Romanian Journal of Ophthalmology has already reached the age of one year and it is my duty as the Editor in Chief to assess the achievements and also the non-achievements of our review.The aim of changing Oftalmologia in Romanian Journal of Ophthalmology, in other words switching from publishing in Romanian to publishing in English, was to obtain a better visibility and quotation.The “new look” of the Romanian Journal of Ophthalmology was greatly appreciated by everyone. Regarding the quality of the graphic design, as well as that of the paper and of the pictures, this has improved; especially in that we succeeded in publishing the entire iconography in color.The Editorial Board established a standard format of article editing, which was respected by the authors. We will keep on mentioning these details , because these elements are important for the quotation process.We succeeded in publishing four issues of our review between May and December 2015, a necessary condition for quotation. It was a great effort for the ophthalmologic community, but this effort must continue; it is mandatory to publish an issue at every three months.www.rjo.ro. The electronic version of our review can be found by anyone when accessing the link, with a delay of one issue behind the printed version, together with all the information needed for publishing an article, under the title “Guidelines for authors”. This is another method to increase the international visibility of our review and also a necessary condition for a favorable quotation.A web site for our journal is already available: Initially, there were some concerns about publishing in English and I am sure that this was not the ideal solution, but as time passes results start to show and I can only hope they continue. It was very difficult to publish Oftalmologia due to the lack of articles and the Board of Oftalmologia and of the Romanian Society of Ophthalmology had to make a difficult decision: either to continue publishing in Romanian, which would have resulted into having no review, so, the end of it, or make a change. With the risk of being redundant, I wish to reinforce the fact that in the past year we have managed to publish an issue at every two months.The effort of indexing our review in some of the most important international databases carries on. It is a process more difficult than we expected. In addition, for the assessment of our journal in the databases we were required to send the last four issues (or the last 50 articles), these being sent at the beginning of this year, and the evaluation process takes some months.We look forward to announcing the indexing of Romanian Journal of Ophthalmology in some important international databases (such as PubMed) in one of the future issues.Mihail ZembaEditor in Chief


Temperate woody perennials survive to low temperatures in winter entering a dormant stage. Dormancy is not just a survival strategy, since chilling accumulation is required for proper flowering and arbitrates species adaptation to different latitudes. In spite of the fact that chilling requirements have been known for two centuries, the biological basis behind remain elusive. Since chilling accumulation is required for the normal growth of flower buds, it is tempting to hypothesize that something might be going on at this particular stage during winter dormancy. Here, we characterized flower bud development in relation to dormancy, quantifying changes in starch in the flower primordia in two sweet cherry cultivars over a cold and a mild year. Results show that, along the winter, flower buds remain at the same phenological stage with flower primordia at the very same developmental stage. But, surprisingly, important variation in the starch content of the ovary primordia cells occurs. Starch accumulated following the same pattern than chilling accumulation and reaching a maximum at chilling fulfillment. This starch subsequently vanished during ecodormancy concomitantly with ovary development before budbreak. These results showed that, along the apparent inactivity during endodormancy, flower primordia were physiologically active accumulating starch, providing a biological basis to understand chilling requirements. Woody perennials, in temperate and boreal regions, cease growth and enter into a dormant stage to survive to low winter temperatures , 2016. BSince this paradoxical chilling requirement was early noticed , it has Prunus genus, which contains all the stone fruits, blooms in late winter or early spring, but flower buds develop over several months, with flower initiation occurring at the end of the previous summer (Prunus avium) shows that flower development is halted in the winter, but most interesting this halting occurs at a precise developmental stage of flower primordium  cultivars Burlat and Bing were selected for the experiment from a collection held at the Centro de Investigación y Tecnología Agroalimentaria (CITA), Zaragoza, Spain, at 41°44′30″ N, 0°47′00″ W and 220 m above sea level on a fine-loamy and calcareous soil. The 21-year-old trees were grafted on Santa Lucia 64 rootstock .Three trees of sweet cherry  containing at least 10 flower buds, were randomly collected from each cultivar. Dormancy status of shoots from each collecting day was determined by the evaluation of the response of the flower buds after a week in the growth chamber . To haveTemperature was recorded hourly at a meteorological station located in the experimental orchard at CITA. Winter chilling accumulation was calculated according the “Utah Model,” which better fits in cooler areas of temperate zones . This moHeat requirements was estimated using the Growing Degree Hours (GDH) model developed by Phenology and flower development characterization were performed over 2 years. Seven flower buds per cultivar were randomly collected every 2 weeks from the end of the summer, in September, to bud burst in February–March. Flower buds were sampled on spurs, where are located most of the flower buds in sweet cherry trees .Phenological characterization was carried out through field observation of flower buds, which were classified following the BBCH code for sweet cherry . To charThe other five flower buds sampled per cultivar and collecting date were fixed, after removing the external scales, in ethanol (95%)/acetic acid 3:1 (v/v) over 24 h, and then transferred to ethanol (75%) at 4°C for conservation .For histochemical examination, two individual flower primordia per date were embedded in Historesin , sectioned at 5 μm in a Leica EM UC6 ultramicrotome with a glass knife and then place onto distilled water on a glass slide previously coated with 1% gelatine. A set of Historesin-sections were stained with periodic acid Schiff’s reagent (PAS) for insoluble carbohydrates, and counterstained with toluidine Blue for general histological observations . Another2KI) for 5 min and mounted with Histomount  , embedded in paraffin wax, sectioned at 10 μm in a Jung 2045 rotatory microtome  and placed onto glass slides previously coated with Haupt’s adhesive. Prior to staining, the sections were rehydrated . The samples were then stained using the potassium iodide-iodine reaction (I States) . Ovary s2KI-stained preparations, the images were photographed using a DC-300 digital camera  connected to the microscope. Each image was processed using a Quantiment Q550 Image Analysis System . Starch quantification was made by measuring the optical density of black and white images using the method described by Figure 1A). The dimension of the frame used to quantify the starch in each area was 1337 μm2, which represents the general layout of starch in the sweet cherry ovaries. Starch granules were clearly distinguished from the background after I2KI staining  and they were recognized by the image analyzer. The system identifies an individual color as the combination of three colors: red, green, and blue. Color thresholds for starch were set by increasing the detection levels until the size of the detected binary image exactly reflected the stained starch granules observed both under the microscope and in the digitalized image. These levels were stored and used for all preparations. Thus, a binary image of starch was obtained in each observation and used as a superimposed mask on the black and white original image . The optical density of every pixel under the mask was measured, and the sum of all the values of the pixels was considered as the value of the starch content in the measured frame. The starch content was determined in six ovaries per collecting date.Starch in the flower primordium is highly compartmentalized in the different tissues, being a very small amount available for carbohydrate extraction or other analytical methods . As an aTo relate possible variations in the nutritive status of the ovary primordium with morphological changes, the relationship between starch content and ovary size was studied. For this purpose, the ovary diameter and the number of cell layers in each ovary was quantified in the same preparations used to measure starch content. Thus, the preparations were washed in distilled water, stained with 0.07% calcofluor white for cellulose  and obseF-value mean separations were determined by Duncan’s multiple-range test. Correlations between flower starch content and the number of chilling hours accumulated until chilling fulfillment were calculated for the two cultivars over 2 years. Once chilling was fulfilled, flower starch content was correlated with GDH accumulation. Correlations were analyzed by Pearson’s correlation coefficients at the 0.01 significance level.Statistical analyses were performed using SPSS 12.0 statistical software . One-way ANOVA was performed to analyze the starch content and the number of ovary cell layers. When ANOVA generated a significant Figure 2A). Ovary cells had slight amounts of starch , and nuclei had a spongy appearance, reflecting euchromatin . Flower buds arrested development at late-October and enter dormancy. No anatomical changes could be detected all throughout endodormancy . Still, in the ovary, starch accumulated within a dense cytoplasm , and nuclei had a more condensed appearance, reflecting heterochromatin . Following endodormancy, flower buds increased in size, and papilla started to develop in the stigma . Starch in the ovary decreased, as the ovary cells vacuolized, increasing in size , and divided .Flower primordia started developing at the end of the summer showing incipient verticiles: sepals, petals, anthers, and pistil . Observation of starch in the ovary cells showed a steady accumulation along the winter months  and a progressive decrease after winter . Ovary cells were devoid of starch at the early developmental stages, but starch started to accumulate at stage 3, when flower whorls had developed and clearly further built up in the dormant stage 4 . Following winter dormancy, starch remained at stage 5, to decrease progressively, as flower primordia continued growth at stage 6. These observations were consistent in the two cultivars studied, over the two different years.Flower buds developed along the autumn (stages 2–4) and arrested development during dormancy (stage 4), to resume growth in the spring (stages 5 and 6) . In spite to the fact that the 2 years monitored had different winter temperatures, chilling accumulation followed a similar pattern, with a slow rate in the autumn, followed by a fast accumulation in the winter.The calculation of the number of CUs accumulated until the breaking of endodormancy showed that cultivar Burlat had lower chilling requirements (981 ± 83 CU) than Bing (1082 ± 27 CU) . Facing chilling accumulation to starch accumulation in the ovary, the two events followed a close pattern. This was so for both cultivars and years with a significant positive correlation between chilling and starch accumulation, until chilling