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Detecting vertical root fractures represents an immense challenge for oral health professionals. One of the main tools used to detect this type of biological complication is the periapical radiograph. However, conventional radiography consists of two-dimensional imaging that is limited by the superimposition of bony structures that complicate the detection of root fractures. The alternative, a Cone-Beam Computed Tomography (CBCT) scan, cannot be prescribed in every case since radiation should be kept to a minimum as stipulated by the “As Low As Reasonably Achievable” (ALARA) principle. Therefore, to justify the use of a CBCT scan to detect a vertical tooth root fracture, the clinician must prove that it has significant benefits over traditional imaging. Since few systematic reviews have compared CBCT technology to traditional radiography for the diagnosis of vertical root fractures, it is of utmost importance in clinical practice, especially in endodontology and clinical dental medicine, where the available reviews are examined to generate a clinical recommendation. The four hypotheses of this protocol are that (1) CBCT is superior to traditional radiography for detecting vertical root fractures of vital teeth; (2) CBCT is superior to traditional radiography for detecting longitudinal root fractures of vital teeth with radiopaque restorations; (3) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth without a radiopaque post that may cause artifacts; and (4) CBCT is superior to traditional radiography for detecting vertical root fractures of root-filled teeth with a radiopaque post regardless of its longitude. To test these hypotheses, all the current secondary resources related to the aim of this meta-review are evaluated. If there is sufficient evidence to support clinical decisions, then the appropriate recommendations will be formulated. PROSPERO ID: CRD42018067792

Background There is a lack of functional performance measures for children and young people with haemophilia (CYPwH) with associated control data from typically developing boys (TDB). The literature advocates development of a core set of outcome measures for different chronic conditions. As medical treatment improves, CYPwH are experiencing better outcomes; therefore, more challenging measures are required to monitor physical performance. Such testing is not performed routinely, due to practical and safety concerns. Aim Evaluate the feasibility, safety and acceptability of select outcome measures as part of a study protocol testing CYPwH; including myometry, 10 metre incremental shuttle walk test (10-m ISWT), iSTEP (an incremental step test, with data from TDB), and 1 week of accelerometry-wear at home. Methods Sixty-six boys aged 6–15 years with mild, moderate or severe haemophilia A or B (including inhibitors) attending routine clinics at Great Ormond Street Hospital were approached to participate. Descriptive statistics and content analysis were used to assess outcomes of feasibility, safety and acceptability, which included recruitment/retention rates, protocol completion within routine appointment timeframes, performance testing without serious adverse events/reactions (SAE/SARs), and acceptability to CYPwH of high-level performance measures. Results Outcomes were met: 43 boys completed testing at clinic review (Jan–Nov 2018) within a 10-month timeframe, retention was 95% at completion of protocol and no SAE/SARs were reported throughout testing. Conclusion Feasibility, safety and acceptability of the study protocol have been established in this population. Both high-level performance tests, iSTEP and 10-m ISWT, were an acceptable addition to boys’ routine clinic appointments and could be safe, acceptable choices of outcome measure as part of a core set of tests for CYPwH. Further investigation of the psychometric properties for the iSTEP is now justified, in order for it to be used as a standardised, validated, reliable outcome measure in clinical or research settings. Trial registration Retrospectively registered on September 3, 2019, on ClinicalTrials.gov (ID: NCT04076306).

To inform management and conservation decisions, environmental DNA (eDNA) methods are used to detect genetic material shed into the water by imperiled and invasive species. Methodological enhancements are needed to reduce filter clogging, PCR inhibition, and false-negative detections when eDNA is at low concentrations. In the first of three simple experiments, we sought to ameliorate filter clogging from particulates and organic material through a scaled-up, multi-filter protocol. We combined four filters in a 5 mL Phenol-Chloroform-Isoamyl (PCI) procedure to allow for larger volumes of water (~1 L) to be filtered rapidly. Increasing the filtered water volume by four times resulted in 4.4X the yield of target DNA. Next, inhibition from organic material can reduce or block eDNA detections in PCR-based assays. To remove inhibitory compounds retained during eDNA isolation, we tested three methods to chemically strip inhibitors from eDNA molecules. The use of CTAB as a short-term (5–8 day) storage buffer, followed by a PCI isolation, resulted in the highest eDNA yields. Finally, as opposed to a linear relationship among increasing concentrations of filtered genomic eDNA, we observed a sharp change between the lower (70–280 ng) and higher (420–560 ng) amounts. This may be important for effectively precipitating eDNA during protocol testing.

