the state of the current memory unit to Ct−1. Finally, the output gate reads the values of xt and ht−1, operates through the sigmoid function, and multiplicates the memory unit state 7 processed by the tanh function to determine the output information of the memory unit state.According to The LSTM neuron adds a unit state to the traditional cyclic neurons to preserve long-term information. Therefore, the LSTM network has the same structure as the traditional cyclic neural network and consists of an input layer, a hidden layer, and an output layer. In the hidden layer structure, the connection from the hidden layer at the previous moment to the hidden layer at the next moment is added, and the unfolded structure of the single-layer LSTM network according to time is shown in For the coordinated forecast of the cargo throughput of the three ports around the port of Tianjin Port, Dalian Port, and Tangshan Port, the experiment was completed in five steps. The experimental design and the best LSTM model are shown in In the first step, the forecasting experiments are divided into three types: target port forecasting, two-dimensional port cooperative forecasting, and three-dimensional port cooperative forecasting. There are 12 forecasting schemes. The target port forecasting scheme separately uses the historical monthly cargo throughput data of the target port as the input variable of the forecasting model and uses the next month's cargo throughput of the target port as the output variable, and then applies the LSTM model for prediction. The two-dimensional port collaborative prediction scheme uses the historical monthly port cargo throughput of the target port and the other two ports (input port 1 and input port 2) as the input variables of the prediction model, and takes the cargo throughput of the target port for the next month as the variables are output, and then the LSTM model is applied for prediction. The three-dimensional port collaborative prediction scheme takes the historical monthly port cargo throughput of the three ports as the input variable of the forecasting model and uses the next month's cargo throughput of the target port as the output variable, and then applies the LSTM model for prediction.In the second step, the three ports historical monthly cargo throughput data are collected and sorted as the original dataset, and the original dataset is divided into the training dataset and the test dataset in the ratio of 7.5 : 2.5.In the third step, the training dataset is used to train the LSTM prediction model, and the experimental parameters are repeatedly modified to optimize the prediction accuracy of the LSTM model.In the fourth step, the test training set is used as the input index, and the prediction results and errors of the 12 prediction schemes are obtained by the LSTM prediction model.In the fifth step, the predicted values and errors of each prediction scheme are compared and analyzed.The prediction model proposed in this study was designed using MATLAB 2017a and Linux system environment using Python 2.7 programming. The LSTM model parameters are Epoch = 5000, Hidden_layer = 100, LR = 0.002, step = 2.xg is the actual value and xp is the corresponding predicted value.To accurately assess the effectiveness of the experimental model, three evaluation metrics, mean absolute percentage error (MAPE), root mean squared error (RMSE), and mean absolute error (MAE), are used in this paper to quantitatively evaluate the prediction performance of the proposed model. The smaller the value, the higher the accuracy of the model, and the better the prediction performance. Among them, MAPE is used as the main evaluation index. The formulas for these three evaluation criteria are shown below:The research object of this paper is the three ports around the Bohai Sea. The Bohai Rim region refers to the Bohai Rim Economic Region with the Beijing-Tianjin-Hebei as the core, and the Liaodong Peninsula and the Shandong Peninsula as the two wings. It is located in the northern part of China along the west coast of the Pacific Ocean, including Beijing, Tianjin, Tangshan, Qinhuangdao, Dalian, Yantai, Weihai, Qingdao, Dongying, Baoding, Shijiazhuang, Jinan, Shenyang, and many other cities. The Bohai Sea Port Group is one of China's five major port groups and plays an important role in China's open coastal development strategy.Based on the geographical location characteristics of the ports around the Bohai Sea and the cargo throughput of each port, the three ports of Tianjin Port, Dalian Port, and Tangshan Port were selected as research objects. The geographical location of each port is shown in Tianjin Port is located at the mouth of the Haihe River in Tianjin, China, as an important area of the Bohai Economic Circle. Dalian Port is located in the Dalian Bay at the southern end of the Liaodong Peninsula. It is at the center of the Northeast Asian economic circle and is one of the most important comprehensive foreign trade ports in the Northeast. Tangshan Port is located at the north bank of the Bohai Bay in Tangshan City, Hebei Province. It is located in the center of the Bohai Sea and the Beijing-Tianjin Double Economic Circle, including the Jingtang Port Area and the Caofeidian Port Area. It is an important component of China's energy, raw materials, and other specialized materials transportation systems. The data used in this study is the monthly cargo throughput of the above three ports from March 2009 to January 2019, obtained from the live data released by the China Port Network. The raw