fulfillment. Interestingly, differences in weather conditions were also reflected in the pattern of starch accumulation. Chilling started to accumulate about 20 days earlier in the cold , than in the mild winter , resulting in a 20–25 days difference between both years for the chilling fulfillment of each cultivar. Thus, in the cold year, both chilling hours and starch content accumulated earlier and quicker than in the mild year.The quantitative analysis of starch in the ovary primordia showed that starch accumulated following a similar pattern in the two cultivars over the 2 years. A slow accumulation at early autumn was followed by a rapid accumulation in the following months to reach a maximum at different times for the two cultivars and years . To evaluate whether starch decrease had a reflection on ovary growth, both were related to heat accumulation. While heat accumulation was also different over the 2 years, being lower in the cold year  than in the mild year , in all circumstances starch decreased following an inverse pattern with heat accumulation, with a significant negative correlation.Following the breaking of endodormancy, starch did not further accumulate, but started to decrease and progressively vanished along ecodormancy in the weeks before bud burst .The number of the ovary cell layers and the ovary size followed a similar pattern. Active cell division and ovary growth occurred in the early autumn, until the flower primordia reached the dormant stage. At this point, 13–14 cell layers formed the ovary and remained during endodormancy and starch accumulation. Following early starch vanishing during ecodormancy, the number of cell layers and ovary size increased, as heat accumulated, between the end of February and mid-March, in the weeks before bud burst (Results herein showed that, along the apparent inactivity during endodormancy, cherry flower primordia were physiologically active and starch accumulated in the ovary cells. Quantification of starch accumulation by image analysis fitted with the accumulation of chilling until the fulfillment of the chilling requirements. This starch subsequently vanished during ecodormancy concomitantly with ovary development before bud burst in the spring.Results showed that, along endodormancy, starch actively accumulated in the ovary primordia of sweet cherry flower buds. This occurred within the same flower primordium developmental stage . In contArabidopsis thaliana, this flower stage has the longest duration (Results showed that starch accumulated in the ovary at a particular flower developmental stage, in which all the flower whorls were differentiated. This was consistent in two different sweet cherry cultivars over 2 years. Interestingly, this particular developmental stage has been shown to be consistent for dormancy in other sweet cherry cultivars along different years , and alsduration  and starduration . This opA high and significant correlation was recorded between accumulation of starch and chilling hours, and this pattern varied in the cold and mild year in a consistent way. Whether starch accumulation is triggered by cold, or is a reflection of arrested development and reduced metabolism, being the flower a clear sink for carbohydrate accumulation , needs fAfter chilling fulfillment, bud remained in an ecodormancy status during several weeks when starch progressively vanished and was inversely correlated with heat accumulation. Following starch decrease, the ovary cells, which had been quiescent over months, showed a decondensed nuclear chromatin, cell division, and vacuolization, as indicators of cellular activity , that waThe question remains on what it is the physiological significance of starch accumulation in the flower primordia during endodormancy. Changes in starch in relation to cold acclimation have been described in mature leaves, in which conversely rapid acclimation to cold is associated with starch hydrolysis, resulting in sugar increase  that redWhile it remains to be elucidated if starch has a role at the time of accumulation, it is clear that this starch accumulated during winter endodormancy plays a clear part in subsequent flower development and in the reproductive process. This is in line with the fact that all along flower biology, cycles of starch accumulation and subsequent depletion do occur in different flower structures before key reproductive events, as pollen tube growth through the style , ovule dTaken together, these results showed that in both sweet cherry cultivars analyzed herein and over both years, a restless rest occurred during endodormancy, with an intense accumulation of starch in the ovary of flower primordia, concomitantly with chilling accumulation. This provides a biological basis to understand dormancy and chilling requirements, but also may provide a frame for future studies.EF, MH, and JR conceived, designed the study, and wrote the paper. EF performed the microscope observations and analyzed the data.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Israel Journal of Health Policy Research (IJHPR) will soon be completing 6 years of publication. During this period, it has published well over 300 articles and has become a stable and vital part of Israeli health care. The number of IJHPR articles published annually has increased significantly over time, and the number of submissions has increased even more significantly. The journal is regularly drawing submissions from a very broad range of Israeli universities, hospitals, health plans, and other institutions, and from leading institutions abroad. The journal’s articles cover a wide spectrum of subjects related to health policy, as reflected in the diversity of the article collections that the journal has launched to date. True to its mission statement, the IJHPR is promoting “intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy”.The journal has been indexed in all of the leading international academic databases and its current impact factor (1.36) puts it in the third quartile in two key Web of Science subject categories. Several IJHPR articles have been accessed over 10,000 times and the IJHPR has become the predominant vehicle in which Israeli scholars are publishing articles with a health policy orientation. IJHPR articles are also figuring prominently in many course syllabi in Israel, and Israeli universities have incorporated IJHPR publications into assessments of faculty members for promotion. The journal’s success and progress are a part of a larger trend of greater reliance on data and analysis in health policymaking in Israel and the increasing prominence of health in the Israeli policy agenda and public discourse.During the journal’s seventh year, its editors will be carrying out a serious assessment of the challenges and opportunities ahead and developing an updated plan for the journal’s development. In doing so, they will draw on data presented in this editorial as well as on in-depth discussions with those who have contributed to the journal’s success to date: it publisher, sponsor, and editorial board members, as well as a sample of authors, reviewers and readers. The expectation is that, by working together, it will be possible to take the journal to new heights. The Israel Journal of Health Policy Research was launched in 2012 by the National Institute for Health Policy and Health Services Research. Based on several well attended international meetings held in Israel, and frequent collaboration of the rapidly growing community of Israeli health policy scholars with counterparts abroad, the editors and the National Institute recognized that the level of international interest in the Israeli health system was substantial, and well in excess of the norm for health systems in small countries. At the same time, they realized that, because of its small size, it is particularly important for Israeli health care to learn from the experience of other countries. They realized that a peer-reviewed journal could take this cross-national learning, and existing efforts to link policy and research within Israel, to a new level. Thus, as indicated in the journal’s mission statement “Israel Journal of Health Policy Research seeks to promote intensive intellectual interactions among scholars and practitioners from Israel and other countries regarding all aspects of health policy…. The ultimate aim of these intellectual interactions is to contribute to the development of health policy in Israel and around the world.”The IJHPR will soon be completing its sixth year of publication and beginning its seventh. In both Biblical and academic traditions, after 6 years of intensive activity, the seventh year is championed as a time for reflection. At the IJHPR, we are also planning to use the upcoming seventh year as a time of summing up and looking to the future. Accordingly, in comparison with previous end-of-year editorials, we are using our 2016 editorial to provide a more comprehensive look at what the journal has accomplished to date. This will lay the groundwork for a serious assessment during 2017 of the challenges and opportunities ahead.Perhaps first and foremost, the journal has become a stable and vital part of Israeli health care. When the journal was launched, there were many who had serious questions about the need for such a journal and whether it would attract a sufficient volume of high quality articles. Now, after 6 years in which the journal has published well over 300 articles, with at least one article published every month of its existence, those questions about viability have disappeared. Indeed, in the words of Orly Manor, the chairperson of the National Institute’s executive committee, “The National Institute takes great pride in the accomplishments of the IJHPR and it is an integral part of the National Institute’s program. The journal is also an integral part of the Israeli health care system, documenting its strengths as well as opportunities for improvement in policies and practices.”The journal’s success and progress are a part of a larger trend of greater reliance on data and analysis in health policymaking in Israel and the increasing prominence of health in the Israeli policy agenda and public discourse. Related phenomena are the increased attention to health in the media, the growing number of health policy conferences, and the growing levels of attendance at these conferences. The journal has certainly benefited from these broader trends; we believe that the journal has contributed to them as well.Health policy in general, and the IJHPR in particular, are also becoming more prominent in Israeli academia. IJHPR articles are figuring prominently in many course syllabi in Israel, and Israeli universities have incorporated IJHPR publications into assessments of faculty members for promotion. The journal has been indexed in all of the leading international academic databases, including PubMed, PubMed Central, Web of Science, Social Science Citation Index, and Scopus.As can be seen in Fig. A related point is that the IJHPR has become the predominant vehicle in which Israeli scholars are publishing articles with a health policy orientation. In fact, the IJHPR accounts for over a third (52 out of 142) of the articles associated with Israeli universities that were published in 2015–6 in any of the 77 journals included in the Web of Science’s Health Policy and Services category.Significantly, the journal is drawing submissions from a broad range of Israeli universities, as can be seen in Fig. Also worthy of note are the major contributions from three universities from outside of Israel: Harvard University, the University of London and University of California. These contributions are mostly in the form of commentaries, highlighting the international significance of empirical studies of Israeli health care. The IJHPR is also increasingly publishing original research