Evolutionary Decision-Making and Planning for Autonomous Driving Based on Safe and Rational Exploration and Exploitation

Decision-making and motion planning are extremely important in autonomous driving to ensure safe driving in a real-world environment.This study proposes an online evolutionary decision-making and motion planning framework for autonomous driving based on a hybrid data-and model-driven method.First,a data-driven decision-making module based on deep reinforcement learning(DRL)is developed to pursue a rational driving performance as much as possible.Then,model predictive control(MPC)is employed to execute both longitudinal and lateral motion planning tasks.Multiple constraints are defined according to the vehicle’s physical limit to meet the driving task requirements.Finally,two principles of safety and rationality for the self-evolution of autonomous driving are proposed.A motion envelope is established and embedded into a rational exploration and exploitation scheme,which filters out unreasonable experiences by masking unsafe actions so as to collect high-quality training data for the DRL agent.Experiments with a high-fidelity vehicle model and MATLAB/Simulink co-simulation environment are conducted,and the results show that the proposed online-evolution framework is able to generate safer,more rational,and more efficient driving action in a real-world environment.

Clinical study of different prediction models in predicting diabetic nephropathy in patients with type 2 diabetes mellitus

BACKGROUND Among older adults,type 2 diabetes mellitus(T2DM)is widely recognized as one of the most prevalent diseases.Diabetic nephropathy(DN)is a frequent com-plication of DM,mainly characterized by renal microvascular damage.Early detection,aggressive prevention,and cure of DN are key to improving prognosis.Establishing a diagnostic and predictive model for DN is crucial in auxiliary diagnosis.AIM To investigate the factors that impact T2DM complicated with DN and utilize this information to develop a predictive model.METHODS The clinical data of 210 patients diagnosed with T2DM and admitted to the First People’s Hospital of Wenling between August 2019 and August 2022 were retrospectively analyzed.According to whether the patients had DN,they were divided into the DN group(complicated with DN)and the non-DN group(without DN).Multivariate logistic regression analysis was used to explore factors affecting DN in patients with T2DM.The data were randomly split into a training set(n=147)and a test set(n=63)in a 7:3 ratio using a random function.The training set was used to construct the nomogram,decision tree,and random forest models,and the test set was used to evaluate the prediction performance of the model by comparing the sensitivity,specificity,accuracy,recall,precision,and area under the receiver operating characteristic curve.RESULTS Among the 210 patients with T2DM,74(35.34%)had DN.The validation dataset showed that the accuracies of the nomogram,decision tree,and random forest models in predicting DN in patients with T2DM were 0.746,0.714,and 0.730,respectively.The sensitivities were 0.710,0.710,and 0.806,respectively;the specificities were 0.844,0.875,and 0.844,respectively;the area under the receiver operating characteristic curve(AUC)of the patients were 0.811,0.735,and 0.850,respectively.The Delong test results revealed that the AUC values of the decision tree model were lower than those of the random forest and nomogram models(P<0.05),whereas the difference in AUC values of the random forest and column-line graph models was not statistically significant(P>0.05).CONCLUSION Among the three prediction models,random forest performs best and can help identify patients with T2DM at high risk of DN.

教育数字化赋能乡村教师高质量发展的时代意涵、现实隐忧与推进路径

为了顺应数字化社会的发展趋势,实施教育数字化战略行动,推动教育数字化转型势在必行。教育数字化赋能乡村教师高质量发展意指依托数字技术的核心支撑与创新应用,推动数字技术与乡村教师发展各维度的深度整合,助力乡村教师的教育空间、教学范式、知识储备、能力结构与乡村教师队伍管理等多方面的转型与变革,打造适应教育数字化发展趋势的高质量乡村教师队伍。同时教育数字化赋能乡村教师高质量发展也面临着数字技术焦虑,压制乡村教师高质量发展动力;数字素养薄弱,制约乡村教师高质量发展行动;数字资源不均,加剧乡村教师高质量发展鸿沟;数字成本繁重,加重乡村教师高质量发展负担等现实问题。基于文化路径、素养路径、资源路径与管理路径等推进逻辑,通过培养乡村教师数字文化自觉观念、实施乡村教师数字素养提升工程、构建乡村教师数字资源共享群落与完善乡村教师数字负担管理体系等路径,促进乡村教师高质量发展。