data of the cargo throughput of each port is shown in It can be seen from The cargo throughput forecast of Tianjin Port is based on the design steps of the experimental method. The LSTM model is used to test the four prediction schemes of Tianjin Port, Tianjin Port + Dalian Port, Tianjin Port + Tangshan Port, and Tianjin Port + Dalian Port + Tangshan Port. MAPE was selected as its error evaluation index. The forecast results of Tianjin Port's cargo throughput are shown in The cargo throughput forecast of Tianjin Port is based on the design steps of the experimental method. The LSTM model is used to test the four prediction schemes of Dalian Port, Dalian Port + Tianjin Port, Dalian Port + Tangshan Port, and Dalian Port + Tianjin Port + Tangshan Port. MAPE was selected as error evaluation index. The cargo throughput forecast results of Dalian Port are shown in The cargo throughput forecast of Tianjin Port is based on the design steps of the experimental method. The LSTM model is used to test the four prediction schemes of Tangshan Port, Tangshan Port + Tianjin Port, Tangshan Port + Dalian Port, and Tangshan Port + Tianjin Port + Dalian Port. MAPE was selected as the error evaluation index. The cargo throughput forecast results of Tangshan Port are shown in Before entering the discussion section, in order to more fully evaluate the prediction performance of the LSTM model, which has reached the final model to achieve optimality, this paper compares the LSTM model with other models, including ARIMA, GBRT, and some popular deep learning models. To make the comparison results more obvious and concise, the prediction results of the best of the three ports are used to compare with other models. And MAPE is used as the comparison metric. With all other conditions held constant, the final results are shown in From the comparison results, we can see that the prediction accuracy of the LSTM model is significantly better than other models. It may be because the LSTM model method is more advanced. It is a novel method in the field of artificial intelligence, with the ability to learn longer time series, which can mine effective feature representations from a large amount of input data. The interference of features such as volatility and noisiness of air pollutant data is avoided, and the prediction stability is improved.The historical cargo throughput of Tianjin Port, Dalian Port, and Tangshan Port has a certain periodicity, showing an overall upward trend, but the respective trends are obviously different. This is because although the three ports are in the Bohai Rim region, the economic hinterland of each port has both overlapping areas and areas covered by them. The economic hinterland of Tianjin Port and Tangshan Port is dominated by Beijing, Tianjin, North China,and Northwest China. Among them, the direct economic hinterland includes Tianjin, Beijing, Hebei, and Shanxi provinces, and the indirect economic hinterland extends to the provinces of Shaanxi, Gansu, Ningxia, Qinghai, Xinjiang, Inner Mongolia, Sichuan, Tibet, and Mongolia through the integrated transportation network area. The economic hinterland of Dalian Port is mainly Shandong Province, the three northeastern provinces, and Inner Mongolia. The differences in the coverage areas of the three ports and the different economic strengths of their respective hinterlands have affected the port's cargo throughput and its changing trend to some extent.In the analysis of the results of the combined forecasting scheme, it is found that the cargo throughput of Tangshan Port has a strong predictive ability for the cargo throughput of Tianjin Port and Dalian Port. In the forecast of cargo throughput of Tianjin Port, the predicted result of the Tianjin Port + Dalian Port + Tangshan Port combination plan is 10.08%. On the other hand, forecasting of cargo throughput of Dalian Port, the predicted result of the Dalian Port + Tangshan Port combination plan is 11.45%. Whereas, forecasting cargo throughput of Tangshan Port, the predicted result of the Tangshan Port + Tianjin Port + Dalian Port combination scheme is 12.31%. Tangshan Port is the youngest port in China, and its location is between Tianjin Port and Dalian Port. In 2018, Tangshan Port ranked fourth in the global ports with a cargo throughput of 630 million tons, an increase of 11.14%, ranking first in the world's top ten ports. The sharp increase in cargo throughput of Tangshan Port had a non-negligible impact on the cargo throughput of Tianjin Port and Dalian Port.There are mutual influences and differences between the ports. The forecasting accuracy of Tianjin Port + Tangshan Port forecasting scheme is better than Tianjin Port + Dalian Port forecasting scheme, which indicates that Tangshan Port has a greater impact on the forecast of Tianjin Port cargo throughput; Dalian Port + Tangshan Port forecasting scheme has better prediction accuracy than Dalian Port + Tianjin port forecasting scheme showing that Tangshan Port has a greater impact on the forecast of Dalian Port cargo throughput; the forecast accuracy of Tangshan Port + Tianjin Port Forecasting Plan is better than that of Tangshan Port + Dalian Port Forecasting Plan, which indicates that Tianjin Port forecast of cargo throughput of Tangshan Port is even greater. This is because the distance between Tangshan Port and Tianjin Port is shorter than that between Tangshan Port and Dalian Port, and most of the economic hinterland covered by Tianjin Port and Tangshan Port is repeated; hence, the cargo handling demand is similar. Moreover, the