articles and integrative articles written jointly by Israeli scholars and scholars from other countries. These contributions from abroad are a testimony to the high regard in which the Israeli health system, and its researchers, are held by leading international scholars.We are also pleased that the journal is increasingly drawing high-quality submissions from professionals working in the government and in health care provider organizations. This reflects both the journal’s policy orientation and the growing involvement in research, analysis and academia among professionals in these organizations. The journal’s policy orientation also accounts for the important contributions from scholars in other countries who had recently served in high-level positions in their respective governments.While institutions provide vital support for research and publication, in the end it is individuals who write the articles and select the journals to which they will submit them. And so, after 6 years, we feel the time is ripe to publicly acknowledge those individuals who have made particular contributions to the IJHPR’s growing corpus of intellectual holdings.Table Table Pharmaceutical policy issuesHealth economicsDigital HealthHealth care equityPrimary carePrioritizationHealth promotion and disease preventionThe healthcare workforceQuality of careThis breadth is also reflected in the journal’s growing list of article collections , which currently includes the following:These article collections are important tools for both research and teaching, and help our authors reach additional audiences. Of course, the range of topics covered by the journal is even broader, including such topics as health care and the elderly, medical education, and much more. We welcome suggestions of additional topics for article collections.In recent years, the journal has been attracting and publishing more articles that take on major, national health policy issues. The topics covered include: reducing the burden of STI infections , Israel’Data on the IJHPR’s Web of Science impact factor are presented in Fig. The data also suggest that the IJHPR has become a venue in which Israeli authors are publishing some of their best articles related to health policy. In 2015–6, 27,757 articles were published in the 77 journals in the Web of Science’s Health Policy & Services, and 142 of those articles are associated with an Israeli university. Despite the recency of publication, 9 of the 142 have already been cited five or more times, and 4 of those 9 were published in the Israel Journal of Health Policy Research.The IJHPR recognizes that its success is due in large part to its authors – authors who have carried out important scholarly work, written it up, submitted a manuscript to the IJHPR, and stuck with us through the rigorous process of review and revision. We appreciate the contributions of all of our authors, and are especially appreciative of those who publish with us regularly. Sixteen Israeli scholars have published 4 or more articles in the IJHPR, and nine of them have published five or more articles in the IJHPR. As editors, we work hard to ensure that authors have a positive experience in their interactions with the journal, so “repeat business” of this sort is particularly gratifying.here; the list for 2017 is due to be published in early 2018.The journal’s success is also due in large part to the work of hundreds of reviewers, from Israel and abroad. As editors, we repeatedly and consistently hear from our authors about how impressed they are with the quality of the reviews they receive and how appreciative they are of how the reviewers’ constructive input has helped them improve their papers. The names of all IJHPR reviewers for the years 2012 through 2016 can be found here. Editorial board members play a vital role in helping us identify reviewers and commentators, as well as undertaking a large number of reviews themselves. A special thanks goes to the journal’s associate editor, Steve Schoenbaum, for the tremendous amount of work he has put in to ensure the quality of our articles.Another group that has played a key role in the journal’s work is its editorial board, whose members are listed Another special thank you goes to Alik Aviram, who will soon be completing his tenure as scientific director of the National Institute, and who has been a major factor in the IJHPR’s success. Alik has been a regular source of wise counsel and encouragement. We wish Alik success in all his future endeavors and are delighted that he has informed us that he will now have more time available to help out with the journal.We also wish to express our profound appreciation for the late Haim Doron, who for decades played a central role in the development of the Israeli health care system, and who also played a key role in the launching and development of the IJHPR. He was the Director-General of Clalit Health Services, Chairman of the National Institute’s Board of Directors, one of the fathers of primary care in Israel, and Chairman of the IJHPR’s editorial board. Professor Doron, who passed away in November 2017 at the age of 89, was throughout his long and productive life a visionary, a leader, and a mensch. He began talking about the need for an Israeli health policy journal over 15 years ago, and as such was probably the first significant figure in Israeli health care to do so. In appreciation of this, the journal’s primary care article collection will be dedicated to the memory of Professor Doron. May his memory be an ongoing inspiration for all of us.As we look to the future, we hope that more and more of our readers will submit high quality manuscripts to the IJHPR. Articles published in the IJHPR have the potential to contribute significantly to improved health policymaking and population health, both in Israel and around the world.In the year ahead, we will be exploring several new ways to use the journal to better link research and policymaking and to bring the international experience to bear on the Israeli policy development process. We also plan to use the journal’s seventh year to carry out a serious assessment of the challenges and opportunities ahead and to develop an updated plan for the journal’s development. In doing so, we will draw on the data presented here as well as in-depth discussions with all of the journal’s key partners and constituents. We look forward to working together in the effort to take the journal to new heights.


Background. The information available about osseointegration and the bone to implant interaction of zirconia implants with various surface modifications is still far from sufficient. Objective. The purpose of this systematic review and meta-analysis was to evaluate and compare zirconia dental implants with different surface topographies, with a focus on bone to implant contact and removal torque. Methods. The systematic review of the extracted publications was performed to compare the bone to implant contact (BIC) with removal torque (RT) values of titanium dental implants and machined and surfaced modified zirconia implants. Results. A total of fifteen articles on BIC and RT values were included in the quantitative analysis. No significant difference in the BIC values was observed between titanium and machined zirconia implants . However, a significantly better BIC values were observed for acid etched zirconia implants compared with those of titanium implants . Unmodified zirconia implants showed favorable BIC values compared to modified-surface zirconia implants . Conclusion. Acid etched zirconia implants may serve as a possible substitute for successful osseointegration. Commercially pure titanium and some of its alloys have so far been the material of choice in implant dentistry and orthopedics . HoweverOsseointegration is biological fixation of implant relating to direct bone to implant contact (BIC) without an intervening connective tissue layer . BIC is The present systematic review and meta-analysis was conducted to evaluate BIC around zirconia implants with different surfaces. The null hypotheses are as follows. (1) There are no differences in BIC for machined zirconia dental implants compared with titanium implants and (2) there are no differences among zirconia dental implants with different surface modifications with regard to BIC and RT.This systematic review adheres to the criteria of the “Preferred Reporting Items for Systematic Review and Meta-Analysis” (PRISMA) . British Journal of Oral and Maxillofacial Surgery, Clinical Implant Dentistry and Related Research, Clinical Oral Implants Research, European Journal of Oral Implantology, Implant Dentistry, International Journal of Oral and Maxillofacial Implants, International Journal of Oral and Maxillofacial Surgery, International Journal of Periodontics and Restorative Dentistry, International Journal of Prosthodontics, Journal of Clinical Periodontology, Journal of Dental Research, Journal of Dentistry, Journal of Oral Implantology, Journal of Craniofacial Surgery, Journal of Cranio-Maxillofacial Surgery, Journal of Maxillofacial and Oral Surgery, Journal of Oral and Maxillofacial Surgery, and Journal of Periodontology.Electronic searches without time restrictions were performed in the PubMed database for relevant publications until 15 June 2016. The following search terms were used in this study: dental implant, zirconia implant, zirconia dental implant, zirconia osseointegration, removal torque values, histomorphometry, zirconia surface treatment, and dental implant surface treatment with OR and AND. Authors also manually searched the literature for relevant publications inThe studies were included if they met the following inclusion criteria: (1) animal studies, (2) publication in the international peer reviewed literature, (3) English language, and (4) histological  assessment of BIC and RT.Exclusion criteria were (1) animal studies with less than two animals per observation or group, (2) computational studies, (3) human studies, (4) studies that evaluated only one type of implant surface, and (5) reviews.Based on population, intervention, control, and outcome (PICO) criteria, the focused questions were as follows. (1) Does the choice of implant material affect bone to implant contact when comparing titanium to zirconia in animal models? (2) What is the impact of zirconia implant surface modification on BIC and RT when comparing modified to as sintered zirconia in animal models? The study population was the animals which received machined or surface-modified zirconia and titanium dental implants. The comparison was made between titanium and machined zirconia, between titanium and surface-modified zirconia implants, and between machined and surface-modified zirconia implants. The two outcomes evaluated were the BIC and RT of implants.The titles were screened independently by the two reviewers. The abstracts of all studies were assessed for relevance to the review and those appearing to meet the inclusion criteria were retrieved. Also, all reference lists of the selected studies and relevant reviews were checked manually to identify additional articles that have been missed in database searches. Disagreements were settled by discussion between the authors until a consensus was achieved.All studies were assessed for quality depending on whether they met all the quality criteria or if one or more criteria were partially met or not met using the SYRCLE's risk of bias tool . This toIn the majority of included studies, the animals were subdivided into various groups. The comparison was performed for different implant materials and surface treatments. These data were recorded separately during the review to be incorporated into the analysis. Thus the population of the study was more than indicated by the numbers of the included studies.p < 0.05. The data were analyzed using comprehensive meta-analysis software version 2 .The meta-analysis was based on the Mantel–Haenzel and Inverse Variance methods. Bone to implant contact and the removal torque were the continuous outcome measures which were expressed in standard difference in mean. A fixed model was used to calculate the weighted means at 95% confidence intervals (CI). The values were considered significant when The search in the database retrieved an initial number of 2018 references. 