OBJECTIVE To compare and analyse the accuracy of four age estimation methods using the mineralisation stages of the permanent teeth (Cameriere et al. [16] [CAM], Liliequist and Lundberg [LLH] and Nolla without third molars [NOL7] or with them [NOL8]) in a mixed population of Brazilians and a homogeneous population of Croatians. METHODS Orthopantomograms of 930 Brazilians (366 males and 564 females) and 924 Croatians (365 males and 556 females) aged between 8 and 14.99 years were analysed using the CAM, LLH, NOL7 and NOL8 age estimation methodologies. RESULTS LLH presented the best absolute differences (ADs) among both populations without sex stratification, while CAM presented the worst results. In addition, the mean differences revealed underestimations, except when the LLH and NOL7 methods were used for the Brazilians. When the sample was stratified by sex, the best AD values were found with NOL7 (0.80) for the Brazilians and with LLH (0.98) for the Croatians. When the sample was stratified by sex and age, CAM presented high accuracy at the early ages, and LLH presented high accuracy at the older ages. The results obtained with the Nolla methods (NOL7 and NOL8) were mostly similar, but NOL7 yielded slightly better results. CONCLUSIONS The values for the Brazilians and the Croatians were relatively similar, and the techniques were properly applied in both population samples. The best method for evaluating both countries was LLH, followed by NOL7, NOL8 and CAM.

Providing appropriate legal mechanisms, that evaluate the progression of development from the age of childhood innocence to maturity and full responsibility, considered one of the difficult areas of criminal justice policy. The minimum age of criminal responsibility (MACR) in children varies among countries and differs widely owing to history and culture. Due to rising and brutality of criminal offenses, particularly by juveniles, few countries have lowered the minimum age of criminal responsibility, and many have considered/considering to do the same. India is one such country in which is under the proposal of lowering the age of criminal responsibility to 16 years. As there is lack of useful age assessment methods, that can indicate whether if the individual in question is younger (<16 years) or older than MACR (≥16 years), the present study was undertaken to derive a specific cut-off value of the third molar maturity index (I3M) for this purpose. The sample consisted of 1078 orthopantomograms (OPTs) from Andhra Pradesh, India, aged between 11 and 20 years (45.4% males and 54.6% females). The reproducibility of I3M was calculated by intra-class correlation coefficients, which showed an intra-rater and inter-rater agreement of 0.912 and 0.891, respectively. The sample was divided into training dataset (819 OPTs), to test I3M and gender as independent variables and MACR as a dependent variable by logistic regression analysis, and test dataset (259 OPTs). A receiver operating curve (ROC) analysis was performed to evaluate the specific cut-off value of I3M for predicting MACR status. A logistic regression analysis showed that gender was not statistically significant for predicting MACR status while ROC analysis indicated a cut-off value of I3M = 0.293 as best for predicting MACR status. The performance of derived cut-off value was tested in a test data set. The sensitivity of the test was 90.6% and 90%, while specificity was 86% and 87.1% in males and females, respectively. The proportion of correctly classified individuals was 88.0% and 88.7% in males and females, respectively. The estimated Bayes post-test probability in males was 87.2% and while in females it was 88.3%. The results highlight the contribution of the derived cut-off value of I3M for discriminating individuals around MACR and should be evaluated in other populations.

Poor adherence to medical recommendations is a well-recognized catalyst for public health consequences worldwide. The literature highlights health consciousness as a likely antecedent to patient–physician trust, which in turn promotes medical adherence. Nevertheless, principles of patient-centered care suggest that patient perceptions of their doctor’s appraisal of their emotions may influence the path between trust and medical adherence. Accordingly, this study tested the mediating role of patient–physician trust in the relation between health consciousness and medical adherence and assessed whether patient ratings of their doctor’s appraisal of their own and their patients’ emotions moderated the mediated relation. Data were collected via self-report questionnaires from two culturally and economically diverse countries: Bosnia-Herzegovina (N = 262) and the United States (N = 314). Participants were young, healthy adults who visited their primary care physician in the past year. The study employed confirmatory factor analysis, mediation, and moderated mediation analyses. The results indicate that health consciousness positively related to patient–physician trust, which was in turn related to higher medical adherence and which mediated 28% of the total effect of health consciousness. Nevertheless, among patients who rated their physicians to have low appraisal for their patients’ emotions but high appraisal for their own emotions, the path from trust to adherence was not significant. These results highlight the importance of promoting health consciousness among young individuals, all while training practitioners to be attuned to their patients’ emotions and circumstances above their own. However, additional findings indicate that the interrelation between doctors’ emotional attributes and adherence is not necessarily one directional and warrants further investigation.