Graphical abstract, Various research activities require the programming of a large numbers of devices. This programming can be difficult to co-ordinate and organise, and requires considerable labour time. These issues often mean that testing on real hardware is abandoned or taken only to small scale implementation thus limiting the real-world findings. The method described in this paper adopts a three-tiered approach to programming large numbers of devices. Tier 1 is comprised of a single Master Controller which is networked to individual tower modules, these towers form the final 2 tiers with the Local Controller as tier 2 and up-to 15 target devices forming tier 3. The Master Controller co-ordinates and distributes the code for each device to the Local Controller which then programs the target devices. In the domain of networking this allows for: • Large networks of varied protocols to be programmed quickly, since towers are programmed in parallel, additional towers don’t extend programming times. • Distributed networks are possible since towers are controlled over Ethernet. • Dramatically reduced labour time and defect rates due to human error in setting up devices. • This paper presents the implementation of this method for IoT Networking research with ESP-01 Target devices.

We sought to understand the sequence of testing and treatment among nine infants offered both conventional and point-of-care testing and diagnosed as HIV-positive by 6 months of age in Kenya. One infant received per protocol testing and treatment. Patient-level (late presentation and disengagement), provider-level (reluctance and error/oversight) and system-level (stock outs, errors) challenges delayed diagnosis and treatment. Early point-of-care testing can streamline testing; however, challenges mitigate benefits.

The paper describes implementation process of GigaSpaceWire protocol simulation System-C model. At current point there are no available or implemented simulation models of this protocol. Implementation of the GigaSpaceWire model will offer the possibility of protocol testing and validation. After the model description, the paper provides results of the GigaSpaceWire protocol specification validation, obtained during protocol simulation.

Modeling gives the opportunity to the user to test new platforms, techniques, and technology, with lower cost, high safety and in a fast pace, when compared with the experimental approach. A precise battery model is required to specify their appropriateness for different applications and to study their dynamic behavior. In addition, it is important to design an efficient battery system for power applications. This paper describes the modeling of a Nickel Manganese Cobalt (NMC) 18650 lithium-ion cell intended for testing new charging methods testing. An electric circuit model with 2RC network is used, and the elements parameterization are performed for charge and discharge. The data is collected experimentally using an automated battery system to run the hybrid pulse test (HPT). A detailed analysis of the parameters identified will be done, along the performance results of the proposed ECM with the standard constant–current constant–voltage (CC–CV) and constant–temperature constant–voltage (CT–CV) current profiles.

[Abstract] During the last few years, the FIDO Alliance and the W3C have been working on a new standard called WebAuthn that aims to substitute the obsolete password as an authentication method by using physical security keys instead. Due to its recent design, the standard is still changing and so are the needs for protocol testing. This research has driven the development of a web application that supports the standard and gives extensive information to the user. This tool can be used by WebAuthn developers and researchers, helping them to debug concrete use cases with no need for an ad hoc implementation. Xunta de Galicia; ED431C 2018/49

Background Wide variability exists in opioid doses prescribed after pediatric orthopaedic surgery. Increasing opioid prescriptions by a single day increases the risk of aberrant opioid behavior by almost 10% in the pediatric population. Objectives The goal of this study is to increase the percentage of patients prescribed opioids based on a standard dosing protocol after pediatric orthopaedic surgery from 0 to 90%. Methods A multidisciplinary team developed a key driver diagram (figure 1). A prescribing protocol was developed based on the surgery severity. Baseline data began in October 2017 with initial protocol testing starting in November 2017. The primary measure was the weekly percent of patients correctly dosed by the protocol. The secondary measure was the average number of opioids prescribed at discharge each week for all children undergoing orthopaedic surgery between October 2017 and September 2018. Statistical process control charts were used for data analysis with Nelson rules used to determine special cause. Results 1645 patient records were prospectively reviewed during the study time period. Adherence to the dosing protocol increased from 0% at baseline to 97% for all categories of surgery (figure 2). Mean prescribed opioid doses following surgical procedures were reduced from 21.9 to 17.8 doses (figure 3), achieving special cause variation. Conclusions Implementation of a standardized opioid dosing protocol for pediatric patients undergoing orthopaedic surgery improved protocol-based adherence to over 90% and was associated with reduced opioid doses prescribed at discharge. Future work will investigate whether this may lead to a decrease in aberrant opioid behaviors in pediatric patients.

Alzheimer’s disease (AD) is the most common form of dementia and currently affects over 5 million Americans and 30 million individuals worldwide. Unfortunately, the current approach to treating AD provides nothing more than a marginal, unsustained, symptomatic effect, with little or no effect on disease progression itself. To attain effective improvements in AD, one must determine risk factors, address the underlying causes, and focus on a combination of functional and lifestyle medicine strategies that provide a comprehensive, programmatic, and network-based approach that is sufficient to achieve epigenetic transformation and neurologic healing through its multiple and necessary synergistic components. Rather than normalizing metabolic parameters, the focus is on optimization of each metabolic parameter. Papers published by research neurologist, Dr Dale Bredesen have documented that symptoms of mild cognitive impairment and early AD may often be reversed within 6 months after initiating a comprehensive, functional and lifestyle medicine-focused program. The purpose of this article are as follows: 1. Shed light on a promising clinical protocol that focuses on a comprehensive functional and lifestyle medicine approach to treating mild cognitive decline and Alzheimer’s disease; 2. Identify the Bredesen Protocol testing, diagnostic and treatment guidelines; 3. Review several case studies and discuss the promising results of the program. Although published case studies such as those reported here are relatively few, clinicians applying these comprehensive strategies have reason to expect improvement in their patients. Lifestyle medicine can be a source of greatly needed hope for those suffering with cognitive decline.

