The damaged indoor nonstructural components in the earthquake often cause casualties. To improve the indoor earthquake safety capacity of occupants, a mixed reality (MR) drill method for indoor earthquake safety considering seismic damage of nonstructural components is proposed. First, an MR device, HoloLens, is used to capture indoor point clouds, and the indoor three-dimensional scene is reconstructed using point clouds. Subsequently, the seismic motion models of indoor components are established, so that the indoor nonstructural seismic damage scene is constructed using the physics engine and displayed using HoloLens. Finally, a guidance algorithm for a safe zone was designed for the drills. Taking a typical office as an example, an indoor earthquake safety drill was performed. The drill results show that the proposed MR method can increase the average efficiency of moving to a safe zone by 43.1%. Therefore, the outcome of this study can effectively improve the earthquake safety ability of occupants, thereby reducing casualties. However, it is important to note that even with these improvements, nonstructural damage  would still result in serious casualties3. Therefore, ensuring the safety of occupants during an earthquake is critical for reducing casualties.With advances in seismic design and construction techniques, the incidence of building structure collapses resulting from earthquakes has significantly decreased7 and virtual drills12. Practical drills generally require participants to practice safety actions when they receive the assumptive earthquake signal, like the Great ShakeOut14 earthquake drill. While practical drills are unable to replicate the actual earthquake scenes, it is difficult for occupants to experience a sense of urgency or tension. On the other hand, virtual drills can provide highly realistic earthquake scenes, but participants are often limited to a fixed location due to the virtual equipment , which reduces their mobility.Earthquake safety drills are an effective way to improve the safety capability of occupants. Current methods of earthquake safety drills mainly include practical16 enables participants to freely move in the real world while experiencing realistic earthquake scenes, therefore it blends the advantages of practical and virtual drills, and provides a new approach to earthquake safety drills.Mixed reality (MR) technology18 is one of the most popular MR headset devices, which can offer some featured functions such as mobility and spatial mapping. As a result, it has been widely utilized in various MR studies, including those focused on safety drills23. For example, Sharma et al.19 utilized HoloLens to provide three-dimensional (3D) holographic views of building floor plans, facilitating users in finding exits during evacuations. Asgary21 developed a research project named Holodisaster using HoloLens for emergency management training and public safety education.Currently, Microsoft’s HoloLens24. However, the above HoloLens-based earthquake studies have focused on emergency evacuation, without considering the hazards posed by indoor nonstructural components. If the evacuation environment is added with the indoor nonstructural seismic damage, the drills can help participants better avoid injuries caused by nonstructural damaged components and improve their safety capability during earthquakes. Therefore, it is very important to fully consider the indoor nonstructural component damage in MR earthquake safety drills.As aforementioned, nonstructural components are important factors affecting the safety of ocuppants25. Since the calculation of seismic damage is independent, it is necessary to extract the detailed information of nonstructural components. However, it is difficult to obtain information on individual components from the entire point cloud. Therefore, how to accurately extract the geometric and spatial information of nonstructural components from the entire point cloud is crucial for reconstructing the indoor 3D model.How to reconstruct the indoor 3D scene with nonstructural components? HoloLens can directly scan indoor scenes and provide indoor point cloud models for seismic damage simulation of nonstructural componentsHow to display MR seismic scenes of indoor nonstructural components? Unreasonable seismic damage scenes of nonstructural components may mislead occupants to make wrong decisions and fail to achieve the drill aims in indoor earthquake drills. Therefore, it is a challenge to create an accurate model of the nonstructural component physical processes for simulating indoor seismic damage, and to visualize the mixed-reality damage.How to guide earthquake safety drills considering seismic damage of nonstructural components? Providing safety guidance can assist occupants in learning reasonable indoor earthquake safety strategies. However, occupants face difficulty in identifying dangerous zones indoors as they cannot predict the impact of complex nonstructural components during an earthquake. Moreover, in MR drills, it is crucial to consider how to provide feedback to occupants on dangerous zones. Therefore, identifying safe zones and providing feedback to occupants on dangerous zones using the constructed indoor seismic scenes is an important issue in guiding earthquake safety drills.To implement such a HoloLens-based MR drill considering seismic damage of nonstructural components, the following three challenges need to be addressed.30. Hübner et al.28 proposed a voxel-based approach to construct indoor models using HoloLens triangle meshes. Martin et al.30 used HoloLens localization and spatial mapping in indoor environments to reconstruct a semantic indoor scene model. However, most of the existing scene reconstruction studies focus on building interior layouts, with fewer studies on reconstructing indoor nonstructural components. Therefore, this study aims to use HoloLens to reconstruct indoor nonstructural component scenes to provide better model support for indoor earthquake safety drills.For challenge (1), several studies have utilized the HoloLens’ spatial mapping for scene model reconstruction34. Hamaguchi et al.35 conducted shaking table tests on general full-size furniture and proposed a simple prediction method for furniture damage. Cimellaro et al.36 proposed a method to assess the risk of furniture tipping based on geometric parameters of furniture and seismic intensity measurements. However, these methods failed to show the damage of nonstructural components based on physical simulations. Xu et al.38 proposed a method to simulate and visualize the seismic damage of ceiling and movable furniture based on time-history analysis (THA), FEMA P-58 , and a physical engine. However, their seismic damage model for movable furniture did not analyze cases such as overturning. Therefore, based on the method of Xu et al.38, this study improved the seismic damage model of movable furniture so as to simulate and visualize the seismic damage of indoor ceilings and movable furniture.For challenge (2), the display of seismic damage scenes for nonstructural components such as ceilings and furniture has been studied41. Stigall et al.20 used HoloLens to provide users with 3D holographic views of building floor plans and guide them to evacuate. However, most earthquake guidance methods only considered the outward evacuation, ignoring the importance of indoor shelter. Feng et al.40 proposed immersive virtual reality serious games that guide people to take refuge indoors by embedding recommended behaviors into game scenarios, however, this method is only used in virtual reality scenarios without the integration with real environment. Amin et al.41 employed You Look Only Once (YOLO) for target detection to identify harmful objects during an earthquake. However, this method does not predict the extent movements of the damaged components, and therefore cannot identify safe spaces. The aim of this study is to use HoloLens to identify both safe and dangerous indoor areas, and provide guidance for participants seeking safe refuge.For challenge (3), several studies on earthquake guidance and hazard identification have been conductedIn this study, an MR drill method for indoor earthquake safety based on HoloLens is proposed considering seismic damage of nonstructural components. First, HoloLens is used to capture indoor point clouds, and the indoor three-dimensional scene is reconstructed by point clouds. Subsequently, the seismic motion models of indoor components are established, so that the indoor nonstructural seismic damage scene is constructed using the physics engine and displayed using HoloLens. Finally, a guidance algorithm for a safe zone was proposed based on HoloLens. Taking a typical office as an example, an indoor earthquake safety drill was performed to demonstrate the advantages of this method.42 is used to parametrically establish the indoor building information modeling (BIM) model. Therefore, a 3D reconstruction model of a real indoor environment is provided for earthquake safety drills.Indoor 3D scene reconstruction. Using HoloLens spatial mapping to quickly obtain indoor 3D point clouds. Then the spatial and geometric information of indoor nonstructural components is extracted through data processing. Finally, DynamoSimulation of nonstructural component seismic damage. Based on the BIM model, the seismic damage process for nonstructural