Tianjin Port Group and the Tangshan Port Group have synergistic cooperation and the integration of soft and hard resources for container transportation. Therefore, the mutual influence between Tangshan Port and Dalian Port is deeper.The forecast of port cargo throughput is not only affected by historical data but also by the cargo throughput of nearby ports. Therefore, it is necessary to use historical data and data from nearby ports as input indicators. In order to obtain reliable prediction results, this study used a multilayer LSTM model, and after repeated experiments, the final prediction results were obtained. The results show that the LSTM model can solve effectively both the nonlinear and volatility problems, and has good predictive ability for port cargo throughput. It can provide reference for practical work, improve the overall efficiency of the target port, and reduce operating costs.LSTM artificial neural method was used as port cargo throughput collaborative predive model for the three Bohai Rim ports. Twelve prediction schemes are designed to predict cargo throughput of Tianjin Port, Dalian Port, and Tangshan Port as the research objects. The research conclusions are as follows:The MAPE of all the three port cargo throughput forecasts are below 18%, and the average MAPE of all the combined schemes is 11.76%, indicating that the LSTM model is suitable for port cargo throughput forecasting. The LSTM prediction model can accurately predict the port cargo throughput and can effectively solve the nonlinear time series prediction problem as compared to the general linear prediction model. Since the experimental data in this paper is based on three Bohai Sea ports data, the data obtained is however limited. If the data can be collected more comprehensively as a training sample, the predicted value of the model may be better. Therefore, the LSTM prediction model has strong applicability and high application value in predicting port cargo throughput.The forecasting analysis revealed that all the three ports exert mutual influence on each other despite of any differences. The combined forecasting model significantly improved the forecasting accuracy of port cargo throughput, and the stability also has improved substantially. It is also noticed that the combined forecasting scheme predicts the trend of port cargo throughput more accurately than the traditional single forecasting scheme. Therefore, it is believed that multiple port collaborative predictions can make the forecast results of port cargo throughput better and more accurate. In the subsequent port throughput forecasting problem, historical data of ports with strong influence on the target port can be used as input indicators for joint predictions.The current work on forecasting cargo throughput of ports in the Bohai Rim region of China based on the LSTM model needs to be further extended. First, it is necessary to further understand the influencing factors among ports in the Bohai Rim region. Secondly, there is still room for improvement of the LSTM model in terms of predicting port throughput in terms of improving the prediction accuracy, such as the use of attention mechanism and other methods can be considered in the future.


The inerter is a two-terminal component that can be added to the spring-and-damper configuration of a suspension system. It has the property that the force exerted is proportional to the relative acceleration at its terminals. Studies have demonstrated the inerter’s benefit of providing superior vibration isolation when it is used in the vehicle suspension of passenger cars. However, similar benefit on another common vehicle class on the roads, namely heavy vehicles, remain to be shown, as these vehicles have vastly different parameter values than passenger cars. This study is an investigation on the performance improvement brought by an inerter in the suspension of common heavy vehicles. In the study, the parameter values of a truck and a bus were adopted in the quarter vehicle model with two different spring-damper-inerter configurations , and the improvements in vibration isolation and road holding capability were determined by optimization of inertance. Results show that the inerter is similarly effective in providing the said improvements when implemented on heavy vehicles instead of on passenger cars, judging from reductions in sprung mass acceleration and dynamic tire load. It is also observed that the performance benefit is associated with larger optimum inertance than that for passenger cars. Overall, the inerter has been shown to be beneficial in the parallel and serial configurations, both of which are common and can be practically implemented in the suspension of heavy vehicles. The suspension system of a vehicle is a system of springs, dampers and linkages which connect between the wheel and the vehicle body. When designed and tuned accordingly, a vehicle suspension can serve the purposes of isolating the vehicle body from vibrations coming from the ground due to road irregularities, as well as maintaining consistent contact between the wheel and the road surface by minimizing the tire’s normal load variations . The forRegardless of the complexity of a modern vehicle suspension system, it can currently be generalized to having two major elements: the spring element and the damper element. The former supports the static load of a vehicle and temporarily stores the undesirable energy due to ground vibrations, while the latter dissipates this unwanted energy and literally