Concept of Artificial Intelligence (AI) and Its Use in Orthopaedic Practice: Applications and Pitfalls: A Narrative Review

Background: The growth and use of Artificial Intelligence (AI) in the medical field is rapidly rising. AI is exhibiting a practical tool in the healthcare industry in patient care. The objective of this current review is to assess and analyze the use of AI and its use in orthopedic practice, as well as its applications, limitations, and pitfalls. Methods: A review of all relevant databases such as EMBASE, Cochrane Database of Systematic Reviews, MEDLINE, Science Citation Index, Scopus, and Web of Science with keywords of AI, orthopedic surgery, applications, and drawbacks. All related articles on AI and orthopaedic practice were reviewed. A total of 3210 articles were included in the review. Results: The data from 351 studies were analyzed where in orthopedic surgery. AI is being used for diagnostic procedures, radiological diagnosis, models of clinical care, and utilization of hospital and bed resources. AI has also taken a chunk of share in assisted robotic orthopaedic surgery. Conclusions: AI has now become part of the orthopedic practice and will further increase its stake in the healthcare industry. Nonetheless, clinicians should remain aware of AI’s serious limitations and pitfalls and consider the drawbacks and errors in its use.

Artificial Intelligence for Global Health: Difficulties and Challenges: A Narrative Review

Global health (GH) aims to improve healthcare for all people on the planet and eradicate all avoidable diseases and deaths. The inception of Artificial Intelligence (AI) is innovating healthcare practices and improving patient outcomes by shuffling enormous volumes of health data—from health records and clinical studies to genetic information analyzing it much faster than humans. AI also helps in the improvement of medical imaging and medical diagnosis. There is an increased optimism regarding the use of applications of AI locally but can these facets be translated globally in the advancement and delivery of healthcare with the help of AI. At present majority of AI developments and applications in health care provide to the needs of developed countries and there is little effort to develop programs which could help to improve healthcare delivery globally. We performed this narrative review to assess the difficulties and discrepancies in implementing AI in global health delivery and find ways to improve.

Toward Trustworthy Decision-Making for Autonomous Vehicles:A Robust Reinforcement Learning Approach with Safety Guarantees

While autonomous vehicles are vital components of intelligent transportation systems,ensuring the trustworthiness of decision-making remains a substantial challenge in realizing autonomous driving.Therefore,we present a novel robust reinforcement learning approach with safety guarantees to attain trustworthy decision-making for autonomous vehicles.The proposed technique ensures decision trustworthiness in terms of policy robustness and collision safety.Specifically,an adversary model is learned online to simulate the worst-case uncertainty by approximating the optimal adversarial perturbations on the observed states and environmental dynamics.In addition,an adversarial robust actor-critic algorithm is developed to enable the agent to learn robust policies against perturbations in observations and dynamics.Moreover,we devise a safety mask to guarantee the collision safety of the autonomous driving agent during both the training and testing processes using an interpretable knowledge model known as the Responsibility-Sensitive Safety Model.Finally,the proposed approach is evaluated through both simulations and experiments.These results indicate that the autonomous driving agent can make trustworthy decisions and drastically reduce the number of collisions through robust safety policies.

Orientation and Decision-Making for Soccer Based on Sports Analytics and AI:A Systematic Review

Due to ever-growing soccer data collection approaches and progressing artificial intelligence(AI) methods, soccer analysis, evaluation, and decision-making have received increasing interest from not only the professional sports analytics realm but also the academic AI research community. AI brings gamechanging approaches for soccer analytics where soccer has been a typical benchmark for AI research. The combination has been an emerging topic. In this paper, soccer match analytics are taken as a complete observation-orientation-decision-action(OODA) loop.In addition, as in AI frameworks such as that for reinforcement learning, interacting with a virtual environment enables an evolving model. Therefore, both soccer analytics in the real world and virtual domains are discussed. With the intersection of the OODA loop and the real-virtual domains, available soccer data, including event and tracking data, and diverse orientation and decisionmaking models for both real-world and virtual soccer matches are comprehensively reviewed. Finally, some promising directions in this interdisciplinary area are pointed out. It is claimed that paradigms for both professional sports analytics and AI research could be combined. Moreover, it is quite promising to bridge the gap between the real and virtual domains for soccer match analysis and decision-making.