components is calculated. Dynamic simulation in the physics engine using the THA results, so as to build a virtual scene of indoor seismic damage. The application is released on HoloLens to visualize the seismic damage scenes in MR, and the realism of seismic damage scenes is verified through a shaking table test.Guidance for Earthquake Safety. The motion area of nonstructural components is obtained by calculating various parameters during the moving process. Safety zones are identified based on three discriminant conditions. Visual guidance is provided by highlighting safety, danger, and caution zones with different colors, allowing participants to quickly reach a safe location during an earthquake.As shown in Fig. The study was approved by the Ethics Review Committee of the University of Science and Technology Beijing (2023-2-155). All experiments were performed in accordance with relevant guidelines and regulations in the Declaration of Helsinki. All participants were informed and informed consent was obtained to collect and publish their data and images.The consistency between the real indoor environment and the virtual drill scene is crucial for ensuring the effectiveness of the MR earthquake safety drill. If this study chooses to directly import available 3D models of nonstructural components, it will require significant manual work such as measuring the dimensions of nonstructural components and determining their coordinates to match the real indoor environment. On the contrary, reconstructing scenes by the spatial mapping of HoloLens can easily and quickly create indoor nonstructural components and keep the consistency between the real indoor environment and the constructed scene. Therefore, this study employs indoor 3D scene reconstruction, rather than importing available 3D models.Compared to high-cost and complex-to-operate terrestrial or mobile laser scanning (TLS/MLS) devices, HoloLens provides a low-cost and highly operable solution of spatial mapping. This study fully utilized the accessible triangle meshes generated by the spatial mapping of HoloLens 2, wherein the indoor 3D point cloud model was obtained without the need for additional tools. By adopting the 3D point cloud model for indoor 3D reconstruction, this study efficiently established a BIM model that provides the necessary information and can be converted into various model formats, such as FBX. This provides important model support for subsequent seismic damage calculations and safety drills.43 to obtain an optimized point cloud. Bilateral upsampling was employed to increase the resolution of the point cloud, while voxel filtering was used to remove noise points and outliers. Then, feature points were extracted to achieve registration, resulting in usable indoor point cloud data.Model collection. The indoor scene is scanned using HoloLens 2 for generating triangle meshes and obtaining a point cloud model that can be used for subsequent calculations after preprocessing. To begin with, 3D scanning was performed with a focus on maintaining model integrity. The environment was scanned every 3 s using the spatial mapping of HoloLens. The surface grid of the collected objects could be dynamically observed, and the vacant areas were re-scanned to obtain a relatively complete model. Subsequently, the scanned model was preprocessed using the point cloud library (PCL)44 proposed PointNet +  + , a relatively mature point cloud processing algorithm capable of achieving preferable semantic segmentation results. Therefore, the PointNet +  + algorithm was used to identify and segment the point cloud model, resulting in a point cloud model file for the nonstructural components. The 3D size of each nonstructural component was calculated, and the relative spatial position of the nonstructural components was determined by acquiring the center coordinates.Data extraction. The point cloud model is semantically segmented to include semantic information about the nonstructural components, allowing the geometric dimensions and spatial coordinates of these components to be extracted. The geometric and spatial information of each nonstructural component was extracted. The core issue was to semantically segment the point cloud, which aims at obtaining the point cloud of each nonstructural component. Charles et al.45 can generate BIM models that are detailed down to the component level, manually selecting walls, floors, ceilings, etc. is still necessary. To achieve automatic parametric modeling, Dynamo was selected due to its convenient visual programming environment. By importing only nonstructural component categories and the corresponding dimensional information to Dynamo, the indoor BIM model could be efficiently created for seismic damage simulation and MR display.Parametric modeling. The BIM model is parametrically modeled to obtain a 3D reconstructed model. While commonly used BIM software such as RevitThis study proposes a solution for reconstructing indoor 3D scenes using HoloLens, as shown in Fig. Accurate seismic damage simulation can provide effective seismic damage scenes for MR drills. This study calculated seismic damage to suspended ceilings and movable furniture, simulated the seismic damage process of nonstructural components using object motion models and physical engines, and visualized indoor MR seismic damage scenes using HoloLens.46, engineering demand parameters (EDPs), such as inter-story drift ratio and peak floor acceleration, are necessary for accurately calculating the seismic damage of nonstructural components. Generally, the EDPs can be calculated by the THA. This study performed the THAs of the building structures according to the reference47 and used the EDPs outputted by the THAs to calculate the seismic damage of nonstructural components according to FEMA P-58.Time-history analysis: According to FEMA P-58 38. This model can accurately predict the falling-out state of suspended ceilings by the probability value of the FEMA P-58 vulnerability curve corresponding to the peak floor acceleration obtained through the THA. The comprehensive description of this seismic motion model of the suspended ceiling can be found in the reference37.Seismic motion model of suspended ceiling: To calculate the seismic damage to the suspended ceiling, this study adopted the seismic motion model proposed by Xu et al.m, and an aspect ratio of W and H present the weight and the height of the movable furniture, respectively. The angle α is given by Seismic motion model of movable furniture: Given the various hazardous motions exhibited by movable furniture, such as rock and overturn, it is essential to obtain its motion model. The schematic of the seismic motion model is shown in Fig. Fx and Fy are the horizontal and vertical forces on the movable furniture, respectively; M is the moment of inertia.When the movable furniture remains stationary, the following equilibrium equations are satisfied:49:sgn is the signum function.When the movable furniture rocks, without considering slipping and energy loss, its motion equation can be expressed asθ is always greater than the angle α, i.e., Eq. ) in ) in 3)) 50, a widely-used 3D visualization platform is employed in this study for the above simulation and visualization, because it is open source and provides some good interfaces with HoloLens.The aforementioned seismic motion models were used to simulate the seismic damage of nonstructural components, and then the simulated seismic damage scene was visualized by using HoloLens. UnityFirst, the indoor scene containing nonstructural components was constructed by converting the BIM models created by HoloLens into 3D models in Unity. Subsequently, the physical parameters of nonstructural components, such as friction and mass, were configured in Unity, which can be extracted from the BIM model of nonstructural components. Finally, a physics engine  integrated in Unity was used to simulate the seismic damage of indoor nonstructural components based on the seismic motion models in this study.38. The physics engine was used to activate the gravity of these falling-out suspended ceilings, and assign them instantaneous horizontal velocity of the floor, which can be obtained from the THA.For the suspended ceiling, a random function was used to select a certain number of fallings-out suspended ceilings according to the aforementioned seismic motion model proposed by Xu et al.For movable furniture, according to the motion model, the inertial force and frictional force can be calculated by Eqs.  and 2)..2). PhysRendering configuration: The background was set to black, allowing it to be processed as transparent during rendering. The graphic quality was adjusted to ensure optimal rendering performance.Spatial registration: The camera coordinates and angles were set to match the user’s line of sight and camera direction. Spatial anchors were enabled to ensure proper registration between the holographic objects and the real world.Application deployment: The project generated in Unity was deployed through Visual Studio. This project will be uploaded to HoloLens device, which enables the MR visualization of the seismic damage scene in HoloLens.The above constructed seismic damage scene can be visualized in HoloLens, which includes three steps:38 has demonstrated that the simulation results were consistent with the experimental data.To validate the effectiveness of the