dampen the vehicle response. Presently, the design and tuning of a vehicle suspension is largely around these two components. However, less known is that apart from spring and damper, there is another two-terminal element known as the inerter  that canThe inerter has been shown to be applicable in various areas, some of which include train suspension –5, buildThis study investigates the improvements in vibration isolation (ride) and road holding ability brought by the incorporation of an inerter, specifically concerning heavy vehicles. In the study, the suspension performance criteria were evaluated theoretically, considering two heavy vehicle classes (trucks and buses) as well as common suspension layouts. Through the analysis presented in the sections that follow, it was determined that the inerter, when incorporated in heavy vehicles, is similarly effective in achieving superior vibration isolation. This is important as it translates to better passenger comfort (for buses) and prevention of goods damage (for heavy trucks) in the transportation scene.Finerter is the force at the terminals, b is the property of the inerter known as the inertance with the unit of kilogram (kg), while a1 and a2 are the relative acceleration of the terminals. In other words, an inerter has the property that the force exerted is directly proportional to the relative acceleration at its terminals. From a microscopic point of view, each of the physical realizations of inerter device described earlier has its own detailed derivation in which the inertance is a function of its design variables, and each also has some non-ideal factors apart from the inertial effect, such as inherent elasticity, friction, and backlash as reported previously 11]. Howems, mu are the sprung and unsprung masses, k is the suspension stiffness, c is the suspension damping, b is the inertance of the added inerter, kt is the tire stiffness, and zs, zu, zg are vertical sprung mass displacement, unsprung mass displacement and the road input displacement respectively. For serial inerter, mn represents the mass of the node that connects between the damper and the inerter, while zn is the corresponding displacement.In which The additional inerter component in Meanwhile, for serial inerter layout, Eqs  to 6) a a6) are The aforementioned combinations of vehicle model and suspension layout are the common setup as seen in various studies concerning inerter in vehicle suspension. In all these studies, suspension performance improvements have been shown. For instance, in the early work of  and 11]11], the While the above, among others, all lead to the consistent point that the inerter is capable of giving superior performance when adopted in the suspension of passenger cars, presently there has not been similar performance study that is specifically meant for heavy vehicles. As mentioned earlier, the implementation of inerter is still new in heavy vehicles. Since heavy vehicles differ vastly from passenger cars in terms of vehicle parameter values, it is worth to consider a few heavy vehicle types and investigate the suspension performance due to the implementation of inerter in these vehicles.In line with earlier studies of inerter, the two-DOF quarter vehicle model was taken as the representative system of vehicle in this study. This is a lumped-mass, rigid body mathematical model that is commonly used in studies concerning fundamental suspension analyses, including inerter and semi-active suspensions . While m®), following the dynamics of parallel inerter layout ))®), follout (Eqs  to 6)).).®), folb from 0 kg to 1000 kg was tested for the parallel inerter layout, while the range of 0 kg to 3000 kg was applicable to the serial inerter layout. These are in line with similar past studies which considered inertance to sprung mass ratio of close to one as the evaluation limit [b while keeping reasonable actual device mass [-1 to 30000 Nsm-1 in the optimization of second approach of study. In general, all these ranges are wider than those adopted in similar past studies involving passenger cars, since the heavy vehicle parameter values are greater, and by consistent scaling considering transfer function, the suitable inertance (and damping if optimized together) is expectedly greater as well.The suspension performance improvements due to inerter were investigated via two separate approaches. In the first approach, the inerter was treated solely as an add-on suspension component to the existing quarter vehicle models to emulate retrofitting a suspension, thus having the suspension stiffness and damping maintained. This is applicable to both analyses involving the parallel inerter layout and the serial inerter layout. Meanwhile, in the second approach, both the inertance and the damping rate were subjected to optimization of suspension performance criteria to determine the performance benefit. This emulates suspension tuning from scratch. It is also in accordance to past research which suggests combined consideration of inerter and damping in vehicle suspension implementation . For boton limit –14. Meanice mass . MeanwhiFrom the computational results corresponding to the two quarter vehicle models with inerter, the performance of heavy vehicle suspension with inerter was looked into, and any benefit of incorporating inerter in the suspension of heavy vehicles would be known. In the study, two suspension performance criteria were considered, namely the root-mean-squared (RMS) sprung mass acceleration and the RMS dynamic tire load. Basically, the former