Search results for: dental procedures.

Authors: Seiyed Hamid Zareh, Atabak Sarrafan, Kambiz Ghaemi Osgouie

Abstract:

This paper will first describe predictor controllers when the proportional-integral-derivative (PID) controllers are inactive for procedures that have large delay time (LDT) in transfer stage. Therefore in those states, the predictor controllers are better than the PID controllers, then compares three types of predictor controllers. The value of these controller-s parameters are obtained by trial and error method, so here an effort has been made to obtain these parameters by Ziegler-Nichols method. Eventually in this paper Ziegler-Nichols method has been described and finally, a PIP controller has been designed for a thermal system, which circulates hot air to keep the temperature of a chamber constant.

Keywords: Proportional-integral-predictive controller, Transferfunction, Delay time, Transport-lag.

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Authors: Miodrag T. Manić, Dejan I. Tanikić, Miloš S. Stojković, Dalibor M. ðenadić

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The design of technological procedures for manufacturing certain products demands the definition and optimization of technological process parameters. Their determination depends on the model of the process itself and its complexity. Certain processes do not have an adequate mathematical model, thus they are modeled using heuristic methods. First part of this paper presents a state of the art of using soft computing techniques in manufacturing processes from the perspective of applicability in modern CAx systems. Methods of artificial intelligence which can be used for this purpose are analyzed. The second part of this paper shows some of the developed models of certain processes, as well as their applicability in the actual calculation of parameters of some technological processes within the design system from the viewpoint of productivity.

Keywords: fuzzy logic, manufacturing, neural networks

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Authors: Sanjay Saraf

Abstract:

The oral cavity can be the site for early manifestations of mucocutaneous disorders (MD) or the only site for occurrence of these disorders. It can also exhibit oral lesions with simultaneous associated skin lesions. The MD involving the oral mucosa commonly presents with signs such as ulcers, vesicles and bullae. The unique environment of the oral cavity may modify these signs of the disease, thereby making the clinical diagnosis an arduous task. In addition to the unique environment of oral cavity, the overlapping of the signs of various mucocutaneous disorders, also makes the clinical diagnosis more intricate. The aim of this review is to present the oral signs of dermatological disorders having common oral involvement and emphasize their   importance in   early detection of the systemic disorders. The aim is also to highlight the necessity of oral examination by a dermatologist while examining the skin lesions. Prior to the oral examination, it must be imperative for the dermatologists and the dental clinicians to have the knowledge of oral anatomy. It is also important to know the impact of various diseases on oral mucosa, and the characteristic features of various oral mucocutaneous lesions. An initial clinical oral examination is may help in the early diagnosis of the MD. Failure to identify the oral manifestations may reduce the likelihood of early treatment and lead to more serious problems. This paper reviews the oral manifestations of immune mediated dermatological disorders with common oral manifestations.

Keywords: Vesiculobullous lesions, Desquamative gingivitis, Nikolsky’s sign, Erythema.

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Authors: O. A. Akinfenwa, N.M. Yao, S. N. Jator

Abstract:

In this paper, a self starting two step continuous block hybrid formulae (CBHF) with four Off-step points is developed using collocation and interpolation procedures. The CBHF is then used to produce multiple numerical integrators which are of uniform order and are assembled into a single block matrix equation. These equations are simultaneously applied to provide the approximate solution for the stiff ordinary differential equations. The order of accuracy and stability of the block method is discussed and its accuracy is established numerically.

Keywords: Collocation and Interpolation, Continuous HybridBlock Formulae, Off-Step Points, Stability, Stiff ODEs.