This paper presents an educational game fostering a new experience-based approach to teaching knowledge transfer using a codification strategy alone. The goal is to address and highlight some common issues and challenges that occur during knowledge transfer in product development and that are often difficult for especially students to grasp through exclusively a theoretical teaching approach. The game is introduced to 60 students in the final year of their Master's curriculum. In parallel, the game has been applied in a similar setting in a comparable higher educational institution, as well as in a product development organization.“Sometimes you win—other times you lose and learn.”

Epileptic seizures may be initiated by random neuronal fluctuations and/or by pathological slow regulatory dynamics of ion currents. This paper presents extensions to the Jansen and Rit neural mass model (JRNMM) to replicate paroxysmal transitions in intracranial electroencephalogram (iEEG) recordings. First, the Duffing NMM (DNMM) is introduced to emulate stochastic generators of seizures. The DNMM is constructed by applying perturbations to linear models of synaptic transmission in each neural population of the JRNMM. Then, the slow-fast DNMM is introduced by considering slow dynamics (relative to membrane potential and firing rate) of some internal parameters of the DNMM to replicate pathological evolution of ion currents. Through simulation, it is illustrated that the slow-fast DNMM exhibits transitions to and from seizures with etiologies that are linked either to random input fluctuations or pathological evolution of slow states. Estimation and optimization of a log likelihood function (LLF) using a continuous-discrete unscented Kalman filter (CD-UKF) and a genetic algorithm (GA) are performed to capture dynamics of iEEG data with paroxysmal transitions.

Burst suppression includes alternating patterns of silent and fast spike activities in neuronal activities observable (in micro or macro scale) electro-physiological recordings. Biological models of burst suppression are given as dynamical systems with slow and fast states. The aim of this paper is to give a method to identify parameters of a mesoscopic model of burst suppression that can provide insights into study underlying generators of intracranial electroencephalogram (iEEG) data. An optimisation technique based upon a genetic algorithm (GA) is employed to find feasible model parameters to replicate burst patterns in the iEEG data with paroxysmal transitions. Then, a continuous-discrete unscented Kalman filter (CD-UKF) is used to infer hidden states of the model and to enhance the identification results from the GA. The results show promise in finding the model parameters of a partially observed mesoscopic model of burst suppression.

Abstract The present work deals with analysis of instabilities in DCMIX1 ternary systems in the experimental geometry when two liquid layers with different concentrations are superimposed. In multicomponent mixtures, depending on the initial conditions, it is possible to have convective motion even when the top part is less dense than the bottom one. This unstable behavior destroys boundary interfaces unpredictably and affects diffusion processes. Such behavior was examined considering as multicomponent mixture the DCMIX1 ternary system. Due to its three different constituents, the mixture could easily generate two possible types of instability regimes such as: fingers and overstability. Five different compositions have been initially selected, three around the fingers-like type region and two around the overstability region. Experimental results obtained during Sliding Symmetric Tubes (SST) technique based experiments have been compared with the analytical pure diffusion solution and also with a 3D numerical simulation which includes the buoyancy effects. For this purpose, a specific solver in the open source software OpenFOAM has been created. Predicted instabilities agree well with experimental results in most of the cases, confirming the accuracy of the obtained diffusion coefficients.