describes the effect on the sprung mass (vehicle body) due to road input and is a measure of vehicle ride comfort, while the latter represents the variation of tire loads on the ground, which affects the tire-ground contact and therefore is a measure of road holding ability. In both considerations of implementation (inerter as add-on component and inerter with damping considered), reductions of RMS sprung mass acceleration and RMS dynamic tire load represent respectively the improvements in ride and road holding of the tested vehicle models.b for the truck and bus models, respectively, under the step road input of 0.1 m. The responses of truck and bus models are of similar trend, for which the RMS sprung mass acceleration shows reduction while the RMS dynamic tire load increases with b. It can be observed from -2 and 1.883 ms-2 when the b values are 145 kg and 140 kg, respectively, for the truck and bus models. Meanwhile, there is no minimum RMS dynamic tire load observed for both models. In fact, at the ride-optimized b values, the RMS dynamic tire loads for the truck and bus models are greater at 8.070 kN and 14.474 kN, respectively, as displayed in b values (145 kg and 140 kg) that are two orders of magnitude greater compared to that of a typical passenger car [In the context of suspension performance, the add-on parallel inerter with step road input of 0.1 m has resulted in reductions of 10.67% and 5.54% in RMS sprung mass acceleration, respectively, for the truck and bus models. These are, in fact, greater improvements compared to that achieved for some tested passenger car in earlier studies  achieves greater reduction in RMS sprung mass acceleration with step road input compared to random road input. This implies that the ride comfort improvement of the truck model is greater in transient scenarios such as road bumps. Conversely, the ride improvements for the bus model, even though exist for the add-on parallel inerter, are about the same between the two road inputs. From these comparisons, the performance benefits due to the incorporation of inerter on vehicle suspensions are generally affected by the combinations of vehicle parameter values that differ for different vehicle categories.With step road profile as the road input, it is also possible to investigate the ride performance from the perspective of transient response characteristics. In particular, reasonably long rise time and peak time, as well as low percentage overshoot and short settling time, are some of the characteristics of a vehicle with good ride comfort. b. Consequently, in order to compare with the add-on parallel inerter, the b values at which changes in both RMS values become small and insignificant were chosen, namely 800 kg and 1000 kg for the truck and bus models, respectively. The results show that the add-on serial inerter does not improve the responses due to road inputs, for both the truck and bus models. From Conversely, the implementation of serial inerter as add-on component to the suspension of heavy vehicle is much less effective relative to parallel inerter at the existing damping rate. There is basically no absolute minimum for RMS sprung mass acceleration and RMS dynamic tire load across the range of inertance values c should be adjusted together with inertance b to harness more potential from inerter [b and c values are considered in the optimization for ride and road holding ability. The results are discussed in the next sub-section.Even though the serial inerter layout does not bring performance benefits when considered as an add-on component to existing suspensions, it is important not to rule it out for further investigation. Due to the sequential arrangement between suspension damper and inerter, it is possible that the add-on approach to existing damping rate is not exactly optimum yet for the serial inerter layout. In fact, it has been suggested before that the suspension damping  inerter . Thus, ib and suspension damping c were optimized based on the same suspension performance criteria, namely the RMS sprung mass acceleration, an indication of ride comfort, and the RMS dynamic tire load, an indication of road holding ability. However, both criteria were analyzed together in the optimization. Admittedly, the nature of ride comfort and road holding ability are known to be conflicting among each other. Generally, an emphasis towards the former will lead to a compromise of the latter. Therefore, to optimize, or minimize, both RMS sprung mass acceleration and RMS dynamic tire load, the Pareto optimization approach considering these two as optimization objectives were adopted. The idea of Pareto optimization is that the solutions obtained are non-dominated solutions, as none of these can minimize one objective without worsening another. It follows that the set of optimum solutions are equally dominant with only different emphasis on each objective. Using the specified ranges of inertance b and damping c as described in the vehicle modeling section, the optimum solutions considering the two objectives are shown as Pareto fronts for the truck and bus models with parallel and serial layouts of inerter. These are illustrated in In the last part of the study, both inertance b and damping c are allowed to vary, the suspension with serial inerter is superior to the suspension with parallel inerter which, in turn, is better than the reference suspension without inerter (the spring-and-damper configuration). This is applicable to step road input and random road input. Additionally, Pareto