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Authors: Christian A. Romero, Tanja Grkovic, John. R. J. French, D. İpek. Kurtböke, Ronald J. Quinn

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A high-throughput and automated 1H NMR metabolic fingerprinting dereplication approach was used to accelerate the discovery of unknown bioactive secondary metabolites. The applied dereplication strategy accelerated the discovery of new natural products, provided rapid and competent identification and quantification of the known secondary metabolites and avoided time-consuming isolation procedures. The effectiveness of the technique was demonstrated by the isolation and elucidation of arglecins B (1), C (2) and actinofuranosin A (3) from a termite-gut associated Streptomyces sp. (USC 597) grown under solid state fermentation. The structures of these compounds were elucidated by extensive interpretation of 1H, 13C and 2D NMR spectroscopic data. These represent the first report of arglecin analogues isolated from a termite gut-associated Streptomyces species.

Keywords: Actinomycetes, actinofuranosin, antibiotics, arglecins, NMR spectroscopy.

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Authors: R. Kozik, A. Leśniak A., E. Plebankiewicz

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Contracting authorities in the public sector are obligated to apply the principles provided for in the Polish law for the evaluation and selection of contractors. In order to analyse the methods of contractors selecting applied in practice by public clients, the notices of contract award results for construction works were analysed. The analysis shows that the procedure selected more and more often is open competitive bidding, where the assessment of the competence of contractors is not very precise, as well as noncompetitive bidding, i.e. single source procurement. The share of procurement procedures, where the only criterion is price, is increasing. The solution to the problems existing here might be the introduction of one of the forms of pre-selection of contractors. The article also briefly discusses verification systems for companies applying for public contracts used in EU countries.

Keywords: Certification, contractors selection, open tendering, public investors.

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Authors: Sharan Badiger, Prema T. Akkasaligar, Deepak Kadeli

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Human Immunodeficiency Virus is known to affect almost all organ systems in the body. In addition to central nervous system it also affects the autonomic nervous system. Autonomic nervous dysfunction has been known to severely affect the quality of life in human immunodeficiency virus positive patients. It is known to have caused fatal consequences in late stages of the disease in patients who go in for invasive diagnostic or therapeutic procedures. The aim of this review is to determine the incidence, clinical significance and frequency of cardiac autonomic neuropathy in patients human immunodeficiency virus infection.

Keywords: Autonomic nervous system, autonomic nervous dysfunction, cardiac autonomic dysfunction, human immunodeficiency virus.

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Authors: Gouda K. Helal, Marwa I. Shabayek, Heba A. El-Ramly, Heba A. Awida

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The adverse effects of Clindamycin (Clind.) / Ibuprofen (Ibu.) combination on liver, kidney, blood elements and the significances of antioxidants (N-acetylcysteine and Zinc) against these effects were evaluated. The study includes: Group I; control n=30, Group II; patients on Clind.300mg/Ibu.400mg twice daily for a week n=30, Group III; patients on Clind.300mg/Ibu.400mg+Nacetylcysteine 200mg twice daily for a week n=15 and Group IV; patients on Clind.300mg/Ibu.400mg+Zinc50mg twice daily for a week n=15. Serum malondialdehyde (MDA), alanine transferase (ALT), aspartate transferase (AST), γ glutamyl transferase (GGT), creatinine, blood urea nitrogen (BUN) were measured. Applying one way ANOVA followed by Tuckey Kramer post test, Group II showed significant increase in ALT, AST, GGT, BUN and decrease in Hb, RBCs, platelets than Group I. Group III showed significant decrease in ALT, AST, GGT, BUN than Group II. Moreover, Group IV showed significant decrease in ALT, AST, GGT and increase in Hb, RBCs, and platelets than Group II. Conclusively, Adding Zinc or Nacetylcysteine buffer the oxidative stress and improve the therapeutic outcome of Clindamycin/Ibuprofen combination.

Keywords: Clindamycin, Ibuprofen, Adverse effects, Antioxidant, Zinc, N-acetylcysteine.