1900 titles were excluded after further assessment . All selA total of 15 studies were included in this quantitative meta-analysis which were published from 2004 to 2015. Seven of the selected studies , 18–23 eFifteen studies assessed the mean BIC values (%) around the implants in different observation periods. The range of BIC values for titanium, machined zirconia, blasted zirconia, and surface etched zirconia implant groups in selected studies was 31.80% to 87.85%, 33.74% to 84.17%, 41.35% to 67.4%, and 51.1% to 71.4%, respectively.p = 0.373) and between titanium and blasted zirconia implants . However, a significant increase was observed in BIC values of acid etched zirconia compared with titanium implants . Comparative studies of machined and surfaced modified zirconia implants showed a greater BIC for unmodified zirconia implants . In addition, PIM untreated zirconia implants showed significantly greater BIC than PIM-treated zirconia implants   .p < 0.001)  .This systematic review and meta-analysis focused on 2 questions. (1) Does the choice of the implant material affect BIC when comparing titanium to zirconia in animal models? (2) What is the impact of zirconia implant surface modification on BIC and RT when comparing modified to as sintered zirconia in animal models? Data synthesis showed a significantly better BIC values for acid etched and unmodified zirconia implants compared with those of titanium and modified-surface zirconia implants respectively. Thus, the null hypotheses were rejected.It is well known that surface topography, chemistry, and roughness affect the rate and quality of new tissue formation . SurfaceWhen comparing the BIC values of modified zirconia surfaces relative to the machined ones, data synthesis has identified that unmodified zirconia surface may be favored over modified zirconia implant. This result was supported by the RT values which also favored to zirconia implants. When evaluating the outcomes reported in these studies, it must be emphasized that mean BIC values assessed after respective healing periods were commonly in agreement with this result. Accordingly, the bone to implant contact around zirconia implants exhibited greater values than those of the modified zirconia implants , 21. ConIt can be concluded that an acceptable BIC is achieved after the healing period independent of implant material and surface treatment. There is a general consensus that roughening the implant surface above the level seen with most machined surfaces enhances the bone response to implants. However, the effects of surface roughness on the cell function and interplay between a zirconia implant and the adjoining bone tissue have to be clearly investigated.Some of the challenges in the translation of animal studies are decreased by meta-analysis of animal studies; however, the results have to be interpreted with caution because of the presence of several confounding factors. The available literature on bone-implant interface involves a wide range of studies with various methods and results; thus the impact of one surface over another can barely be compared . ArguablAnother important issue to consider is the animals used for the experiment. Pigs and rabbit were commonly used as experimental models in accepted studies, while monkey and rat were used in two studies. Variation in animal models among studies may result in considerable variations in the results . SelectiConsidering these limitations, the findings of the current study should be interpreted cautiously. Several other confounding factors such as surface topography, chemistry, roughness, implant design and dimension, and healing time influence the results. Coexistence of multiple factors in the studies makes the evaluation of one particular factor impossible and the lack of control over these factors lowers the potential of definitive result extraction.Within the limitation of the present study, the following conclusions can be drawn.(1) No significant difference in the BIC values was observed between titanium and zirconia and between titanium and sandblasted zirconia implants, (2) a significantly better BIC was observed for surface treated zirconia compared with titanium implants, (3) unmodified zirconia implants showed favorable BIC values compared to machined zirconia implants; moreover, PIM untreated zirconia implants showed significantly better results than PIM-treated zirconia implants, and (4) untreated zirconia implants showed favorable RT values compared to machined zirconia implants.


During 2010–2012, 30% of adults aged ≥65 years living in nonmetropolitan areas had no natural teeth, compared with 21% of those living in metropolitan areas. The percentage of adults aged ≥65 years with no natural teeth was higher in nonmetropolitan areas than in metropolitan areas in all regions of the United States. In both metropolitan and nonmetropolitan areas, the West had the lowest percentage of adults with no natural teeth.Sources: National Health Interview Survey, 2010–2012. Available at http://www.cdc.gov/nchs/nhis.htm.http://www.cdc.gov/nchs/hdi.htm.CDC. Health Data Interactive. Available at Reported by: Ellen A. Kramarow, PhD, ekramarow@cdc.gov, 301-458-4325.


Lathyrus sativus L.) Genotypes under Salinity Stress” [Lathyrus sativus) Genotypes, Differing in Arsenic Tolerance. Agric Res (2013) 2: 330. doi:10.1007/s40003-013-0085-3 in Figure 6.International Scholarly Research Notices has retracted the article titled “Growth Responses and Leaf Antioxidant Metabolism of Grass Pea ( Stress” . The art


Arabidopsis thaliana, was made in understanding the structure and metabolism of starch and its conjunction. The process underlying the initiation of starch granules remains obscure, although this is a fundamental process and seems to be strongly regulated, as in Arabidopsis leaves the starch granule number per chloroplast is fixed with 5-7. Several single, double, and triple mutants were reported in the last years that showed massively alterations in the starch granule number per chloroplast and allowed further insights in this important process. This mini review provides an overview of the current knowledge of processes involved in the initiation and formation of starch granules. We discuss the central role of starch synthase 4 and further proteins for starch genesis and affecting metabolic factors.Starch is the primary storage carbohydrate in most photosynthetic organisms and allows the accumulation of carbon and energy in form of an insoluble and semi-crystalline particle. In the last decades large progress, especially in the model plant  Arabidopsis thaliana leaves.Starch is one of the most abundant biopolymers on earth. The entire process of starch biosynthesis encompasses: the generation of a suitable primer (glucosyl acceptor); the biosynthesis of a glucosyl donor (in most cases ADPglucose); the elongation of the primer by repetitive glucosyl transfer reactions via starch synthases (SS) and most probably via plastidial phosphorylase (see below); the introduction of branching points via branching enzymes and the removal of excess branching points via debranching enzymes; and the ordering of the glucans to the final physical organization. Starch granule synthesis in green algae, mosses, ferns, and higher plants occurs inside the plastids. In many other eukaryotic algae starch is formed in the cytosol, which is assumed to represent an earlier evolutionary state . This restarch initiation in a strict sense as a process in which a primer-like structure/initiation complex is generated, that can in principle be further used for polymerization reactions. This also includes the possibility that no starch granules are detectable since the primer-like structure/initiation complex is not further synthesized. The term starch formation indicate when these potential primer-like structures/initiation complexes are used to form starch granules, and so starch granules are detectable in chloroplasts.To some extent, the initial steps of the starch biosynthesis, the generation of a suitable primer , and the further elongation of the glucosyl acceptor by the action of glucosyl transferases is not precise to separate. The first elongation processes as well as the first branching/debranching events does not immediately result in a native starch granule rather generate a polyglucan. Furthermore, SS specifically interact with branching enzymes during the process of starch synthesis . But onlStarch synthases (SSs) are the enzymes responsible for elongation of amylose and amylopectin chains. These enzymes transfer glucosyl residue from ADPglucose to the non-reducing end of a preexisting glucan. It was discussed whether SSs are able to synthesize glucan chains without a glucan primer . Howeverss4 mutant reveals mostly one starch granule per chloroplast . Thus, immature leaves of ss4 have no detectable starch granules in contrast to mature leaves .dpe2/phs1 revealed mostly one starch granule per chloroplast when grown under 12 h light and 12 h dark conditions, similar to ss4. However, expression of SS4 was unaltered in this mutant . ptst2/ptst3 revealed also a high accumulation of ADPglucose (with ∼30-fold compared to wild type) that was twice of that of ptst2 (ss4/ss3 showed a similar high accumulation of ADPglucose as ss4 (with ∼100-fold increase compared to wild type). dpe2/phs1 and especially dpe2/phs1/ss4 also revealed mostly one starch granule per chloroplast but showed only a very moderate increase in ADPglucose content . Furthermore, dpe2/ss4 and phs1/ss4, each having one starch granule per chloroplast, revealed totally different ADPglucose values . Under continuous light, an increase in the granule number per chloroplast was observed for ss4, dpe2/phs1, and dpe2/phs1/ss4. But these observations were not accompanied by a reduction in the ADPglucose amounts  was observed in mex1/phs1 compared to wild type  the granule was large and spherical, whereas when 5-7 starch granules were monitored (under continuous light) the starch granule morphology was similar to wild type . The initiation of starch seems to depend on a chloroplastidial maltodextrin metabolism. At least PTST2 and PHS1 seem to be involved in this process. As this maltodextrin metabolism can be influenced by the ongoing starch turn-over and distinct enzymes of the starch metabolism  the involvement of further proteins/enzymes is highly likely. In yeast cells, starch-like synthesis was recreated by introduction of Arabidopsis SSs without plant enzymes related to synthesis of a primer, thus the intrinsic primers of yeast seems to be sufficient for the formation of starch like polyglucans. Furthermore, the experiments again showed that SS4 can be substituted by other SSs, as starch-like polyglucans were observed not exclusively when SS4 was introduced (In the last years we got more insights into starch granule biosynthesis. The appearance of starch granules is a rather complex mechanism influenced by various factors. According to this, it is very important to distinguish between the possibility to initiate starch and the formation of starch granules. It is quite clear that SSs, or more precisely SS4, is important in the formation of the typical number of starch granules per chloroplast in Arabidopsis 5-7, . Howevertroduced .All authors listed have made a substantial, direct, and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.The reviewer NC and handling Editor declared their shared affiliation.