fronts for the bus model also display the same trend as that for the truck model. In general, the implementation of inerter in the suspension of heavy vehicles does bring better ride comfort while maintaining the road holding ability.In a qualitative comparison, a case is superior to another if its Pareto front is towards the direction of minimizing the objectives, relative to that of another. b and c values. The approach of taking the middle point from each set of solutions brings a balanced emphasis on the minimization of both objectives. This allows a fair comparison of performance improvements among different layouts of inerter, as well as different types of heavy vehicle.Finally, to evaluate the suspension performance quantitatively, the middle point of the Pareto front from each case is selected as the sample solution for comparison, as shown in The truck model with serial inerter displays the greatest reductions in the RMS sprung mass acceleration, with 5.72% and 4.05% observed for the step and random road inputs, respectively, without significant changes in the RMS dynamic tire load. In fact, the RMS dynamic tire load is actually also reduced by 1.69% with the case involving step road input. Meanwhile, the truck model with parallel inerter shows 2.45% and 3.22% reductions in the RMS sprung mass acceleration, with 2.19% and 4.42% increments in RMS dynamic tire load, respectively, for the step and random road inputs. Thus, the serial inerter layout does indeed outperform the parallel inerter layout for the truck model, as the former is capable of achieving better ride comfort and road holding ability. It is now apparent that when the suspension damping is tuned together with the inertance, the benefit brought by a serial inerter can be boosted further.For the bus model, the serial inerter gives slightly more reduction of 4.62% in the RMS sprung mass acceleration with the step road input, while showing less reduction with the random road input (2.01%). The indication that the inerter gives better transient response, as first pointed out in the previous sub-section, is again observed here. Meanwhile, the reduction of RMS sprung mass acceleration for the parallel inerter is similar between the two road input cases (approximately 3.2% reduction is achievable). Comparing by using the bus model, the serial inerter layout is again superior to the parallel inerter layout as the former has less increment of the RMS dynamic tire load, hence less compromise to the road holding ability when the ride is improved.This study investigates the inerter-based suspension systems for heavy vehicles, and it shows that the inerter brings superior performance compared to a suspension without inerter. Results have shown that the inerter is capable of improving two major suspension performance criteria, whether it is implemented in the parallel or serial layout. When the inerter is treated as an add-on device, the parallel inerter layout improves the sprung mass acceleration at the expense of dynamic tire load. Meanwhile, when both inertance and suspension damping are considered, the serial inerter demonstrated superiority with improvements in both sprung mass acceleration and dynamic tire load, although this comes with narrower Pareto optimal design points than that of the parallel inerter layout. Regardless of layouts, the level of performance improvement for heavy vehicles is comparable to that for passenger cars with improvements of up to 10%, but generally the required optimum inertance for heavy vehicles is two orders of magnitude greater than that for passenger cars. Overall, this study has demonstrated that the inerter has similar improvements in vibration isolation and road holding performance when incorporated in heavy vehicles instead of in passenger cars where the improvements are already known. The benefits that these translate to, namely better passenger comfort and prevention of goods damage, together with the greater installation space and less critical penalty of weight due to the installation of an additional device, make the mass-adoption of inerter in heavy vehicles especially promising.S1 File(PDF)Click here for additional data file.S2 File(PDF)Click here for additional data file.


Much of the published literature on suicide comes from high income countries. In countries such as India, female suicide rates exceed the global suicide rate and suicide rates found in their male counterparts. Results from previous studies indicate that factors related to suicide among men and women in India are different from those seen in high-income countries. To date, no reviews have considered the relationship between gender and suicide in India. Therefore, the aim of this scoping review is to provide a comprehensive understanding of existing literature reporting gender differences in suicide rates, methods, risk factors and antecedent factors in India by reviewing published studies.