The paper presents an approach to web-based visualization of automatically generated data models, which combines visualization principles used in desktop applications, and usage of web-based technologies. The proposed approach is implemented and integrated with an existing online system for automatic synthesis of conceptual database models based on business process models. The approach and implemented online system named AMADEOS are illustrated by an example of visualization of the UML class diagram representing the conceptual database model automatically generated based on the source BPMN model.

BACKGROUND Clinical Chemistry is the backbone of medical treatment, diagnostics, and prevention. The laborato-ries are trying to improve the quality and to reduce diagnostic errors and processing time and safeguard trace-ability of all laboratory procedures to ensure patient safety. Six sigma belongs to statistical quality control and provides a new methodology for measuring and improving process performance in laboratory. METHODS Activities of AST, ALT, CK, LDH, Amy, and γ-GT were determined by standard kinetic methods on a Vitros 5600 biochemistry analyzer. Two daily quality controls (Verifier I and Verifier II) were run over 60 days. Total percent CV was calculated from routine daily QC. Between-instrument bias was also calculated from daily QC. RESULTS The calculated sigma metrics for AST were 6.9 and 3.8; for ALT 9.3 and 5.6; for CK 6.6 and 5.3; LDH 5.2 and 5.2; for γ-GT 4.9 and 2.7; and for amylase 8.7 and 7.1. Analytical performance for AST, ALT, CK, LDH, and Amylase is world class. On the other hand, γ-GT analytical performance is poor. CONCLUSIONS Six Sigma benefits from earlier quality management approaches that creates new challenges for medical laboratories.

Objective. Childhood-onset systemic lupus erythematosus (cSLE) is usually a more severe and aggressive disease than adult-onset SLE (aSLE), but cellular and subcellular reasons for these differences are not well understood. The present study analyzed Th subsets, STAT1/STAT5 signaling response, and cytokine profiles of cSLE. Methods. FOXP3+ regulatory (Treg) and effector Th subsets, expression and phosphorylation of STAT1/STAT5 in Th, and cytokine profiles were measured in the peripheral blood of patients with cSLE and healthy controls (HC), using flow cytometry and immunoassay on a biochip. Results. Significant correlation between expression of the activation marker HLA-DR and decreased Th counts, an increase in the percentage of FOXP3+ Th, and a decrease in the activated Treg (aTreg) subset among them were found in cSLE. In contrast to our previous findings in aSLE, no significant differences in percentages and a significant decrease in the numbers of the naive-resting Treg (rTreg) subset compared to HC were found. The percentages of CD25− cells, possibly reflecting interleukin 2 depletion, were significantly increased in cSLE aTreg, but not in the rTreg subset. Consistent with the results of our previous studies in aSLE, increased expression of STAT1, along with significant correlation between decreased Th counts and their increased basal phosphorylation of STAT5, were also found in cSLE. Conclusion. Our results suggest that the key difference in Treg homeostasis between cSLE and aSLE is in the rTreg subset. However, perturbed aTreg homeostasis, increased levels of STAT1 protein, and homeostatic STAT5 signaling appear to be intrinsic characteristics of the disease, present in cSLE and aSLE alike.

OBJECTIVES To provide an overview of the paediatric rheumatology (PR) services in Europe, describe current delivery of care and training, set standards for care, identify unmet needs and inform future specialist service provision. METHODS An online survey was developed and presented to national coordinating centres of the Paediatric Rheumatology International Trials Organisation (PRINTO) (country survey) and to individual PR centres (centre and disease surveys) as a part of the European Union (EU) Single Hub and Access point for paediatric Rheumatology in Europe project. The survey contained components covering the organization of PR care, composition of teams, education, health care and research facilities and assessment of needs. RESULTS Response rates were 29/35 (83%) for country surveys and 164/288 (57%) for centre surveys. Across the EU, approximately one paediatric rheumatologist is available per million population. In all EU member states there is good access to specialist care and medications, although biologic drug availability is worse in Eastern European countries. PR education is widely available for physicians but is insufficient for allied health professionals. The ability to participate in clinical trials is generally high. Important gaps were identified, including lack of standardized clinical guidelines/recommendations and insufficient adolescent transition management planning. CONCLUSION This study provides a comprehensive description of current specialist PR service provision across Europe and did not reveal any major differences between EU member states. Rarity, chronicity and complexity of diseases are major challenges to PR care. Future work should facilitate the development, dissemination and implementation of standards of care, treatment and service recommendations to further improve patient-centred health care across Europe.