An Adaptive Hybrid Optimization Strategy for Resource Allocation in Network Function Virtualization

With the rapid development of Network Function Virtualization(NFV),the problem of low resource utilizationin traditional data centers is gradually being addressed.However,existing research does not optimize both localand global allocation of resources in data centers.Hence,we propose an adaptive hybrid optimization strategy thatcombines dynamic programming and neural networks to improve resource utilization and service quality in datacenters.Our approach encompasses a service function chain simulation generator,a parallel architecture servicesystem,a dynamic programming strategy formaximizing the utilization of local server resources,a neural networkfor predicting the global utilization rate of resources and a global resource optimization strategy for bottleneck andredundant resources.With the implementation of our local and global resource allocation strategies,the systemperformance is significantly optimized through simulation.

Mapping the geography of editors-in-chief

Purpose:This study aims to explore the geography of editors-in-chief to demonstrate which countries exercise the highest-level decision-making in scholarly communication.In addition,the study seeks to investigate the potential relationships between the origin and nationality of academic publishers and the geography of editors-in-chief.Design/methodology/approach:The analysis involves 11,915 journals listed in Web of Science’s Social Sciences Citation Index(SSCI)and Science Citation Index Expanded(SCIE).These journals employ 15,795 scholars as editors-in-chief.The geographical locations of the institutions the editors-in-chief are affiliated with were identified;then,the data were aggregated at the country level.Findings:The results show that most editors-in-chief are located in countries of the Anglosphere,primarily the United States and the United Kingdom.In addition,most academic publishers and professional organizations that publish academic journals were found to be based in the United States and the United Kingdom,where most editors-in-chief are also based.Research limitations:The analysis involves journals indexed in the Web of Science’s SCIE/SSCI databases,which are demonstrably biased toward the English language.Furthermore,the study only takes a snapshot of the geography of editors-in-chief for the year 2022,but it does not investigate trends.Research implications:The study maps the highest-level decision-making in scholarly communication.Originality/value:The study explores and maps the geography of editors-in-chief by using a massive dataset.

Ethical Decision-Making Framework Based on Incremental ILP Considering Conflicts

Humans are experiencing the inclusion of artificial agents in their lives,such as unmanned vehicles,service robots,voice assistants,and intelligent medical care.If the artificial agents cannot align with social values or make ethical decisions,they may not meet the expectations of humans.Traditionally,an ethical decision-making framework is constructed by rule-based or statistical approaches.In this paper,we propose an ethical decision-making framework based on incremental ILP(Inductive Logic Programming),which can overcome the brittleness of rule-based approaches and little interpretability of statistical approaches.As the current incremental ILP makes it difficult to solve conflicts,we propose a novel ethical decision-making framework considering conflicts in this paper,which adopts our proposed incremental ILP system.The framework consists of two processes:the learning process and the deduction process.The first process records bottom clauses with their score functions and learns rules guided by the entailment and the score function.The second process obtains an ethical decision based on the rules.In an ethical scenario about chatbots for teenagers’mental health,we verify that our framework can learn ethical rules and make ethical decisions.Besides,we extract incremental ILP from the framework and compare it with the state-of-the-art ILP systems based on ASP(Answer Set Programming)focusing on conflict resolution.The results of comparisons show that our proposed system can generate better-quality rules than most other systems.