* AND India*]. The searches took place in November 2020 and May 2021, with no language restrictions. Articles published from 2014 onwards from India were included. Reference lists of selected studies were searched for studies that could meet the inclusion criteria.A scoping review was conducted to map the existing literature on gender differences in suicide in India. To identify peer-reviewed publications, online databases PsycINFO and Embase were searched. The search terms were [suicidThis review identified 17 studies that met the inclusion criteria. The ratio between women and men who die by suicide in India is much lower than in high-income countries. Hanging was found to be a more commonly used method of suicide among both men and women, in comparison to high-income countries where hanging is more common among men. This review also identified several gaps in the literature. There were few studies that examined suicide among transgender Indians. There was limited literature on gender differences in risk and protective factors for suicide. Limitations such as the omission of a lack of gender-based analyses in several studies and under-reporting of suicide rates were identified.Understanding suicide within the context of individual countries is essential in designing culture-appropriate suicide prevention strategies. This review identified an urgent need to establish and evaluate suicide surveillance systems in India. Furthermore, additional research is warranted to understand suicide among individuals who identify outside the gender binary, and gender-specific risk and protective factors. Suicide is a major challenge to global public health. The World Health Organisation (WHO) estimates that around 800,000 suicide deaths occur worldwide every year, with an annual global age-standardised suicide rate of 10.5 per 100,000 population , which aFor those countries where suicide data is available, the suicide rate in men exceed those found in women . HoweverIndia has a population of more than 1.3 billion, which is roughly one sixth of the world's population . India aScoping reviews are indicated when the aim is to provide an overview of existing literature and identify gaps in this literature, while a systematic review is conducted to appraise the strength of evidence for theories or treatments, confirm current practises in a field, identify conflicting results, and to understand the quality of existing studies . A limitFor the purpose of this review, suicide is defined as the act of deliberately killing oneself; gender is used to describe the characteristics of women and men that are socially constructed, while sex refers to those characters that are biologically determined . In thisThe Joanna Briggs Institute (JBI) guidelines  for scop* AND India*]. The searches took place in November 2020 and May 2021, for studies that were published starting from May 1, 2014. Identification of relevant studies was based on screening the title and abstract of identified studies. Reference lists of identified studies were searched for studies that met inclusion criteria. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension Fillable Checklist (PRISMA-ScR)  were searched, encompassing literature in the field of psychology, medicine, and health sciences. The search terms used were: [suicidSMA-ScR)  was follIncluding grey literature in a review can provide a more comprehensive view of the available evidence. While peer-reviewed literature ordinarily utilises a specific format, grey literature can differ in format and length, which makes their inclusion and analysis time- and resource-intensive . As the Articles published from May 2014 onwards focussing on suicide in India were included. This date was selected to provide a recent overview of gender differences in suicide in India, since the most recent review examining suicide data in India by Rane and Nadkarni  covered During the initial screening of publications, articles were included if it was unclear whether the data examined suicide attempts or suicide deaths. The full text of these articles was then reviewed to determine whether the study examined self-harm, suicide attempts, or suicide deaths. Only data on suicide deaths from these studies were included for the narrative synthesis. Similarly, for those studies that only assessed gender differences for one variable of interest , the study was included, but only relevant information was extracted. PR screened studies and extracted data from selected studies. Any questions around study eligibility were jointly discussed and resolved by PR, PT, RM and CR. PR summarised the findings from the studies included.Data from the studies were entered into a pre-piloted extraction form. The form included details on authors, year of publication, location of the study, study aims, period of data collection, method and type of data collected, suicide rates, methods, risk factors, and antecedent factors.The PRISMA study selection flowchart is provided in A total of 17 studies were included in this review. Out of the seventeen studies that were included in the review, fifteen studies reported suicide rates . Out of Out of the twelve studies that reported methods of suicide, nine reported gender differences . Six stuBoth males and females within the age group of 18–35  and 15–2Suicide rates were higher among males and females who are married . This raThis review found that females who die by suicide are more likely to be literate  and haveThere were two studies that looked at suicide in specific populations—Bardale and Dixit  examinedSeven studies assessed reported antecedent factors . Of thesOne study  examinedThe results of this review provide an overview of the literature on gender differences in suicide in India. This review also aimed to identify gaps in the literature. It was found that the suicide rate for males was higher than the rate for females in all studies that reported gender differences. This review identified hanging as the most common method of suicide for both males and females. Suicide rates were particularly high among women in the younger age group (15 to 39 years), men and women with a secondary