Background: Accurate understanding of complex health data is critical in order to deal with wicked health problems and make timely decisions. Wicked problems refer to ill-structured and dynamic problems that combine multidimensional elements, which often preclude the conventional problem solving approach. This pilot study introduces visual analytics (VA) methods to multi-stakeholder decision-making sessions about child injury prevention; Methods: Inspired by the Delphi method, we introduced a novel methodology—group analytics (GA). GA was pilot-tested to evaluate the impact of collaborative visual analytics on facilitating problem solving and supporting decision-making. We conducted two GA sessions. Collected data included stakeholders’ observations, audio and video recordings, questionnaires, and follow up interviews. The GA sessions were analyzed using the Joint Activity Theory protocol analysis methods; Results: The GA methodology triggered the emergence of ‘common ground’ among stakeholders. This common ground evolved throughout the sessions to enhance stakeholders’ verbal and non-verbal communication, as well as coordination of joint activities and ultimately collaboration on problem solving and decision-making; Conclusions: Understanding complex health data is necessary for informed decisions. Equally important, in this case, is the use of the group analytics methodology to achieve ‘common ground’ among diverse stakeholders about health data and their implications. Public health data are ‘data for action’ . They arThe emerging science of visual analytics seeks to provide theories and empirical methods that can enable application designers to more effectively apply information visualization techniques and computational analysis methods within the context of human decision-making to better deal with complex data . AccordiVisual analytics plays a pivotal role in the data analysis process. It offers analysts two key functionalities: visualization and interactivity. Data visualization amplifies the cognitive capabilities of the analyst, and facilitates problem solving by making the solution to the problem prominent or salient. Interactivity provides a platform to establish an “analytic discourse”  between The present research begins with the need to bridge the visual analytics approach and collaborative decision-making methods. Proposed solutions to public health problems must be consistent with a rational analysis of the available health data and take into account the values and beliefs of multiple stakeholders in the relevant community. Thus, communication of thoughts and ideas among stakeholders support the advancement of solutions to complex problems in the context of a structured approach to collaborative decision-making.This pilot study proposes the design and evaluation of a new methodology termed “group analytics (GA)”, as applied to the complex injury prevention problem in Canada ,13. The Selected local and national injury stakeholders were invited to attend a one-day workshop meeting entitled, “Child and Youth Injury Dashboard using BC CHIRPP data” at BC Children’s Hospital in Vancouver, Canada. A purposeful sampling strategy was employed to select the study participants who were injury stakeholders . The aimiAID) was designed to assist injury stakeholders to understand complex and heterogeneous injury data, and to effectively engage in a real-world injury problem solving process [The Interactive Analytical Injury Dashboard  database was the source of data for this pilot study . CHIRPP During the workshop, the GA methodology was pilot tested in two group sessions. Each session lasted approximately 30-min. The VAE provided SMEs with an overview tutorial of the visualization tool and explained its features and functionalities. A large rectangular table was placed in the middle of the room in order to facilitate each group meeting. An augmented projection mounted on the wall faced all participating SMEs to allow them to synchronously access the interactive information and observe all at once the manipulations of the data when generating customized visualizations. SME interaction data were collected using audio and video recordings, as well as screen capture using Camtasia software  to record on-screen interactions with the visualization dashboard. The research was reviewed and approved by the University of British Columbia and BC Children’s Hospital Research Ethics Board (certificate #H09-01135). iAID. VAE assisted injury stakeholders in manipulating the visual display and customizing the dashboard visualizations based on their needs as they worked through the injury scenarios. The GA methodology pilot testing encompassed four phases . We supplemented these ethnographic techniques with video- and audio-recordings of the GA sessions, as well as screen capturing of the analysts’ interactions with the The analysis of the transcribed audio and video recordings as well as the screen captures of the collaborative sessions were conducted using ATLAS.ti and Chronoviz software . Transcripts of the video and audio files were closely examined using open, axial, and selective coding techniques  to categThe qualitative analysis methodology was grounded in Clark’s Joint Activity Theory (JAT)  and the Common ground represents joint beliefs and knowledge as the basic foundation upon which individuals’ coordination of actions and collaboration rely. The emergence of three types of common ground were classified and documented as follows.The analysis revealed evidence of Clark’s notion of ‘common ground’. “Common ground” is defined as the aggregation of “mutual, common, or joint knowledge, beliefs and assumptions” of two individuals . Common Community, cultural, and personal shared bases were emphasized among SMEs and were established based upon their prior shared knowledge and expertise in the field of injury prevention. These shared bases represented the foundation upon which SMEs coordinated their activities to achieve a common purpose and solve the analytic tasks. “We had a common goal but we might have taken different pathways to get there, but they’re coming together to talk about it in one group…we have the trauma surgeon, we have the epidemiologist, we have the policy makers, we have the researcher, the coordinator.”SME: iAID platform. Insight into the injury data was facilitated by the iAID, which SMEs used to establish a common understanding of the injury problem. Interaction between SMEs through verbal communication then generated possible solutions. New assumptions and shared beliefs were built and accumulated through interactions between SMEs on the “that exchange (of knowledge) in the group session got us all on the same page.”SME: Equity in data understanding led to new beliefs, knowledge, understanding of the injury issue, as well as new approaches shared by SMEs to address the injury problem. “So, we see that the major thing here is head injuries and eight and four years old and it’s about ‘falls’. So that at least really does start narrowing it down but it still says: ‘So, what are you going to do about that?’”SME 7: common ground while SMEs worked on solving the analytical problem were evident in the style of interactions observed among SMEs and with the iAID. The following four interactions styles were observed as follows: iAID): All SMEs focused their attention on the single visual display and observed the content of the visual interface : SMEs focused their attention and listened to one SME who actively expressed a point of view, supported a claim or rejected another SME’s viewpoint and proposed an alternative approach to problem solving b;iAID): One SME shared minor observations about the visualization with a nearby SME without engaging the whole group : Two SMEs discussed various aspects of the problem solving process, presented their personal perspectives, shared their background knowledge, and convinced each other in a one-on-one setting, before returning to the group conversation d.In both GA sessions, SMEs interacted with other group members by verbally expressing their viewpoints and understanding of the content of the visualizations. The video captured instances of interactions between SMEs . CommuniiAID visual display and customized the visualizations according to SMEs’ needs and task requirements. With the assistance of VAE, SMEs interacted with the dashboard to refine the visual representations in a way that enhanced their understanding of the multidimensional injury data and empowered them with the best approach to address the injury problem at hand, raise questions, converge to a solution and reach a consensus , “support-problem solving” (100%) and “decision-making processes” (85.6%) , SMEs rated the  (85.6%) .“They  provide a great deal of information very quickly and allow me to understand trends and variation in the injury data.”“I thought the interaction and having the other experts there as well, people who have used the data differently, I thought that the interaction was really helpful.”“It  helps to present the story.”“I think that our group session was great because we sort of all, everyone got some words in and they were able to work together on that.”“It  helps to think about the data in different way. It’s kind of different ways to slice the pie to get the creativity going in terms of what the data are actually telling us and possible directions for preventions.”“The visual representations of the data for me are key in understanding what I’m looking at.”“I trust what I see.”SME expressed their experience interacting with the visualization tool:common ground, consequently improving the coordination of collaborative activities. In his book ‘Using Language’, Clark explains that according to Thomas Schelling, people coordinate their activities to address coordination problems. He further posits, “Two people have a coordination problem whenever they have common interests, or goals, and each person’s actions depend on the actions of the other” [iAID and to investigate the health problem in a collaborative social setting.Collaborate to Explore (C2E): The GA session fostered a dynamic learning environment for SMEs to jointly explore the injury data using the iAID dashboard. This visual analytics tool amplified SMEs cognitive capabilities and improved their collaboration in order to facilitate their problem-solving and decision-making process.Collaborate to Visualize (C2V): SMEs collaboratively interacted with the shared visual display of the Collaborate to Argue (C2A): SMEs collaborated to present various viewpoints, to argue broader perspectives and to suggest solutions about the injury problem. During the GA sessions, SMEs communicated their viewpoints with each other, clarified their perspectives, justified their thinking, and supported their claims through dialogue and argumentation.Collaborate to Solve (C2S): SMEs integrated their prior knowledge through interactions and communication to make sense of the problem situation. SMEs collaboratively manipulated the injury data and re-represented the information in an easy-to-understand format to gain insights into the injury data, build knowledge, and solve the analytical task.iAID to monitor the injury situation, assess the current state of the injury problem, and consequently support the decision-making process. SMEs collaboratively embraced an interdisciplinary discussion and argumentation. This process enhanced the chain of inference through the distributed cognition process to solve the analytical problem and reach an informed decision.Collaborate to Decide (C2D): SMEs collaboratively