seismic damage simulation, the existing experiment and the simulation results in this study were compared. For the suspended ceiling, the existing research conducted by Xu Zhen et al.34 in this study, as shown in Fig. In terms of movable furniture, the simulation was compared with the shaking table test of the bookcase by Luo et al.Figure 14 recommended by the U.S. federal, state and local emergency management experts and other official preparedness organizations, seeking a safety zone that can cover the body of a participant is important for indoor earthquake safety drills. To help participants identify such a safety zone, this study proposed a new algorithm for guiding earthquake safety drills, which includes three parts: (1) motion area acquisition, (2) safety zone identification, and (3) guidance, as shown in Fig. During indoor earthquake safety drills, participants are supposed to learn proper earthquake safety strategies through guidance. According to “Drop, Cover, and Hold on” strategyAcquiring the center coordinates: In the process of modeling, exporting, and importing, it is possible that the axis of the model may not be in the center. To address this, the MeshRenderer component in Unity was used to obtain the mesh information, allowing for the calculation of the model’s center coordinates L), width (W), and height (H), were obtained using the GetComponent < MeshFilter > .mesh.bounds.size function, from which the actual dimensions of the model can be obtained.Acquiring the model’s dimensions: The dimensions of the model, including the length  was useg to Eq. , the coon q Fig. .7\documeGenerating the motion area: The corner coordinates calculated by each frame were used to generate the motion area of the model. Since the model is expected to slide, rock and overturn, the motion area should be a three-dimensional area. However, displaying a three-dimensional area in MR may obstruct the sight of participants. Therefore, the motion area was simplified into a two-dimensional plane, and the extremum values of the corner point coordinates at the plane projection were recorded to generate the plane of the motion area.The motion area of the 3D models of the nonstructural components can be accurately acquired by the following four steps: (a) acquiring the center coordinates of the 3D model; (b) acquiring the model’s dimensions; (c) calculating the model’s corner point coordinates; (d) generating the motion area of the model.the furniture does not overturn;a shelter space exists inside the furniture;the space’s dimensions meet the average human body.The identification conditions for the indoor earthquake safety zone proposed in this study were as follows Fig. :the furnFor areas that meet all the above three conditions, they will be identified as safety zones. Areas that do not meet condition (a) will be directly identified as danger zones. Areas that do not meet either condition (b) or condition (c) will be recognized as caution zones.θ. According to the seismic motion model, when Eq. (For the identification condition (a), the algorithm of the motion area acquisition was used to determine the model’s rotation angle when Eq.  is satisFor the identification condition (b), there must be an occlusion above the shelter furniture and the interior must be hollow. Collision detection is used to confirm this. A detection ray was emitted from the ground upward and directed towards the model. If the detection ray does not collide with the bottom of the model, it is assumed that there is a shelter space in that area.51, and due to the lower posture during evasion, the height is adjusted by a reduction coefficient of 0.8 based on experimental measurements, giving a final value of 0.7 m. Therefore, if the length and width are greater than 0.5 m and the height is greater than 0.7 m, the shelter space is considered safe.For the identification condition (c), the dimensions of the model were acquired to determine the length, width, and height of the shelter space. Based on the average size of the human body, the width of a person is assumed to be 0.5 m. The crouching height is assumed to be half of the person’s heightVisualizing safety and danger zones can guide participants to quickly reach a shelter during an earthquake. To make the guidance clearer, the motion area was specifically highlighted, and colors were added to the different areas. Safety zones are indicated in green, while to reduce the influence on participants caused by more colors, both danger and caution zones are indicated in red. The GetComponent function was employed to obtain the rendering component of the corresponding plane, and the render.material.color function was used to set the material color of the model. By employing this visualization, earthquake safety guidance was realized, as shown in Fig. An office in a teaching building was chosen as the drill site Fig. a. The roThe indoor BIM model was imported into Unity, where corresponding properties for each component were assigned, including physical parameters, seismic damage scripts, etc. The application was then deployed to HoloLens for completing preparations before the safety drill Fig. b.Traditional on-site earthquake safety drill in a no-seismic damage scene (NoMR): Participants evacuated based on their own experience while viewing holographic images of indoor nonstructural components, without any earthquake response or guidance.MR earthquake safety drill (MR_NoGuide): Participants observed the holographic images of indoor furniture rocking and the ceilings collapsing randomly Fig. , and tooMR earthquake safety drill with guidance (MR_Guide): Participants were shown the holographic scene of the seismic damage and provided with earthquake safety guidance Fig. . With thThe designed MR safety drill was compared under different conditions, including with and without MR, as well as with and without guidance. The starting position of the participants is depicted in Fig. The time interval between the three drills was more than a month, ensuring participants had sufficient time to eliminate the learning influence between different drills. Additionally, a relatively ordinary office was selected as the drill scene to prevent participants from forming deep impressions of the scenes during repeated drills.Nine volunteers participated in the indoor earthquake safety drills, and their characteristic actions were captured using HoloLens. Path tracking was utilized to record their 3D evacuation paths, while attention capture was used to record the direction of their gaze through eye tracking. The obtained data were used to analyze their safety strategies, attention characteristics, and earthquake evacuation efficiency.Figure In the first NoMR drill, only one participant reached the safe zone, while the rest of the participants dispersed in various positions. One participant even chose to flee the room immediately when the earthquake occurred.In the second MR_NoGuide drill, none of the participants were able to reach the safe zone, and most of them sought shelter in an open corner away from objects that rocking heavily, such as bookcases. The path of the participants was chaotic as they tried to avoid overturned furniture and falling ceilings.In the third MR_Guide drill, eight out of nine participants successfully reached the safe zone with relatively regular evacuation paths, indicating minimal hesitation during the process. Only one participant failed to reach the safe zone. According to the interviews with participants after drills, they were afraid of the earthquake scene in MR. The participant who failed to reach the safety zone also expressed that he was too afraid to complete the drill. This further reflects the realism of the MR drill.Figure In the first NoMR drill, participants’ attention to the furniture was distracted, with an average of twice.In the second MR_NoGuide drill, after adding the MR seismic scene, participants paid more attention to the dangerous furniture that was prone to rocking. The average frequency the participants paid attention to “Bookcase 1” increased from 2.3 to 6.In the third MR_Guide drill, with the addition of earthquake safety guidance, the average frequency participants paid attention to indoor components was significantly different. The average frequency participants paid attention to “Desk” in the safe zone reached 8.6, which is more frequent than other indoor components.In this study, evacuation efficiency is defined as the completion time taken from the start of the earthquake drill until participants complete their safety actions. By extracting the time at which the height changed, it is possible to determine the exact moment when participants completed safety actions. Figure P = 0.0444 < 0.05). Similarly, there are significant differences between the MR_NoGuide and MR_Guide (P = 0.0018 < 0.01), as well as between the NoMR and MR_Guide drills (P = 0.0116 < 0.05). This indicates a significant difference in the results of the three drills.Figure Compared to the first NoMR drill, the completion time of the MR_NoGuide drill increased by 3.25 s and the evacuation efficiency decreased by 23.9%. This is because the constructed seismic damage scene makes participants respond more realistically, leading to behaviors such as fear and hesitation. Therefore, participants need to spend more time responding and making decisions, which lengthens the evacuation process and reduces its efficiency. When compared to the MR_NoGuide drill, the completion time of the MR_Guide was reduced by 7.25 s and the corresponding evacuation efficiency increased by 43.1%, which indicates that guided MR drills greatly improved evacuation efficiency.