education, married individuals, housewives, and employed men.Given methodological differences in how the rates of suicide were calculated, it was difficult to make comparisons between studies in this review. However, most studies reported a higher proportion of male suicide decedents. In 2016, the suicide rate in India was estimated to be 16.5/100,000, which was higher than the global average of 10.5/100,000 . The suiThe suicide rate in older adults (95 years and older) were high for both men and women. Suicide rates in older men were higher than those seen in older women—one study reported that the suicide rate was 80.8 per 100,000 in men, and 40.6 per 100,000 in women , althougSimilar differences were found for methods of suicide in Indians. Firearms and hanging account for a higher proportion of suicide deaths across the globe , 34, sinAnother assumption in HICs is that gender norms decrease the likelihood that women will have access to, or be familiar with methods of suicide with a higher lethality such as firearms . The staThis review found that suicide rates were higher among married people, both men and women. This is in contrast to the review by Rane and Nadkarni , which fSuicide rates were higher among men who were self-employed or employed as a daily wage worker. For women, suicide rates were higher among housewives. This may reflect demographic factors rather than risk factors, as men are more likely to report being self-employed or engaged in daily wage work, while women are more likely to be unemployed or housewives .However, the data on the relationship between education and suicide is more conflicting. While previous studies have found that for both men and women in India, illiteracy and lower levels of formal education were associated with a high risk of suicide –47, thisThis review found several limitations in suicide literature in India. First, comparisons between studies were difficult because of the differences in methodology and analysis. For example, some suicide rates were age-adjusted, while most were not, and several studies did not report gender differences for rates, methods, risk factors and antecedent factors. Only variables that were disaggregated by gender from these studies could be included. Additionally, the NCRB database is the most commonly used reference for suicide rates in India, and a majority of the studies identified in this review utilised figures from this database. There are several limitations to the data available on rates and methods for suicide through this source. The NCRB data is not collected for the primary purpose of suicide surveillance, and is dependent on information collected through FIRs submitted to the police. This information is often unreliable, since deaths by suicide are often reported as illness or an accident to avoid registering a case with the police . FamilieContradictory results were also found for methods of suicide. Some studies in this review have concluded that poisoning is the most common method of suicide, based on NCRB data. However, studies in this review that report suicide data from police records and hospital records identified hanging as the most common method of suicide for men and women. This, supports findings from a systematic review on methods of suicide in South Asia , which fSecond, there have been few studies that examine the prevalence of suicide among the transgender community in India. It is estimated that around 50% in this group have attempted suicide before the age of 20 . The lacThird, there were few studies that looked at various risk and protective factors. Although most of the studies in this review identified demographic factors related to suicide, there were few studies that specifically examined the role of potentially important risk factors that have been identified in studies from HICs. For example, research on protective factors from HICs  and LMICScoping reviews are especially suitable for addressing region-specific issues where availability of data may be limited. This review had the strength of providing a comprehensive overview of recent literature on gender differences in suicide in India. This review provided recent evidence that supports the findings of Jordans, et al.  and RaneThese findings have important implications for future research. For instance, suicide surveillance systems need to be established in India in regions where they currently do not exist. Nationally representative surveys of suicide, such as the one conducted as part of the GBD study , are impSuicide is particularly concerning in LMICs such as India, where resources to handle suicide prevention are scarce. A scoping review of research on suicide and gender in India was conducted. This review focused on rates of suicide, methods of suicide, risk factors and antecedent factors for suicide. The suicide rate and proportion of deaths by suicide were particularly high in young women. Hanging was found to be the most common method of suicide. This review also identified several gaps in literature, such as the lack of literature on individuals who identify outside the gender binary of male and female, and the need to understand gender differences in risk and protective factors for suicide.PR wrote the manuscript. PT, RM, RR, and CR contributed to manuscript revision and editing. All authors contributed to the conception and planning of the scoping review.PR was funded by the Global Challenges Research Fund. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.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.