used the The Delphi-structured GA sessions incited interactions and exchange of thoughts and ideas among SMEs through conversation and dialogues. This exchange of knowledge served to supplement additional layers of e other” . During iAID tool in a Delphi structured setting contributed to the multifaceted dimensions of the collaborative analytics process and enabled SMEs to efficiently exchange knowledge and effectively solve the analytical task.SME interactions were tightly linked to their collaborative activities intended to solve the analytical problem. As SMEs attended to a common task and shared mutual goals, they were engaged in collaborative activities facilitated by their various social interactions. SME interactions were pivotal to achieve ‘shared meaning, mutual understanding and the coordination of human conducts’ . One SMEiAID visual display, so as to reflect the needs and preferences of SMEs. Turn-taking within the flow of conversation between SMEs was evident, and suggested a joint resolve to solve the injury problem through rounds of argumentation and discussion. Studying these interactions through the lens of language use enabled further understanding of the social and cognitive aspects of the collaborative analytics process. The Delphi structured social group afforded a unique atmosphere of awareness among SMEs to attend to each other’s viewpoints, thus supporting coordinated actions and collaborative activities in order to reach a consensus. In addition to the social collaboration, the perceptual co-presence of the iAID influenced joint actions between SMEs. The common visual display not only served to align SMEs discussion and argumentation, it also amplified the cognitive and perceptual capabilities of SMEs to effectively understand and interpret the injury data. SMEs discussed, exchanged knowledge, and reasoned about the injury problem using the visual analytics dashboard. The iAID visual display guided stakeholders to move forward based on the gained knowledge from the shared visual representation. Attending to the same visual representation made it easier for SMEs to refer to the data, to reflect on the generated visualizations, to communicate their viewpoints and ideas, and consequently to advance the problem-solving process.Previous similar studies confirmed current results ,34,35,36Off-screen communication was observed between SMEs by way of the gestures captured on video. Gestures constitute an essential component of the conversational interactions among individuals . GestureiAID acted as a coordination device [iAID dashboard, as well as interaction with the social and cultural environment, represented key components of the cognitive and computational system that supported SMEs’ analytical problem solving process and decision-making.The combination of cognitive efforts from multiple SMEs, facilitated and supported by the surrounding computer-mediated environment, enhanced individuals” abilities to perceive and reason complex cognitive tasks . The iAIn device  to suppoWe acknowledge that our GA study encounters a number of limitations. Firstly, we had a relatively small sample size, which may limit the generalizability of the study and its applicability to the larger injury stakeholders’ population and the broader public health community. This restriction is imposed by patient information privacy policies that allow only a limited number of authorized stakeholders to access and interact with the available public health data. Secondly, this GA study investigated a hypothetical injury issue and therefore injury stakeholders were not making actual decisions. However, it was essential to acknowledge and take into consideration the challenges and obstacles that might face the collaborative decision-making process, during the course of the group analysis session. Thirdly, injury stakeholders were manipulating the dashboard visual display with the assistance of the VAE during the pilot GA sessions. To help injury practitioners and policy-makers independently generate visualization and accurately analyze data, structured and guided eLearning tutorials should be offered to novice users to acquaint them with the basic concepts and the essential functionalities of the dashboard. ‘Know-how’ or a ‘help’ feature can be integrated into the dashboard to help teach novice users about the dashboard features, provide support on a need-basis and suggest appropriate visualizations based on the type of data analyzed.Following this pilot study, a complementary research work was carried out to conduct an extensive beta testing sessions for dashboard users . The stuDespite these limitations, the study findings clearly reveal the advantages of integrating the analytical dashboard as a decision-support tool to synthesize information from multidimensional and dynamic health data. The study’s empirical findings constitute relevant and valuable resources that contribute to the understanding of collaborative visual analytics and its impact on problem-solving and decision-making within the health care sector and, specifically, to injury prevention. This pilot study of the GA methodology has many implications for future research. The results may inform future innovative visualization tools that will synthesize key social and collaborative components of visual analytics to enhance group knowledge construction and optimize decision-making. Furthermore, GA methodology can be applied to other domains within the healthcare sector which would likely benefit from interdisciplinary insights . ExampleiAID dashboard, helped to address and solve the analytical injury problem. Engaging with the right stakeholders in a real-world setting presented an exceptional opportunity to assess the effect of collaborative visual analytics on addressing a complex health problem. Future work can expand the presented group analytics methodology to other domains of public health, in order to facilitate interdisciplinary analysis of complex data, and ultimately improve the capacity of stakeholders to make timely, evidence-informed decisions. Developing effective interventions to prevent injuries is a challenging task, as injury itself is considered a complex health problem due to its multidimensional nature. To address such challenges inherent in interpreting complex data, we proposed a collaborative method—group analytics (GA), supported by an interactive visualization tool, and theoretically grounded in Clark’s JAT. This pilot study successfully demonstrated the practical application of group analytics in injury prevention to facilitate data analysis, problem-solving, and consensus decision-making for multiple injury stakeholders. The results of the analysis showed that the group analytics methodology empirically evaluated and assessed the impact of collaborative visual analytics on problem-solving and decision-making processes within the context of public health wicked problems. The analytical sessions helped us to successfully capture stakeholders’ reasoning process in a real-world setting. The integration of an interactive visualization tool proved to afford injury stakeholders a useful platform from which to investigate the injury data, effectively discuss retrieved information, and share perspectives related to the analytical injury problem. Pooling multiple injury stakeholders’ ideas and inputs fostered a collective intelligence environment supported by the use of the designed


Individuals with MPV and AIx above the sex-specific medians had worse survival. Association analysis between MPV-related genetic variants and arterial stiffness identified four genetic variants in males and one in females related with AIx. Cox regression analysis for mortality identified one of these joint genetic variants close to ring finger protein 145 gene  linked with increased mortality . Thus, these population-based data demonstrate a close relation between platelet volume as a potential marker of platelet activation and arterial stiffness in both sexes. Further research is warranted to further elucidate the mechanisms underlying larger platelets‘ role in arterial stiffening including the role of shared common genetics.Vessel wall stiffening is an important clinical parameter, but it is unknown whether platelets, key elements in the pathogenesis of arterial thrombosis, are associated with arterial stiffness. The present studies sought to determine whether mean platelet volume (MPV), a potential marker of platelet activation, is linked to vascular elasticity as assessed by the augmentation index (AIx), in 15,010 individuals from the population-based Gutenberg Health Study. Multivariable analysis showed that MPV in both males (β 0.776; 95 Considering the high morbidity and mortality burden triggered by atherosclerosis, efforts are clearly directed towards early recognition and diagnosis of subclinical atherosclerosis. Arterial stiffness as a measure of distensibility and compliance of vessels is an established marker of cardiovascular morbidity and mortality and therefore a potential therapeutic target13The role of platelets in causing increased vascular stiffness is much less well defined5678Several studies suggest that vessel wall stiffening is an important clinical target, but it is unknown to what extent platelets, key elements in the pathophysiology of arterial thrombosis, are associated with arterial stiffness. The Gutenberg Health Study (GHS), as a large, prospective population-based cohort study in Western Germany, offers the potential to explore this relation in depth. To the best of our knowledge, this is the first study to investigate the relation between mean platelet volume (MPV), a potential marker of platelet activation including its known genetic variants, and vascular stiffness, in a large adult general population study sample.Arterial stiffness and MPV have been determined in 15,010 participants enrolled in the GHS at a baseline examination in the period between April 2007 and April 2012. GHS is a population-based, prospective, observational, single-center cohort study in Western Mid-Germany designed predominantly for examination of cardiovascular disease. Residents of the City of Mainz and the County Mainz-Bingen aged 35 to 74 were selected randomly from the local governmental registry offices with a stratification for sex, residence , and decade of age. All participants underwent a 5-hour examination at the study center following standard operating procedures (SOPs) by certified medical technical assistants. Details of the study design have been published earlierArterial stiffness was assessed by digital volume plethysmography using an EndoPat 2000 device , which is based on the fingertip measurement of pulsatile volume changes. The resultant augmentation index (AIx) is automatically calculated by identifying the early (P1) and late systolic peak (P2) with the following formula: (P2-P1)/P1*100. Endo-PAT 2000 has been already validated in many studies for both arterial stiffness and endothelial function measurements12131415Venous blood sampling was performed using tubes containing K3-ethylenediaminetetraacetic acid (EDTA). Platelet parameters (count and MPV) have been automatically determined on an Advia 120 Hematology System . Coefficients of variation for MPV range between 0.8 and 2.2% over time with a mean of 1.4%. Details of internal quality control for Advia 120 hematology systems and validation for inter-instrument variation for MPV measurements have been published earlierFrom the genetic data available for study participants, we systematically searched and selected 51 SNPs see  which ha181920Variable