(1) Effects of MR scene on indoor earthquake safety drill.Table In this study, participants’ evacuation responses in the MR scene are closer to the behavior in real earthquakes. They are more aware of dangerous nonstructural components, with more chaotic evacuation paths and longer completion times. As a result, MR earthquake safety drills provide participants with a more realistic experience of seismic damage scenes. Therefore, the MR drill method is instrumental in deepening participants’ impression of earthquakes and enhancing their preparedness for disasters, improving the effectiveness of earthquake safety drills.(2) Influence of the guidance on indoor earthquake safety drill.Table In the unguided drills, participants made incorrect actions due to their lack of knowledge about indoor earthquake safety. They may hide in corners, next to bookcases, or attempt to flee the room, often ignoring the danger from the head, such as falling ceiling. By providing MR earthquake guidance, participants learned the “Drop, Cover, and Hold on” safety strategy, which will enable them to safely take cover during an earthquake. Additionally, with guidance, the evacuation efficiency of participants significantly improved, with evacuation completed in less than 10 s. Therefore, the MR guidance method can enhance earthquake evacuation efficiency and significantly improve the safety of participants.The proposed method can reconstruct the 3D models with nonstructural components based on the point cloud data scanned by HoloLens, and accurately simulate the earthquake-induced motion process of typical movable furniture and suspended ceiling, leading to a reasonable and realistic sense of the indoor seismic damage scene. Moreover, the method can guide the safety zone for earthquake safety drills.Compared to the safety drills without seismic damage scenes, the completion time of the MR drill increased by 3.25 s and the evacuation efficiency decreased by 23.9%. This is because the constructed seismic damage scene with nonstructural seismic components makes participants fear and hesitation, and thus they need to spend more time responding and making decisions. The result indicates that the MR safety drills in this study can provide realistic seismic damage scenes and make participants’ responses closer to the real earthquake.The MR safety guidance can significantly improve the safety ability of participants. The drill results indicated that the evacuation efficiency increased by 43.1% due to the MR guidance.In this study, an MR method for indoor earthquake safety drills considering nonstructural component damage was proposed, and a typical office was taken as a case study. The main conclusions were drawn as follows.By integrating the virtual seismic damage scene with the actual indoor environment, the MR drills enable participants to learn how to keep safe properly in the earthquake, thereby reducing casualties. However, since the furniture considered in this study is quite regular, it is possible to develop additional seismic damage models for irregular furniture, which can create more indoor seismic damage scenes in the future. Moreover, a safety scoring model can be also incorporated to provide participants with more effective feedback in the following study.


This article was migrated. The article was marked as recommended.Introduction: Students enter new environment in medical colleges at around 17 years of age directly from school which can be challenging. Therefore, in Graduate Medical Regulations 2018 of India, attempt has been made to orient medical learners to MBBS program and provide them with requisite knowledge, communication, technical and language skills through a month-long foundation program. The purpose of this study is to share learning and to document feedback and best practices that would enhance the value and structure of the program in coming years.Methodology: Descriptive evaluation of the foundation program implemented at a medical college located in western India as per the guidelines of the Curriculum Implementation Support Program (CISP). This program was implemented by all medical colleges under the ambit of Medical Council of India from August 2019.Teaching-Learning Methods:Interactive sessions and assessment mainly based on reflective writing or by verbal/written feedback. To help in program evaluation and refinementa pretested semi-structured questionnaire administered to the students and faculty to gather their perceptions about various aspects of the course on a Likert scale of 1-5; 5-Strongly agree, 4-Agree, 3-Uncertain, 2-Disagree, 1-Strongly Disagree and three open-ended questions at the end of the course. Data was entered into Microsoft Excel 2007 and descriptive statistics utilized for interpretation of perceptions, themes and direct quotation used in the analysis.Take Home Message: The enthusiasm, hard work and integrated effort by the faculty members who participated in the program were extremely important for the success of this course. It is learnt that the Foundation program highlights benefits, is a valuable vehicle for increasing students’ overall confidence. There are challenges involved in operationalization viz; it requires more time and effort from faculty, at least in the initial phases of program development. A curriculum defines the learning that is expected to take place during a course or programme of study in terms of knowledge, skills and attitudes. The written and published curriculum is the official or formal curriculum. Curriculum or course needs to be monitored and evaluated to ensure that it is working as planned and to identify areas or improvement.The undergraduate medical curriculum of the Medical Council of India (MCI) has undergone revisions from time to time but the “Regulations on Graduate Medical Education of 2018” represents the first major revision to the medical curriculum since 1997 and hence incorporates changes in science and thought over two decades . The curStudents enter new environment in medical colleges at around 17 years of age directly from school which can be challenging. Therefore, in the new curriculum attempt has been made to allow students from diverse educational streams and backgrounds in terms of geography, culture, language, economy, social construct, medium of instruction and education boards to transition appropriately from school to professional course through a foundation program . The UniThis foundation program is of one-month duration, offered at admission to orient medical learners to MBBS program and provide them with requisite knowledge, communication (including electronic), and technical and language skills. The purpose of this study is to share learning and to document feedback and best practices from the implementation of foundation program during August 2019. It is believed that this learning experience would enhance the value and structure of the program in the coming years.As per the new curriculum guidelines , every yPurpose of the Foundation Program/course is;1.To orient the undergraduate medical students to all aspects of the medical college environment.2.To equip them with certain basic, but important skills required for patient care and enhancing their communication, language, computer and learning skills.3.To provide them opportunity for faculty and peer interactions and an overall sensitization to the various learning methodologies.It contains six modules like; Orientation, Skills, Community orientation, Professionalism & ethics, Enhancement of language, computer skills, Sports and Extracurricular activities . Each moStudy setting & participants: A month-long foundation program commenced on 1st of August 2019, at a Medical College located in western India. A batch of 200 students; 56 (28%) females and 144 (72%) males, from all medium of instructions, took admission to the first professional course of MBBS, through an all India entrance test in the form of National Eligibility cum Entrance Test (NEET), after successful completion of twelve years of schooling. NEET is MCQ based test offered in twelve Indian languages.Curricular Governance: The governance oversight of the curriculum took place through the Curriculum Committee (CC) and the program was owned and conducted by the pre-clinical departments with appropriate input and faculty support by other departments. A foundation Program/Course Committee with a designated foundation program co-ordinator was formed under the principal of the Medical College in collaboration with the Curriculum Committee and MEU for smooth conduction of the foundation course. MEU undertook faculty development program to train and orient the resource persons. The curriculum committee co-ordinator in close collaboration with the foundation program committee members prepared a detailed schedule of the sessions for one month and allocated the sessions to the resource persons . They closely monitored the program on a daily basis and coordinated with the administration, students and clinical faculty.Ethics: Verbal consent was obtained from students and faculty before administration of questionnaire and use of photographs for research