Complex Decision Modeling Framework with Fairly Operators and Quaternion Numbers under Intuitionistic Fuzzy Rough Context

The main goal of informal computing is to overcome the limitations of hypersensitivity to defects and uncertainty while maintaining a balance between high accuracy,accessibility,and cost-effectiveness.This paper investigates the potential applications of intuitionistic fuzzy sets(IFS)with rough sets in the context of sparse data.When it comes to capture uncertain information emanating fromboth upper and lower approximations,these intuitionistic fuzzy rough numbers(IFRNs)are superior to intuitionistic fuzzy sets and pythagorean fuzzy sets,respectively.We use rough sets in conjunction with IFSs to develop several fairly aggregation operators and analyze their underlying properties.We present numerous impartial laws that incorporate the idea of proportionate dispersion in order to ensure that the membership and non-membership activities of IFRNs are treated equally within these principles.These operations lead to the development of the intuitionistic fuzzy rough weighted fairly aggregation operator(IFRWFA)and intuitionistic fuzzy rough ordered weighted fairly aggregation operator(IFRFOWA).These operators successfully adjust to membership and non-membership categories with fairness and subtlety.We highlight the unique qualities of these suggested aggregation operators and investigate their use in the multiattribute decision-making field.We use the intuitionistic fuzzy rough environment’s architecture to create a novel strategy in situation involving several decision-makers and non-weighted data.Additionally,we developed a novel technique by combining the IFSs with quaternion numbers.We establish a unique connection between alternatives and qualities by using intuitionistic fuzzy quaternion numbers(IFQNs).With the help of this framework,we can simulate uncertainty in real-world situations and address a number of decision-making problems.Using the examples we have released,we offer a sophisticated and systematically constructed illustrative scenario that is intricately woven with the complexity ofmedical evaluation in order to thoroughly assess the relevance and efficacy of the suggested methodology.

Stroke Risk Assessment Decision-Making Using a Machine Learning Model:Logistic-AdaBoost

Stroke is a chronic cerebrovascular disease that carries a high risk.Stroke risk assessment is of great significance in preventing,reversing and reducing the spread and the health hazards caused by stroke.Aiming to objectively predict and identify strokes,this paper proposes a new stroke risk assessment decision-making model named Logistic-AdaBoost(Logistic-AB)based on machine learning.First,the categorical boosting(CatBoost)method is used to perform feature selection for all features of stroke,and 8 main features are selected to form a new index evaluation system to predict the risk of stroke.Second,the borderline synthetic minority oversampling technique(SMOTE)algorithm is applied to transform the unbalanced stroke dataset into a balanced dataset.Finally,the stroke risk assessment decision-makingmodel Logistic-AB is constructed,and the overall prediction performance of this new model is evaluated by comparing it with ten other similar models.The comparison results show that the new model proposed in this paper performs better than the two single algorithms(logistic regression and AdaBoost)on the four indicators of recall,precision,F1 score,and accuracy,and the overall performance of the proposed model is better than that of common machine learning algorithms.The Logistic-AB model presented in this paper can more accurately predict patients’stroke risk.

Enhancing IoT Security:Quantum-Level Resilience against Threats

The rapid growth of the Internet of Things(IoT)operations has necessitated the incorporation of quantum computing technologies tomeet its expanding needs.This integration ismotivated by the need to solve the specific issues provided by the expansion of IoT and the potential benefits that quantum computing can offer in this scenario.The combination of IoT and quantum computing creates new privacy and security problems.This study examines the critical need to prevent potential security concerns from quantum computing in IoT applications.We investigate the incorporation of quantum computing approaches within IoT security frameworks,with a focus on developing effective security mechanisms.Our research,which uses quantum algorithms and cryptographic protocols,provides a unique solution to protecting sensitive information and assuring the integrity of IoT systems.We rigorously analyze critical quantum computing security properties,building a hierarchical framework for systematic examination.We offer concrete solutions flexible to diverse aswell as ambiguous opinions through using a unified computational model with analytical hierarchy process(AHP)multi-criteria decision-making(MCDM)as the technique for ordering preferences by similarity to ideal solutions(TOPSIS)in a fuzzy environment.This study adds practical benefit by supporting practitioners in recognizing,choosing,and prioritizing essential security factors from the standpoint of quantum computing.Our approach is a critical step towards improving quantum-level security in IoT systems,strengthening their resilience against future threats,and preserving the IoT ecosystem’s long-term prosperity.