of arterial stiffness derived from digital plethysmography was Augmentation Index (AIx) expressed as percentage augmentation (%). Distribution of MPV is presented as median with interquartile range and tested with the Mann–Whitney U test. Normally distributed continuous variables are described using mean ± standard deviation (SD) and tested with T-test, whereas categorical variables are displayed by absolute and relative frequency and tested by Chi-squared test if needed. The reference group is a subsample of the population sample and included 2,660 individuals without manifest disease  and no known traditional cardiovascular risk factors  for myocardial infarction (MI) or stroke). Relations between continuous variables were explored by Pearson´s correlation coefficients. Multivariable linear regression analysis with AI as dependent variable and adjustment for age, cardiovascular risk factors (CVRFs), comorbidities and medication was used to identify determinants of arterial stiffness. The analysis of prospective mortality data with censoring is presented by using plots of Kaplan Meier curves with log-rank test and by Cox proportional hazards models.Because of the explorative character of the analysis, a significance threshold was not defined for p-values. P-values should be interpreted as a continuous measure of statistical evidence.th% and above 95th% of MPV. In general, individuals with CVRFs had higher AIx compared to the sample without CVRFs. Males with a CVRF had higher AIx. Differently, in females, only those with hypertension, smoking, dyslipidemia and positive FH for MI or stroke had higher AIx with respect to the sample without CVRFs.Arterial stiffness in the population sample without traditional CVRFs and in subsamples with CVRFs is presented sex-specifically in As shown in The unadjusted and the multivariable linear regression model for arterial stiffness, with adjustment for age, CVRFs, comorbidities, medication, fibrinogen and hematocrit confirmed the association between higher MPV and AIx for both males and females . AdjustiLinear regression models for the associations between MPV related SNPs and AIx in males are presented in ring finger protein 145 gene  significantly associated with increased mortality .During a follow-up period until September 2016 with a median follow-up time of 6.8 [5.5–8.2] years, a total of 580 deaths were registered in the total sample. When stratifying individuals for the sex-specific medians of both MPV and AIx, the best survival was present for the combination of both MPV and AIx below the respective medians . Cox regring finger protein 145 gene  linked with increased mortality.To our knowledge, this is a largest population-based study investigating the association between MPV, a potential marker of platelet activity and arterial stiffness. With this study, in a multivariable analysis even after adjustment, we found that there is a positive, strong association between MPV and vascular stiffness in both men and women. An association analysis identified one genetic variant close to MPV has been previously examined as an index of platelet function and associated to other conventional markers of platelet activation2223Vascular stiffness as assessed by the determination of the augmentation index is well validated in large population studies to be a strong predictor of adverse cardiovascular outcomes26Indeed, the main finding of the present analysis is a positive and strong association between MPV and arterial stiffness, implicating a close link between higher MPV, as potential marker of platelet activation, and increased stiffness of the arterial vessel wall. Differently, platelet count was not associated to arterial stiffness, as previously reportedRing Finger Protein 145 gene (RNF145), which is involved in megakaryopoiesis and platelet formationThe second important issue concerns the association of MPV-related genetic variants with arterial stiffness. Whereas the majority of studies focused on the association between arterial stiffness and SNPs related with the renin-angiotensin-aldosterone systemSeveral limitations of this study need to be acknowledged. We did not apply correction for multiple testing for investigating the association of MPV-related genetic variants with arterial stiffness. Although this study was of explorative nature, it was, however, based on the hypothesis of a biological link between platelet activation and arterial stiffness. The hypothetical concept was confirmed by large multivariable models demonstrating a measurable clinical link in humans.Life style changes in particular exercise and pharmacological interventions are two potential strategies suggested for decreasing arterial stiffnessIn conclusion, with the present study we can demonstrate that MPV is closely and strongly associated with increased arterial stiffness in both males and females in the GHS population and we demonstrate for the first time potential joint genetic variants associated with both traits. Future investigations are necessary to fully understand the molecular processes how activated platelets interact with the vessel wall to cause increased vascular stiffness and what antiplatelet measures are necessary to improve arterial compliance.How to cite this article: Panova-Noeva, M. et al. Mean Platelet Volume and Arterial Stiffness – Clinical Relationship and Common Genetic Variability. Sci. Rep.7, 40229; doi: 10.1038/srep40229 (2017).Publisher's note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.


A new stiffness measurement method is proposed that utilizes the lateral deformation profile of an object under indentation. The system consists of a force measurement module between a pair of equidistant touch sensing modules. Unique feature of the method is that by adjusting the touch module separation, indenter protrusion, and spring constant of the force sensing module, one can choose a desired sensing range for the force module. This feature helps to enhance the stiffness differentiation between objects of similar hardness and avoids measurement saturation. We devised a portable measurement system based on the method, and tested its performance with several materials including polymer foams and human skin. Stiffness is an important factor that is needed to perceive the properties of an object through tactile interaction. Intuitively, the stiffness can be understood as the responsive deformation of an object’s surface under an indentation force. Thus one only needs to know the deformation depth and the magnitude of the force applied to determine its stiffness. However, it is difficult to measure the deformation depth of the contacting surface directly while at the same time measuring the applied force. One way to evade this difficulty is to use a cantilever. When the tip of a cantilever is pressed onto an object's surface, the deflection of the cantilever will indicate the indentation depth of the object surface and by pre-measured force-dependent deflection data the amount of applied force may be known allowing the stiffness to be measured ,2. Althok, is defined as the magnitude of a force, F, acting on an object, divided by a deformation, δ, of the object (k = F/δ). Our measurement method utilizes the fact that for the same deformation normal to the force, a different amount of force would be required for surfaces with differing stiffness.Here, we introduce a portable stiffness measurement system that does not require pressure dependent indentation depth measurement to determine the stiffness of the contacted surface. Stiffness, k1 and a force sensor, and a pair of touch modules (t-module), a contact detection sensor. To measure the stiffness of an object, we make contact to the object by the piston portion of the f-module. Here we assume that the object has a flat surface with no roughness. Then force is applied via the piston until the t-module detects contact . When force is applied, the piston transfers the reactive force of the indented object to the force sensor inside the f-module. The t-module, whose edge is separated by a distance td from the piston will determine the moment when the object makes contact to it and when to measure the force at the f-module. When the stiffness of the object increases, the indentation profile will have a lower curvature, requiring higher forces, wider td, shallower piston, or lower spring constant (k1) to activate the t-module. Thus from a geometrical perspective, the stiffness measurement problem transforms to a relation between the location of the t-module and the range of the IE movement, according to the applied force.The cross-section of the plane being pressurized will have an indentation profile following that from the Sneddon’s equation (Equation (3)) , which wk2 can be determined from the equations below. Let us assume that a piston with radius a has a spring constant k1, and it is indented by the object by a depth of x1. The forces experienced by the spring and the object are identical:The stiffness of the object with an effective spring constant x2. At a specific force, F, the IE reaches the t-module, which is located a distance td from the piston. At that moment, we have a relationship:The indented depth of the object by the piston is u(d) is defined as a vertical distance from the imaginary non-deformed surface of the object to the indentation profile at location d. When the IE is at td, then u becomes u(td). According to the Sneddon’s equation [Here a function, equation :(3)u(dt)Equation (3) is based on an assumption that the thickness of the object is infinite. If the indentation depth is much smaller than the thickness of the object, we can still use the equation without significant error. In our tests, the indentation depths were only 3~6 mm, but the thickness of our objects were more than 2 cm. Combining Equations (1)–(3), we have:k2 depends on four factors; the initial piston protrusion height ix, the spring constant k1, the separation distance td, and the measured force F when the t-modules were activated.Thus stiffness k = 2.7 N/mm, Misumi Spring, Schaumburg, IL, USA). The polymer casing that houses the f-module was fabricated using a 3D printer . Two t-modules were fabricated with a mirrored structure necessary for balance and symmetry. The structures holding the lever, spring, and the force sensor were also 3D-printed. Any other type of sensor can be used without the lever for the t-module, if they have a small enough force threshold for touch detection. Also, without the lever mechanism, a smaller module design can be possible, minimizing the whole footprint of the stiffness measurement system.The stiffness measurement system consists of one f-module and two t-modules. It should be noted that the modules were designed to produce a system that will effectively demonstrate the proposed stiffness measuring principle and not optimized for a particular sensing range or reliability. The schematic cross-section diagrams of the f-module and the t-module are shown in  printer b. For th printer c,d When The f-module has a force sensor connected to a piston a. When tFor the t-modules, the threshold force should be minimized since it should be possible to activate them with just a very weak contact. To do so, we used a lever mechanism c. Unliketd, can be adjusted by interchanging the locations of the two t-modules as shown in The f-module and two t-modules were assembled into the stiffness sensing module (s-module). The f and t-modules were held by two frames; the front frame and the back frame a,b. The Four materials with different stiffness were chosen for stiffness