purpose. The protocol of the program was submitted to the Institutional Ethical Committee. The same was approved with no: PDUMCR/IEC/2376/2020, dated: 15/02/2020.Objectives of the implementation of foundation program were: To gather perceptions of the students and faculty about various aspects of the course; to document feedback and best practices.Design: The current study is a descriptive evaluation of the foundation program implemented at a government medical college located in western India.A detailed schedule was prepared well in advance showing all the aforementioned modules with their respective topics and as per the guidelines of the Foundation Program . On veryMost of the orientation/learning took place in hospital setting by dividing the students into small batches of five. They were then taken to community health center, accompanied by faculty from community medicine department. Before visiting these centers, the students were appraised on various National Health Policies and Healthcare System of India. Simultaneously, in rotation these batches undertook stress management & computer skills training. There were detailed sessions on professionalism and ethics module; viz interpersonal relationships, professional and altruistic behavior, time management, learning strategies, disability competences, organ and dead body donation awareness, ragging etc. Dedicated time slots were allocated for local (Gujarati) and English language skills for the students joining from outside Gujarat and from Gujarati medium respectively. There were separate sessions on communication skills and basic computer skills as per the schedule. A protected time was allocated to the students for reflective writing/journal to reflect on their learning of various sessions.To conduct and to complete the entire foundation program effectively and as per schedule a total of 60 faculties contributed their time and efforts. Out of which, 8 were invited as guest faculty from various specialties, who were awarded certificate of appreciation. Others were; the internal faculty from various departments of the institute.T-L Methods: The shift in focus from knowledge acquisition to application necessitates important changes in the learning process: Therefore, the “Regulations on Graduate Medical Education”  females and 144 (72%) males, took admission in the first professional course of MBBS at the Medical College studied in August 2019. We describe the design, implementation and evaluation of one-month long foundation program, the students undertook after admission. Out of the 200 students in the class, 189 were present on the last day to offer feedback, although they were informed a day before. Due to busy schedule and heavy OPD duties in the mornings, only four internal faculties out of the 52 who participated in the program were present on the last day. Others were tried to be contacted through sending the questionnaire at their respective places and after two reminders 18 of them completed the same.(A) Evaluation by the Students:The mean score by students to various aspects of the program on a scale of one to five as shown inFurther research  reported(B): Evaluation by the Faculty:Almost all of the 18 faculty who completed the feedback questionnaire rated the various aspects of the program as good to very good (between 3 to 5 of 5). Major strength of the program was that; the students were thoroughly interested, the program provided them a common platform and enhanced coordination between different faculty. Some of the suggestions for improving the program were;need toinvolve a greater number of external faculty from specific subjects like language , sports, computer, advance planning, greater co-ordination among faculty, optimum and adequate resources, duration of didactic lecture be made shorter.One of the faculty put it like this,“the strength of this program is that students are aware about the whole MBBS curriculum but the challenge is that resource persons from outside needs to be invited”.One another said “what I observed was, some students were thoroughly interested while some were not. So, extra efforts should be made to make every student interested in the program. Also, that the sessions should be made short and sweet”.Lessons learnt: It is learnt that the Foundation Program highlights benefits, is a valuable vehicle for increasing students’ overall confidence. The program benefits as perceived by the students included; helping them to gain clarity on their future roles as medical professional/doctor as envisaged by MCI, orienting them to medical ethics and professionalism, enhancing their time and stress management skills, enhancing their communication, language, computer and learning skills, oriented them towards alternative systems of medicine, exposure to hospital and community health centers provided opportunity to communicate with the patients and their relatives leading to realization of the authentic setting of their future role, orienting them towards importance of sports and extracurricular activities to mention a few. Based on faculty feedback, this provided a common platform and enhanced coordination between different faculties. We also learned that there are challenges involved in operationalization viz; it requires more time and effort from faculty, at least in the initial phases of course development. Other challenges include; finding ways to include a greater number of external faculty from specific subjects like language, sports and computer skills, sound planning and co-ordination among faculty along with strong will of those involved, optimum resources in terms of infrastructure for sports, dedicated vehicle for visits to community health centers and audiovisual aids. Inclusion of in-depth qualitative feedback from faculty and students would yield better insight into scaling of the program.To summarize, we learned that this type of foundation program is feasible within a conventional medical curriculum. The benefits of such learning include clarity on future roles as medical professional/doctor as envisaged by MCI right from intake into the program, thus improving knowledge and skills of learners, and hence likely to improve quality of health care provided to the patients.Limitations: One of the limitations of this study is that it evaluated single medical school, which may not represent the “Indian Medical Graduate” as a whole. Therefore, caution should of course be exercised in extrapolating results to all students in all medical schools. Further studies should aim to determine attitudes of medical students in all medical schools of India to get higher generalizability.What Next: The learning and best practices would be shared, by organizing a dissemination seminar for faculty, professional and regulatory bodies and members of the university’s board of studies committee. Enlisting support and feedback from different colleges of the state would result in achieving uniformity in implementation of the program. It is believed that this learning experience would enhance the value and structure of the program in the coming years. Inclusion of in-depth qualitative feedback from faculty and students would yield better insight into scaling of the program.•The enthusiasm, hard work and integrated effort by the faculty members who participated in the program were extremely important for the success of this program.•It is learnt that the Foundation Program highlights benefits, is a valuable vehicle for increasing students’ overall confidence. The benefits of such learning include clarity on future roles as medical professional/doctor right from intake into the program, thus improving knowledge and skills of learners, and hence likely to improve quality of health care provided to the patients.•There are challenges involved in operationalization viz; it requires more time and effort from faculty, at least in the initial phases of course development. Other challenges include; finding ways to include a greater number of external faculty from specific subjects like language, sports and computer skills, sound planning and co-ordination among faculty along with strong will of those involved, optimum resources in terms of infrastructure for sports, dedicated vehicle for visits to community health centres and audio-visual aids.