MADDPG-D2: An Intelligent Dynamic Task Allocation Algorithm Based on Multi-Agent Architecture Driven by Prior Knowledge

Aiming at the problems of low solution accuracy and high decision pressure when facing large-scale dynamic task allocation(DTA)and high-dimensional decision space with single agent,this paper combines the deep reinforce-ment learning(DRL)theory and an improved Multi-Agent Deep Deterministic Policy Gradient(MADDPG-D2)algorithm with a dual experience replay pool and a dual noise based on multi-agent architecture is proposed to improve the efficiency of DTA.The algorithm is based on the traditional Multi-Agent Deep Deterministic Policy Gradient(MADDPG)algorithm,and considers the introduction of a double noise mechanism to increase the action exploration space in the early stage of the algorithm,and the introduction of a double experience pool to improve the data utilization rate;at the same time,in order to accelerate the training speed and efficiency of the agents,and to solve the cold-start problem of the training,the a priori knowledge technology is applied to the training of the algorithm.Finally,the MADDPG-D2 algorithm is compared and analyzed based on the digital battlefield of ground and air confrontation.The experimental results show that the agents trained by the MADDPG-D2 algorithm have higher win rates and average rewards,can utilize the resources more reasonably,and better solve the problem of the traditional single agent algorithms facing the difficulty of solving the problem in the high-dimensional decision space.The MADDPG-D2 algorithm based on multi-agent architecture proposed in this paper has certain superiority and rationality in DTA.

地铁空间施工中基坑降水对渗流场的影响模拟预测研究

为了对地下水层结构稳定性进行模拟预测,从而保障地铁施工过程的安全,研究利用构建的地质水文模型分析测试三种基坑降水方案的性能。研究结果表明,隔水帷幕下辐射井降水方案在辐射管管径为0.1~0.3 m时,疏降时间维持在5~12 d,最大总抽水量为291279.124 m^(3)。实践结果证明隔水帷幕下辐射井降水方案降水效果较好,应用价值更高,对地铁空间施工中地下地质水文结果的稳定性提升有帮助。

Synergizing Wind,Solar,and Biomass Power:Ranking Analysis of Off-Grid System for Different Weather Conditions of Iran

Nowadays,the use of renewable energies,especially wind,solar,and biomass,is essential as an effective solution to address global environmental and economic challenges.Therefore,the current study examines the energy-economic-environmental analysis of off-grid electricity generation systems using solar panels,wind turbines,and biomass generators in various weather conditions in Iran.Simulations over 25 years were conducted using HOMER v2.81 software,aiming to determine the potential of each region and find the lowest cost of electricity production per kWh.In the end,to identify the most suitable location,the Technique for Order Preference by Similarity to Ideal Solution(TOPSIS)method was employed to rank different stations based on simulation output parameters and some other influential factors.Considering the evaluation of various parameters,the stations in Yazd,Marand,and Dezful achieved the best results,while the stations in Ramsar,Shahrekord,and Gonbad presented the least favorable outcomes.In Yazd,the wind turbine is an economic priority,and a 100 kW wind turbine is utilized in the optimal system.In Yazd,where the simultaneous use of renewable energies is most prominent,the lowest pollutant production occurred with a quantity of 1174 kg/year.Annual energy losses are highest in Jask station and lowest in Yazd.

5-Bromo-2'-deoxyuridine labeling:historical perspectives,factors infiuencing the detection,toxicity,and its implications in the neurogenesis

The halopyrimidine 5-bromo-2′-deoxyuridine(BrdU)is an exogenous marker of DNA synthesis.Since the introduction of monoclonal antibodies against BrdU,an increasing number of methodologies have been used for the immunodetection of this synthesized bromine-tagged base analogue into replicating DNA.BrdU labeling is widely used for identifying neuron precursors and following their fate during the embryonic,perinatal,and adult neurogenesis in a variety of vertebrate species including birds,reptiles,and mammals.Due to BrdU toxicity,its incorporation into replicating DNA presents adverse consequences on the generation,survival,and settled patterns of cells.This may lead to false results and misinterpretation in the identification of proliferative neuroblasts.In this review,I will indicate the detrimental effects of this nucleoside during the development of the central nervous system,as well as the reliability of BrdU labeling to detect proliferating neuroblasts.Moreover,it will show factors influencing BrdU immunodetection and the contribution of this nucleoside to the study of prenatal,perinatal,and adult neurogenesis.Human adult neurogenesis will also be discussed.It is my hope that this review serves as a reference for those researchers who focused on detecting cells that are in the synthetic phase of the cell cycle.

Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency setting.Clinical trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective setting.It is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been highlighted.The present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal emergencies.Furthermore,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute situations.In the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute cases.We then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two fields.In emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality rates.The need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

An Integrated Bipolar Picture Fuzzy Decision Driven System to Scrutinize Food Waste Treatment Technology through Assorted Factor Analysis

Food Waste(FW)is a pressing environmental concern that affects every country globally.About one-third of the food that is produced ends up as waste,contributing to the carbon footprint.Hence,the FW must be properly treated to reduce environmental pollution.This study evaluates a few available Food Waste Treatment(FWT)technologies,such as anaerobic digestion,composting,landfill,and incineration,which are widely used.A Bipolar Picture Fuzzy Set(BPFS)is proposed to deal with the ambiguity and uncertainty that arise when converting a real-world problem to a mathematical model.A novel Criteria Importance Through Intercriteria Correlation-Stable Preference Ordering Towards Ideal Solution(CRITIC-SPOTIS)approach is developed to objectively analyze FWT selection based on thirteen criteria covering the industry’s technical,environmental,and entrepreneurial aspects.The CRITIC method is used for the objective analysis of the importance of each criterion in FWT selection.The SPOTIS method is adopted to rank the alternative hassle-free,following the criteria.The proposed model offers a rank reversal-free model,i.e.,the rank of the alternatives remains unaffected even after the addition or removal of an alternative.In addition,comparative and sensitivity analyses are performed to ensure the reliability and robustness of the proposed model and to validate the proposed result.

Development of a Decision Aid for Family Surrogate Decision Makers of Critically Ill Patients Requiring Renal Replacement Therapy in ICU:A User-Centered Design for Rapid Prototyping

Objectives Renal replacement therapy(RRT)is increasingly adopted for critically ill patients diagnosed with acute kidney injury,but the optimal time for initiation remains unclear and prognosis is uncertain,leading to medical complexity,ethical conflicts,and decision dilemmas in intensive care unit(ICU)settings.This study aimed to develop a decision aid(DA)for the family surrogate of critically ill patients to support their engagement in shared decision-making process with clinicians.Methods Development of DA employed a systematic process with user-centered design(UCD)principle,which included:(i)competitive analysis:searched,screened,and assessed the existing DAs to gather insights for design strategies,developmental techniques,and functionalities;(ii)user needs assessment:interviewed family surrogates in our hospital to explore target user group's decision-making experience and identify their unmet needs;(iii)evidence syntheses:integrate latest clinical evidence and pertinent information to inform the content development of DA.Results The competitive analysis included 16 relevant DAs,from which we derived valuable insights using existing resources.User decision needs were explored among a cohort of 15 family surrogates,revealing four thematic issues in decision-making,including stuck into dilemmas,sense of uncertainty,limited capacity,and delayed decision confirmation.A total of 27 articles were included for evidence syntheses.Relevant decision making knowledge on disease and treatment,as delineated in the literature sourced from decision support system or clinical guidelines,were formatted as the foundational knowledge base.Twenty-one items of evidence were extracted and integrated into the content panels of benefits and risks of RRT,possible outcomes,and reasons to choose.The DA was drafted into a web-based phototype using the elements of UCD.This platform could guide users in their preparation of decision-making through a sequential four-step process:identifying treatment options,weighing the benefits and risks,clarifying personal preferences and values,and formulating a schedule for formal shared decision-making with clinicians.Conclusions We developed a rapid prototype of DA tailored for family surrogate decision makers of critically ill patients in need of RRT in ICU setting.Future studies are needed to evaluate its usability,feasibility,and clinical effects of this intervention.