Hospital care is the single, largest contributor to health spending, yet evidence to guide value transformation is lacking. The large, real-world studies required to fill this void are challenging to conduct in the complex and fast-paced acute care environment. To address these challenges, we created a framework that combines Lean manufacturing methodology and Applied Research principles. We deployed this framework to design, pilot, and iteratively improve a study protocol testing the effectiveness of an innovative care pathway for patients hospitalized with acute exacerbations of Chronic Obstructive Pulmonary Disease. Over a three month period, the protocol was successfully piloted and refined at a single site, subsequently becoming the basis for a large system-wide randomized controlled trial. This framework combining Lean and Applied Research methods resulted in synergies that neither method could accomplish alone and may serve as a template for learning healthcare systems to efficiently generate real-world evidence in the acute care setting. Keywords: Applied research, Pragmatic research, Value-based care, Lean, Quality improvement

International audience; Technology trends, consumer and business tendencies are to drop single PSTN lines in favor of VoIP technology. The kernel of VoIp technology is its signaling protocol, where the Session Initiation Protocol (SIP) has been considered the most widespread signaling protocol overall. Within this context, and by considering the huge amount of Internet users and communications that take place over VoIP technology, our work focuses on conducting conformance tests of distributed complex scenarios of SIP in a black box environment. Experimental results have been successfully obtained and discussed

Approximately 7% to 9% of patients with donor-specific anti-human leukocyte antigen (HLA) antibodies (DSA) fail within 1 year post-DSA onset. However, little is known as to how this DSA-associated failure temporally progresses. This longitudinal study investigates DSA's temporal relationship to allograft dysfunction and identifies predictors of allograft function's progressive deterioration post-DSA.A cohort of 175 non-HLA identical patients receiving their first transplant between March 1999 and March 2006 were analyzed. Protocol testing for DSA via single antigen beads was done before transplantation and at 1, 3, 6, 9, and 12 months after transplantation then annually. Estimated glomerular filtration rate (eGFR) was analyzed before and after DSA onset.Forty-two patients developed DSA and had adequate eGFR information for analysis. Before DSA onset, the 42 patients had stable eGFR. By 1 year post-DSA, the cohort's eGFR was significantly lower (P0.001); however, 30 of 42 had stable function. Twelve patients had failure or early allograft dysfunction (eGFR decline25% from DSA onset). Those who failed early (by 1 year post-DSA) had more antibody-mediated rejection than stable patients (P=0.03). Late failures (after 1 year post-DSA) were predictable with evidence of early allograft dysfunction (eGFR decline25% by 1 year post-DSA; P0.001). Early allograft dysfunction preceded late failure by nearly 1 year.DSA is temporally related to allograft function deterioration. However, in many cases, late allograft failures are preceded by early allograft dysfunction. Therefore, monitoring for early allograft dysfunction provides treating physicians with a window of opportunity for treatment or continued monitoring.

International audience; The development of test cases is an important issue for testing software, communication protocols and other reactive systems. A number of methods are known for the development of a test suite based on a formal specification given in the form of a finite state machine. In this paper, we overview and experiment with these methods to assess their complexity, applicability, completeness, fault detection capability, length and derivation time of their test suites. The experiments are conducted on randomly generated specifications and on two realistic protocols called the Simple Connection Protocol and the ITU-T V.76 Recommendation.

This article presents a method for the application of model checking, i.e., verifying a finite state system against a given temporal specification, on the problem of generating test inputs. The generated test inputs allow state characterization, i.e., the identification of internal states of the software under test by observation of the input/output behavior only. A test model is derived semi-automatically from a given state-based specification and the testing goal is specified in terms of temporal logic. On the basis of these inputs, a model checking tool performs the testing input generation automatically. In consequence, the complexity of our approach is strongly depending on the input model, the testing goal, and the model checking algorithm, which is implemented in the used tool. The presented approach can be adapted with small changes to other model checking tools. It is a capable test generation method, whenever a finite state model of the software under test exists. Furthermore, it provides a descriptive view on state-based testing, which may be beneficial in other contexts, e.g., education and program comprehension.

The community of software testing and that of protocol testing are traditionally disjoint. It is seldom the case that protocol testing experts present papers at the large software testing conferences and vice versa. This raises the question about the peculiarities of protocol testing with respect to general software testing. Here we will examine those peculiarities and the consequences in terms of specific methodology developed for protocol testing.