•We learned that this type of program is feasible within a conventional medical curriculum.Dr. Shobha Misra is working as Professor and Head of department of community medicine at P D U Medical College, Rajkot. She holds degrees in community medicine, naturopathy & yoga, hospital administration, mother & child health, human resource management. She is FAIMER fellow from Philadelphia and has been honoured with F-IAPSM. She has a teaching experience of 28 years. She is actively involved in teaching and training of health professionals. She has 40 publications in various national and international journals to her credit.Dr. Nilesh Fichadiya is working as lecturer in department of community medicine at P D U Medical College, Rajkot. He is involved in teaching undergraduate professional MBBS students for last 10 years. He is MD in community medicine and diploma in public health. He is also working as program incharge for certificate course in community health being conducted at community medicine department.Dr. Viren Kariya is working as Associate Professor in department of Anatomy at P D U Medical College, Rajkot for last 15 years. He was the program coordinator for the program. This review has been migrated. The reviewer awarded 3 stars out of 5 Student contributions are always welcome and this is no exception. The concept of a nation-wide, 4 week-long foundation program for entering medical students is interesting. I believe that most medical schools have programs that ease new students into what is often very intense study, but in most cases I have seen this is usually within the first 1-2 weeks. For secondary school leavers this can be a steep learning curve to different modes of learning with greater autonomy and responsibility. Hence this description is useful, showing how a slower, planned process engages new students. What leapt out at me in the data were a suggestion that the program may have been a little too teacher-centric, with a lot of faculty driven content in lectures. Perhaps more student-run activities with more senior students would add values? The take home messages show that the faculty are thinking about making improvements. Overall this is well worth reading by those engaged in Year 1 course management.Reviewer Expertise:NANo decision status is available This review has been migrated. The reviewer awarded 4 stars out of 5 I am pleased to see that the authors have addressed the major concerns I raised with Version 1 of their paper. The Discussion, though, is still very weak, and the authors have missed the opportunity for this study to be more solidly placed within the literature on the topic. .Nevertheless, the paper is a useful read and contribution to the field. Thank you.Reviewer Expertise:NANo decision status is available This review has been migrated. The reviewer awarded 3 stars out of 5 The paper deals with student and staff perceptions towards the introduction of a Foundation program at a medical school in order to meet changes in guidelines. Overall, the study has been well-conducted. There are, however, areas that need to be addressed.• Introduction: Apart from the local administrative documentation, there is no literature referenced. The problem with doing that is that it confines the importance of the research to a very localised context only. If the authors wish the paper to have interest to a wider audience, then they need to broaden their literature – at the very least, they need to refer to academic literature dealing with these issues in India, by going beyond the three pieces that they have cited.• Results: I would like to see the qualitative data laid out more formally according to themes . At the moment, the qualitative data are simply deposited on the page, with no real context.• The Discussion is weak with, again, no reflection on the results in light of current literature. If the authors leave it as it is, then it remains a paper with very localised interest only. The authors need to be able to relate their results to current literature on the topic.Minor• There are many small language errors, especially in dropping articles, and I would encourage the authors to carefully proof-read their manuscript before re-submission.• The term “ragging” as it appears to be used in this paper, is not universally known, and should be explained.So, while the study is worthwhile, the authors have done themselves a disservice by not viewing their study within the broader context. I look forward to a Version 2 in which this is corrected.Reviewer Expertise:NANo decision status is available This review has been migrated. The reviewer awarded 3 stars out of 5 Interesting article on the foundation program as per the revised competency based undergraduate medical curriculum drafted by Medical Council of India (MCI).Introduction, methodology, and analysis of data have been well explained. My suggestions for intensification of the manuscript are follows:It would have been best to obtain written consent at the beginning of the study once ethical approval was acquired by the institutional ethical authority, since you have presented students pictures, their poster presentation and role play.Validation method of questionnaire has been described. Why this questionnaire was not filled by all the students if everyone had undergone the program (being mandate as per council guidelines). Out of 60 faculty members only 18 filled the feedback form, no specific reason has been highlighted by the author.The authors can compare this program with similar programs globally or it would have been good to compare it with the orientation program being conducted by various Indian medical institutes for previous batches. How this program is better than the earlier orientation program? Quotes from the students could generate a theme thus present as a qualitative analysis of the presented data.The authors need to have continuous focus on this batch so as to identify attitudinal modification of the students as they move ahead.All the best for further analysis of the study.Reviewer Expertise:NANo decision status is available This review has been migrated. The reviewer awarded 4 stars out of 5 This is an interesting article on the foundation program at a medical school in western India. The authors have put in a lot of effort into designing and conducting the program and in carrying out the study. The study is well described and the methodology is clear. My suggestions for further strengthening the manuscript follow:The authors can mention the process followed for selecting medical students in India and mention that most students join the program after twelve years of schooling. The authors have obtained ethical approval for the study but the fact that they obtained only verbal consent may raise some ethical issues. This is especially true as they have also used identifiable student photographs in the article. The same is also true with regard to the participation of faculty members. Where, how and when were the questionnaires administered? The participation of the faculty was low while I believe all students who were present on the final day of the session participated in the study. Where were the sessions held? One challenge would be accommodating the large number of students (200). From the photographs it seems like most sessions were held in lecture halls. The proportion of female students in the college is low. What is the relationship between the MEU and the curriculum committee? The authors in the Discussion can try to compare the foundation program with other similar programs globally though the duration and the methods employed may be different. All educators, especially those from India, will find this article to be of interest.Reviewer Expertise:NANo decision status is available


BCR-ABL1-positive acute lymphoblastic leukemia 2 years later. The patient responded well to tyrosine kinase inhibitors and chemotherapy, and achieved a molecular remission. Although APL usually has a good prognosis, the prognosis of its secondary malignancies is uncertain. There are no effective measures to prevent the occurrence of secondary tumors. Continuing to increase the monitoring frequency of laboratory tests, especially the molecular biomarkers, is essential for the diagnosis and treatment of secondary malignancies after the patients achieving complete remission.Acute promyelocytic leukemia (APL) is currently considered a disease with a higher cure rate. And cases of secondary malignant tumors following successful APL treatment are rare. Here we described a rare case of a 29-year-old man who was treated for APL in 2019 and developed  PML) gene and the retinoic acid receptor alpha (RARα) gene was formed by this chromosomal abnormality  and BCR-ABL1 (p210). And the BCR-ABL1 (p190) mainly occurs in acute lymphoblastic leukemia (ALL) patients (BCR-ABL1 (p190)-positive ALL following successful treatment of APL, and provide a literature review to summarize the characteristics of this subset of patients.Acute promyelocytic leukemia (APL) is a distinct type of acute myeloid leukemia (AML), which is designated as M3 subtype by French-American-British classification . It is cormality . The appormality . Despitepatients . Here, w9/L, hemoglobin level 95.0 g/L, platelet counts 20.0 × 109/L. The bone marrow (BM) morphologic evaluation revealed 80.4% typical promyelocytes  analysis  showed that 83.5% of examined cells possessed BCR (green) and ABL1 (red) fusion signals (yellow) , EP300 (exon31:c.C5957T: p.P1986L) and JAK3 (exon11:c.G1503T:p.Q501H) mutations. Then the patient was treated by chemotherapy with tyrosine kinase inhibitors (TKI) dasatinib (100 mg/day). The induction chemotherapy regime was VICD . After the induction chemotherapy, the patient achieved a complete hematologic response, while FISH showed that 0.1% of examined cells still expressed the BCR-ABL1 fusion signals, and molecular biology showed a considerable reduction in BCR-ABL1 (p190)/ABL1 from 100% to 0.16%  . Quantition gene . RNA-seqto 0.16% . The patBCR-ABL1 (p190) gene could be detected as early as August 2021. However, the patient’s blood counts and bone marrow characteristics was normal at that time, and the PML-RARα gene was also negative, so the chemotherapy regimen was not changed.In order to determine the specific time of the patient’s secondary leukemia, we retrospectively tested his BM samples before November 2021, and the results showed that the positive expression of the MLL/AF-1p fusion gene  should be increased after receiving CR, in order to achieve the purpose of early detection and early treatment.In conclusion, we reported a rare case of secondary