Hyoid bone movement is an important physiological event during swallowing that contributes to normal swallowing function. In order to determine the adequate hyoid bone movement, clinicians conduct an X-ray videofluoroscopic swallowing study, which even though it is the gold-standard technique, has limitations such as radiation exposure and cost. Here, we demonstrated the ability to track the hyoid bone movement using a non-invasive accelerometry sensor attached to the surface of the human neck. Specifically, deep neural networks were used to mathematically describe the relationship between hyoid bone movement and sensor signals. Training and validation of the system were conducted on a dataset of 400 swallows from 114 patients. Our experiments indicated the computer-aided hyoid bone movement prediction has a promising performance when compared with human experts’ judgements, revealing that the universal pattern of the hyoid bone movement is acquirable by the highly nonlinear algorithm. Such a sensor-supported strategy offers an alternative and widely available method for online hyoid bone movement tracking without any radiation side-effects and provides a pronounced and flexible approach for identifying dysphagia and other swallowing disorders.

This paper presents a method for distributed generation (DG) allocation in low voltage distribution network based on the total annual energy loss reduction and Artificial Neural Network (ANN). The proposed method is applied to the PV solar based DG allocation problem in the low voltage distribution network using realistic network data and measurements. This research is motivated by numerous realistic issues faced by the Distribution System Operator in the area of DG planning. The main objective of this work is to develop, test and validate a robust method for DG allocation which can be used in practical problems without the need for extensive system modelling and load flow analysis. The results confirm the importance of appropriate DG planning and show that the proposed method can be used as a promising tool for efficient and effective DG allocation in low voltage distribution network.

A term systems of systems (SoS) refers to a setup in which a number of independent systems collaborate to create a value that each of them is unable to achieve independently. Complexity of a SoS structure is higher compared to its constitute systems that brings challenges in analyzing its critical properties such as security. An SoS can be seen as a set of connected systems or services that needs to be adequately protected. Communication between such systems or services can be considered as a service itself, and it is the paramount for establishment of a SoS as it enables connections, dependencies, and a cooperation. Given that reliable and predictable communication contributes directly to a correct functioning of an SoS, communication as a service is one of the main assets to consider. Protecting it from malicious adversaries should be one of the highest priorities within SoS design and operation. This study aims to investigate the attack propagation problem in terms of service-guarantees through the decomposition into sub-services enriched with preconditions and postconditions at the service levels. Such analysis is required as a prerequisite for an efficient SoS risk assessment at the design stage of the SoS development life cycle to protect it from possibly high impact attacks capable of affecting safety of systems and humans using the system.

Real-time adaptive systems are complex systems capable to adapt their behavior to changing conditions in the environment, and/or internal state changes. Highly dynamic and possibly unpredictable environments, and uncertain operating conditions call for new paradigms of software design, and run-time adaptation mechanisms, to overcome the lack of knowledge at design time. Main application areas include vehicles or robots that need to collaborate to achieve a common task, e.g., minimize fuel consumption, moving objects at a construction site, or performing a set of operations in a factory. Moreover, these vehicles or robots need to interact and possibly collaborate with humans in a safe way, e.g., avoiding accidents or collisions, and prevent hazardous situations that may harm humans and/or machines. % This paper proposes a framework for developing safe and secure adaptive collaborative systems, with run-time guarantees. To enable this, our focus is on requirement engineering and safety assurance techniques to capture the specific safety and security properties for the collaborative system, and to provide an assurance case guaranteeing that the system is sufficiently safe. Moreover, the paper proposes an architecture and behavioral models to analyze the requirements at run-time. Finally, we design a suitable deployment platform to perform the run-time analysis and planning while guaranteeing the real-time constraints.