measurement demonstration; sponge made of polyurethane, black foam made of polystyrene, blue foam made of polyolefin a, and hutd, k1, and ix. In the following subsections, we will show how the stiffness discriminating capability of the s-module was modified, by adjusting piston protrusion, spring constant, and the t-module separation distance.In F1, the IE of the two cases will be d11 and d21 each. In both cases, the t-modules located at distance td1 will not be activated and no measurement will be recorded. If the softer object is pressed further until the force becomes F2, at which point d12 = td1, then the t-module will be activated and the stiffness will be recorded. However at the same force with the harder object, the t-module will not be activated still (d22 > td1). The harder object needs to be pressed further until F3 is applied to activate the t-module (d23 = td1). Thus the difference of the recorded force indicates the difference of the stiffness between the two objects.When force is applied to an object through the piston, the object surface will start to deform accordingly. With increased force, the object surface will touch the s-module bottom surface and the edge of the surface indentation IE point will be definable. The IE will approach toward the center as the reactive force received by the object increases. For a softer object, the indentation depth will be relatively deep and the IE movement range will be narrow and close to the piston a. For a F2 and F3 will not be much different in terms of the sensor output , the stiffness of the skin can be calculated using the following equation:k is the stiffness, E is the Young’s modulus, A is the indentation area, and t is the thickness. The calculated stiffness of skin is 0.08~0.16 N/mm2, which roughly agrees with our result. Further calibration and system optimization should be able to increase measurement accuracies.xi), and the other is to change the spring constant (k1).In the previous subsection, we have shown that the t-module separation can enhance the stiffness discrimination ability. But for some applications, the t-module separation can be limited due to geometrical considerations. Also requirement on local stiffness assessment can limit the size of the s-module itself. In these cases, large separation will not be possible, and other alternative methods for enhancing the discrimination ability should be investigated. One method is to change the piston protrusion , while the IE for the tall protrusion d1 will be larger than d2. Thus compared to the tall protrusion module, one can apply smaller forces for stiffness measurement. For shorter protrusions, the result will be a shift of the IE point curve in The effect of protrusion change was verified from the two data sets shown in the F1. In case of the relatively stronger spring, d1 does not reach td and no force is measured , we can see from measured a. For thtd = 6 mm) and spring protrusion (ix = 3 mm), except for the spring constant. For the case of the weaker spring (k1 = 2.7 N/mm)   f, the di Spring) e.We can understand the dependence on the spring constant by considering the deformation of contacting objects. For the stronger spring, an object needs to be pressed harder for the stiffness measurement to take place. It results in higher pressure applied to the force sensor and the measurement to be taken near the saturation region of the sensor.From the results presented, we find that our method of stiffness measurement overcomes the need for depth measurement, or simultaneous measurement of several force sensors in parallel. Also by alternating passive elements, our stiffness measuring system can be adjusted to measure stiffness at various ranges for better discrimination of stiffness between different objects. Moreover, the operating principle is simple enough that the sensor components may be scaled and optimized to fit onto much smaller areas allowing it to be integrated into passive manipulation tools used today in such applications as, medical examination, remote surgery, and artificial robotic fingers.We have introduced a stiffness measurement system that utilizes the contacting object’s indentation profile depending on applied force. The indentation edge is the key parameter for determination of the stiffness measurement, because it is the triggering factor for the measurement of the stiffness of an object. To enhance the discrimination capability of the system, sensitivity of the IE movement depending on pressure could be controlled by adjusting three design parameters, the t-module separation, the piston protrusion, and the spring constant. Our stiffness measurement system may be scaled and optimized to be integrated into various tools and probes due to the simplicity in operation and the ability to adjust the sensing range to increase the stiffness measurement accuracy.


Purpose. To investigate the relationship between corneal biomechanical parameters, anterior segment parameters, and geometric corneal parameters in a healthy Caucasian group. Methods. This retrospective study included the healthy eyes with best corrected visual acuity of at least 20/40 of 122 Caucasian subjects. The anterior segment parameters and geometric corneal parameters such as corneal volume, central corneal thickness, horizontal and vertical corneal radii, anterior and posterior steep, and flat keratometric values were measured with a Scheimpflug camera. The biomechanical properties were measured with Ocular Response Analyzer. Results. One hundred and twenty-two healthy Caucasian subjects  with a mean age of 45.32 ± 20.23 were enrolled. Both corneal hysteresis and corneal resistance factor were positively correlated with CCT  and CV  and negatively correlated with age . Both in age-gender and multivariate models, CH and CRF had statistically significant negative association with the posterior steep K value. Conclusions. CH and CRF are negatively correlated with posterior steep and average posterior K values. K) value, and corneal biomechanical properties has been also investigated and the results are controversial [K values with 3 mm distance from the apex in a healthy Caucasian group.Many factors affect corneal biomechanical properties in healthy eyes –3. Anteroversial –11. Seveoversial , 13. In This retrospective study was carried out at Department of Ophthalmology of Bursa Yukses Ihtisas Training and Research Hospital. Initially, the medical records of 158 patients with best corrected visual acuity of at least 20/40 in one eye were reviewed. These patients were referred to the department for assessment of eligibility for refractive surgery, renewal of driving license, or obtaining medical report for any reason. The investigation was conducted in accordance with the Declaration of Helsinki and approved by institution. The exclusion criteria were history of previous ocular surgery and contact lens wearing, ocular inflammation, glaucoma, use of topical medication, and presence of diabetes mellitus and collagenous diseases. Of 158 patients, 122 healthy eyes of 122 subjects were included in the study.All the subjects underwent complete ophthalmologic examination including refraction and visual acuity measurement, biomicroscopic examination, intraocular pressure (IOP) measurement with a Goldmann applanation tonometer, and funduscopy.K, and anterior and posterior corneal K values with 3 mm distance from the apex were measured.The anterior segment of the included eye of each subject was imaged with a 3D rotating Scheimpflug camera Sirius  without application of any eyedrops. One of the authors performed all the measurements with Sirius. CCT, CV, anterior chamber depth (ACD), anterior chamber volume (ACV), horizontal and vertical corneal radii, CA, mean corneal Four consecutive ORA  measurements were performed and the averages of the measurements were taken. The high-quality readings defined by the manufacturer, because the force-in and force-out applanation signal peaks on the ORA waveform are fairly symmetrical in height, were accepted and recorded. The parameters used for analysis were CH, CRF, corneal compensated IOP (IOPcc), and Goldmann correlated IOP (IOPgc).K values, IOP, and spherical equivalent.The statistical analysis was performed by SPSS 22.0 statistical program. The relationship between variables was assessed with Pearson correlation analysis. Kolmogorov-Smirnov test was performed for the assessment of normal distribution of the data. Multivariate linear regression analysis was used for assessment of association of CH, CRF with anterior segment parameters, and geometric corneal parameters, including horizontal and vertical corneal radii, anterior and posterior steep and flat r = 0.529, p < 0.001; r = 0.638, p < 0.001) and CV  and negatively correlated with age . The corneal curvature and K values of both anterior and posterior surfaces are listed in K value, anterior flat K value, mean posterior K value, posterior steep K value, and vertical radius of CC. CRF was also correlated with mean posterior K value and posterior steep K value. No correlation was detected between CH, CRF, and mean K value  and CCT was positively associated with CH . In addition, there were positive associations between IOP, ACD, and CCT with CRF   with a mean age of 45.32 ± 20.23 were included in the study. The biomechanical properties, anterior segment parameters, and refraction values are given in  K value . In mult K value . When IO, resp.) .Previous studies showed that there is a correlation between corneal biomechanical properties and age. Though there are some controversial reports, most of the studies found a negative correlation between biomechanical properties and age , 13–16.In the present study, it is found that CH and CRF are negatively correlated with age in Caucasian population. Kotecha et al. also reported that CH and CRF are negatively correlated with age in a group of patients which included patients of different ethnic origin . In a reK value and CH and CRF in 86 eyes of 43 patients with a mean age of 39 years [K and CH and CRF in Chinese adults [K [Central corneal thickness is one of the important geometric corneal parameters that influence IOP measurement . The bioe adults . Hwang ee adults . Kotechae adults . In othedults [K , 21. DivK values of anterior and posterior surface of the cornea. Although no correlation was found between mean K value and CH and CRF, it is noted that there are correlations with posterior steep K value and vertical radius of CC. CRF was also correlated with mean posterior K value and posterior steep K value. According to a multivariate regression model in the present study, posterior K values were found to be associated with CH and CRF. This finding may suggest that posterior surface of the cornea may affect corneal biomechanical properties more compared to anterior surface in normal eyes. In a recent study, it has been shown that CH and CRF were negatively associated with K max value in keratoconic eyes, but this correlation did not exist for normal eyes [Apart from the other studies, this study investigated both steep and flat mal eyes .CV and its relation with corneal biomechanical properties have also been investigated in normal and keratoconic eyes in several studies , 24. HwaK values. Anterior and posterior K values account for 16.6% and 9.5% of variation in CH and CRF, respectively.In conclusion, CH and CRF are positively correlated with CCT and CV and negatively correlated with age in a healthy Caucasian population. It is also shown with this study that CH and CRF are negatively correlated with posterior steep and average posterior