Cardiac rehabilitation (CR) is an essential component in secondary prevention of cardiovascular diseases. Current guidelines recommend that the program should be comprehensive including multidisciplinary behavioral intervention, not only exercise training. While the utilization of CR is gradually increasing, the comprehensiveness of the program has not been systemically evaluated in Korea.During the year 2020, nation-wide survey was done to evaluate the current status of CR in Korea. Survey was done by web-based structured questionnaire. Survey was requested to 164 hospitals performing percutaneous coronary intervention.Among 164 hospitals, 47 (28.7%) hospitals had CR programs. In hospitals with CR, multidisciplinary intervention other than exercise-based program was provided only partially: nutritional counseling (63%), vocational counseling for return to work (39%), stress management (31%), psychological evaluation (18%). Personnel for CR was commonly not dedicated to the program or even absent:  physical therapist , nurse , dietician , clinical psychologist .Comprehensiveness of CR in Korea is suboptimal and human resource for it is poorly disposed. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved. Cardiac rehabilitation (CR) is being recommended as an essential component of secondary prevention of cardiac diseases such as coronary artery disease and heart failure by guidelines –3. ThougExperts have pointed out various barriers in implementing comprehensive CR and among which is a personnel factor . WorkingThe purpose of this study is to investigate and describe the comprehensiveness of CR program and its human resource disposition using Korean nation-wide survey data.This is a descriptive study of current status based on the nation-wide survey data. To examine CR’s current status in the South Korea, the CR-General Questionnaire (CRGQ) was developed after analyzing the national and international CR clinical practice guidelines –3, 10 anSurvey questions regarding the components of CR programs asked about whether following components were being provided or not: cardiovascular(CV) risk factor evaluation, cardiopulmonary function test (or other tests for exercise capacity), evaluation for comorbidity, individualized exercise prescription, supervised exercise session, education for self-monitoring of heart rate, education for CV risk factor management, medication adherence, nutritional counseling, psychological assessment, vocational counseling, stress management, reassessment at the end of the hospital-based program and follow-up after the program. Provided CR components were compared according to the regions: Seoul and Kyunggi vs. other regions. In Korea, medical resources are more concentrated in Seoul and Kyunggi region, the capital area, than the other regions. The numbers of hospitals with CR program are similar between Seoul and Kyunggi versus other regions. The comparison as such may reveal the characteristics of the capital area.For hospitals without CR program, shortened questionnaire was done including questions whether following components were provided or not: cardiovascular (CV) risk factor evaluation, risk assessment for exercise, individualized exercise prescription, education for CV risk factor management, medication adherence, nutritional counseling.Questions regarding the disposition of human resource were asked to the hospitals with CR program, asking whether personnel of the following discipline were available or not: medical director, physical therapist, registered nurse, clinical psychologist, dietician, exercise specialist. And when the personnel were available, it was checked whether the job of the position was dedicated to cardiac rehabilitation program or concurrent with other work.p < 0.05.The proportions were reported in percent. The chi-square test was used to compare the proportions between regions. All statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) . The level of significance was set at This study was approved by the Institutional Review Board of the Samsung Medical Center, Seoul, Korea (IRB No 2020-04-017) and other participating centers. The need to obtain informed consent was waived due to the non-clinical and minimal-risk nature of the study. No personal information  were collected and thus the participants’ anonymity was preserved.Among the 164 PCI-performing hospitals nation-wide, 47 (28.7%) hospitals had established CR programs, which was reported in previously published article  but reprAmong 164 PCI-performing hospitals, 147 hospitals responded to the survey (Response rate 89.6%) and data from the 147 hospitals (47 with CR and 100 without CR) were used for analysis of this study. Among 47 hospitals with CR program, 91.8% were doing coronary artery bypass graft surgery, 41.2% were doing left ventricular assistance device and/or heart transplantation, in addition to PCI (100%). Among 51 medical directors of the CR program 82.4% were in the department of rehabilitation medicine, 11.8% in cardiology. The number of patients participating inpatient CR program was over 300 persons/year in 21.6%, 100–299/year in 35.2%, less than 100/year in 35.3%. However, the number of outpatient CR program is much lower: < 50/year in 45.1%, 50–99/year in 15.7%, ≥ 100/year in 31.4%.While all the hospital with CR program had facility and equipment such as space for exercise therapy and treadmills, designated space for patient education was available only in 43%, 23% of the hospitals had the educational space used concurrently for other purpose, and absent in 12%.In-depth questionnaire administered in 51 medical directors of 47 hospitals with CR program. Results are shown according to the hospitals. Table without CR program. Despite not having CR program, these hospitals were providing some educational components such as CV risk factor evaluation, education for risk factor management and medication adherence in slightly lower frequency compared to the hospitals with CR program. Education for exercise was provided in less than one-third and offering of nutritional counseling was in similar proportion, compared to the hospitals with CR program.Table While medical director , physical therapist and CR nurse  were available in 100% of cases, clinical psychologist were not available in 60% and dietician in 26%. It is rare that clinical psychologist and dietician were appointed to dedicated working positions for CR. Even the personnel considered essential were not entirely in dedicated position but doing other work concurrently in considerable proportion. Table This is the first study to evaluate the comprehensiveness of Korean CR program by nation-wide data. Study finding shows that current CR programs in Korea are mostly exercise-based program and its comprehensiveness is rather limited. Components such as nutritional counseling, psychological assessment, vocational counseling, and stress management were not adequately addressed and personnel for these components were not sufficient. While there already have been several studies to grasp the status of Korean CR program, most of them had some limitation in its scope –18. ThisImplementing comprehensive CR program is a challenging task world-wide, not only in Korea. In a survey study of England , though National survey in Portugal  showed tA recent survey of 15 centers in India  reportedConsidering the study findings showing inadequacy of the program contents, educational contents should be improved and/or newly introduced to implement more comprehensive CR program. However, patient education in Korean CR program is restricted by National Health Insurance. While reimbursement for exercise sessions and cardiopulmonary function test can be extended when there is a new indication, patient education is reimbursed for only once regardless of the change in the patients’ clinical status . Becausewithout CR program seem to have their own educational program though not in the name of CR education. Proportion of providing general education for CV risk management and medication adherence was slightly lower compared to the hospitals with CR and education for exercise was absent in many centers. Introducing exercise-based CR program and integration with preexisting educational program would be a good starting point for these hospitals.Inferring from the findings in the Table During the period of year 2008–2020, the CR programs in Korea were established as a part of the Regional Cardiovascular Centers (RCC) project. Before RCC project, CR programs were established were mainly in the capital area, so the comparison between the capital area and other regions crudely reflected the difference between the RCC and non-RCC programs. The characteristics of the CR program in the RCC were addressed in previously published article reporting regional difference . This stThe comprehensiveness of CR program contents is inadequate, and the staffing of relevant professionals for multidisciplinary team is suboptimal in Korea. In addition to the well-known issue of underutilization of CR, effort to improve the quality of the program is warranted by enhancing its comprehensiveness. More awareness of current status by both clinicians and health policy makers is needed and insurance reimbursement for educational program should be improved.


The development of new bioadhesives with integrated properties remains an unmet clinical need to replace staples or sutures. Current bioadhesives do not allow electronic activation, which would allow expansion into laparoscopic and robotic surgeries. To address this deficiency, voltage-activated adhesives have been developed on both carbene- and catechol-based chemical precursors. Herein, a third platform of voltage-activated adhesive is evaluated based on lipoic acid, a non-toxic dithiolane found in aerobic metabolism and capable of ring-opening polymerization. The electro-rheological and adhesive properties of lithium, sodium, and potassium salts of lipoic acid are applied for wet tissue adhesion. At ambient conditions, potassium lipoate displays higher storage modulus than lithium or sodium salt under similar conditions. Voltage stimulation significantly improves gelation kinetics to Na- and K-lipoates, while Li-lipoate is found to not require voltage stimulation for gelation. Lap shear adhesion strength on wetted collagen substrates reveals that the synthetic metal lipoates have comparable adhesion strength to fibrin sealants without viral or ethical risks. Sh. Sh35].  < 0.05) e, even tr 10 min . Na-lipor = 0.98), did not have a statistical difference (r = 0.51) and no statistical difference  deformation and generally correlated with shear adhesion strength. The yield stresses exhibited by Li-lipoate are 9.9 kPa (±0.4 kPa at 0 V), 10.4 kPa (±0.4 kPa at −3.0 V), and 11.1 kPa (±2.6 kPa at −5.0 V), respectively a. K-lipofference . Yield sfference . This su−2). The experimental set-up for the lap shear adhesion is shown in Lap shear adhesion measures the load capacity between adhesive and substrate. Adhesion strength indicates the shear stress at the failure point  and at 37 °C was 2.72 N.m−1 (±0.34 N.m−1). Thus, there was no significant increase in peel adhesion strength by curing the adhesive at 37 °C. Peel strength is similar to commercial pressure-sensitive cellophane tapes of 3.4 N ± 1.6 N.m−1. All specimens displayed a cohesive failure. The addition of TCEP evaluated reversible adhesion by reducing and cleaving disulfide bonds into thiols  and heat-activated polymerization have prevented its adhesive application. To overcome this limitation, LA has previously been grafted on redox-active macromolecules or particles yielding bioadhesive hydrogels. Chai et al. prepared LA-silver nanoparticle (AgNP) [(±)-Alpha-lipoic acid’s poor water solubility (0.62 g.Le (AgNP)  and polye (AgNP)  that dise (AgNP) . Films oe (AgNP) . This el1H/13C NMR spectra of metal lipoates, despite heating at 80 °C during synthesis, though LA reportedly polymerizes at 70 °C [2H) in the presence of alkali metal hydroxides (LiOH/NaOH/KOH) converts to the corresponding salts , providing stability to metal lipoates in alcoholic solutions at high temperature. In an alcoholic solution, metal lipoates remain monomers for months without decomposition or polymerization ((±)-Alpha-lipoic acids (LA) were prepared into cationic lipoate salts in a one-step synthetic procedure that expands the usage for lipoates, especially for applications requiring rapid dissolution. Other potential benefits include (i) a biocompatibility profile similar to LA, (ii) voltage-tunable material properties, and (iii) depolymerization through disulfide cleavage strategies. No polymerization was observed on at 70 °C . This isrization . It is orization c. The sorization . Thus, irization .1H NMR analysis after 30 min of 4M dissolution, voltage activation, or both revealed that only 34–38% of monomer converts to linear polymeric structures . This limits the application of metal lipoate adhesives for topical use at this stage of development. Furthermore, aqueous depolymerization further restricts their internal application under wet conditions . Adhesion and material properties at this stage require further improvement before dedicated studies on in vitro and in vivo testing. Further design improvement, such as incorporating interpenetrating networks, will enhance both rheological and mechanical properties and is the focus of our future work. It was found that there was no significant change in peel adhesion strength by increasing temperature from 24 °C to 37 °C, indicating not much change in the degree of polymerization.Lap shear adhesion was evaluated with wet collagen films , which is a convenient animal-free mimic of wet tissue substrates. The primary adhesion mechanism is mechanical interlocking and polar/H-bonding with the amino acid network. The collagen has little to no cysteine content. Thus, covalent interactions are unlikely . However1H/13C chemical characterization. For example, some Li-lipoate powders had considerably higher shear moduli of 190 kPa upon dissolution (data not shown), but these stiffer hydrogels could not be reliably reproduced. The data reported herein was the most reproducible between three separate synthetic batches and after careful attention to anhydrous storage conditions and dissolution practices. The ratio of free monomers remains at molar-level hypertonicity, which will cause local dehydration if applied to wet tissue surfaces. The normal levels of Li+, Na+, and K+ in blood are <0.005 mmol/L, 136–145 mmol/L, and 3.6–5.2 mmol/L, respectively. Assuming a ≤ 1g topical application of 4M metal lipoate adhesive, this would increase cation levels by a maximum of 4 mmol under an unlikely instant dissolution scenario. This may increase metal ion concentration of 0.8 mmol/L in the blood (5 L blood/person). Additionally, lithium drugs are used as antimanic medication, and therapeutic toxicity is found at the level of >1.5 mmol/L [+ channel), and thus KCl medication is given to treat the low level of potassium in the blood. In the case of Na+ and K+, an increase of 0.8 mmol/L concentration is within the normal physiological fluctuations. The voltage and current (−5 V DC at less than 1 mA) used in this study are considered safe if topically applied [Some limitations on the cationic lipoates are noted. Viscoelastic properties of metal lipoates varied from batch to batch, despite a reproducible 5 mmol/L ,43. Pota applied . This av applied .Our future work will address methods to further shift metal lipoate equilibrium beyond 35% monomer consumption, tune shear moduli between 10–100 kPa (range of most soft tissues), and attain lap shear adhesion in excess of 20 kPa .This paper describes the synthesis of three alkali metal salts of LA (lipoate) and the evaluation of their rheological and mechanical properties at ambient or under cathodic activation in PBS. Metal lipoates have an improved aqueous solubility (up to 5M) and can be prepared in 5 min. Alkali metal salts display shelf stability of > 6 months in powdered or in alcoholic solutions. At ambient conditions, the optimized formulation (4M solution) of Li-lipoate gels is within 5 min, while Na- and K-lipoate remain viscous with an escalating complex modulus. The application of cathodic voltage significantly accelerates the gelation time of Na- and K-lipoate adhesives, though it remains unchanged for Li-lipoate adhesive. On a wet collagen film substrate, all three metal lipoates display comparable lap shear adhesion strength (~8–12 kPa), similar to that of fibrin glue hydrogels. Peel adhesion strength, performed on pig skin and a wet collagen film, is not significantly different at 37 °C as compared to ambient conditions. The findings provide a platform for spontaneous or voltage-activated gelation of metal lipoate-based hydrogels. It is anticipated that the metal lipoates presented here will find application in ionic hydrogels, interpenetrating networks, or bioadhesive engineering.