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Authors: T. Hudecek, Z. Zakova

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The paper deals with cartographic visualisation of results of transport accessibility monitoring with the use of a semiautomated method of unipolar anamorphosis, developed by the authors in the GIS environment. The method is based on transformation of distance in the map to values of a geographical phenomenon. In the case of time accessibility it is based on transformation of isochrones converted into the form of concentric circles, taking into account selected topographic and thematic elements in the map. The method is most suitable for analyses of accessibility to or from a centre and for modelling its long-term context. The paper provides a detailed analysis of the procedures and functionality of the method, discussing the issues of coordinates, transformation, scale and visualisation. It also offers a discussion of possible problems and inaccuracies. A practical application of the method is illustrated by previous research results by the authors in the filed of accessibility in Czechia.

Keywords: accessibility, GIS, transformation, unipolar anamorphosis

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Authors: K. -H. Yang

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In the past, the quay crane operations have been well studied. There were a certain number of scheduling algorithms for quay crane operations, but without considering some nuisance factors that might disrupt the quay crane operations. For example, bad grapples make a crane unable to load or unload containers or a sudden strong breeze stops operations temporarily. Although these disruptive conditions randomly occur, they influence the efficiency of quay crane operations. The disruption is not considered in the operational procedures nor is evaluated in advance for its impacts. This study applies simulation and optimization approaches to develop structures of pre-analysis and post-analysis for the Quay Crane Scheduling Problem to deal with disruptive scenarios for quay crane operation. Numerical experiments are used for demonstrations for the validity of the developed approaches.

Keywords: Disruptive Quay Crane Scheduling, pre-analysis, post-analysis, disruption.

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Authors: J. Kosikova, B. Vacenovska, M. Vyhnankova

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The paper reports on the subject of recycling and further use of secondary raw materials obtained from solar panels, which is becoming a very up to date topic in recent years. Recycling these panels is very difficult and complex, and the use of resulting secondary raw materials is still not fully resolved. Within the research carried out at the Brno University of Technology, new polymer materials used for industrial floors are being developed. Secondary raw materials are incorporated into these polymers as fillers. One of the tested filler materials was glass obtained from solar panels. The following text describes procedures and results of the tests that were performed on these materials, confirming the possibility of the use of solar panel glass in industrial polymer flooring systems.

Keywords: Fillers, industrial floors, recycling, secondary raw material, solar panel.

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Authors: Wen Po Cheng, Chia Yun Chung, Ruey Fang Yu, Chao Feng Chen

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The main objective of this research was to study the differences of aluminum hydrolytic products between two PACl preparation methods. These two methods were the acidification process of freshly formed amorphous Al(OH)₃ and the conventional alkalization process of aluminum chloride solution. According to Ferron test and ²⁷Al NMR analysis of those two PACl preparation procedures, the reaction rate constant (k) values and Al₁₃ percentage of acid addition process at high basicity value were both lower than those values of the alkaline addition process. The results showed that the molecular structure and size distribution of the aluminum species in both preparing methods were suspected to be significantly different at high basicity value.

Keywords: Polyaluminum chloride, Al13, amorphous aluminum hydroxide, Ferron test.

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Authors: Wajdi Bellil, Chokri Ben Amar, Adel M. Alimi

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An application of Beta wavelet networks to synthesize pass-high and pass-low wavelet filters is investigated in this work. A Beta wavelet network is constructed using a parametric function called Beta function in order to resolve some nonlinear approximation problem. We combine the filter design theory with wavelet network approximation to synthesize perfect filter reconstruction. The order filter is given by the number of neurons in the hidden layer of the neural network. In this paper we use only the first derivative of Beta function to illustrate the proposed design procedures and exhibit its performance.

Keywords: Beta wavelets, Wavenet, multiresolution analysis, perfect filter reconstruction, salient point detect, repeatability.

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Authors: Mahadevan Supramaniam, Mudiarasan Kuppusamy

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In order to survive in a rapidly changing business environment, Malaysian business firms must improve their own business practices and procedures. This paper describes the impact of Critical Success Factors (CSFs) during the Enterprise Resource Planning (ERP) system implementations using the responses from 151 organizations that completed or are in the process of completing an ERP implementation and identifying the key benefits of ERP implementation in the firm. The importance of these factors was investigated within Malaysian companies using questionnaire survey method. Our results provide advice to management on how best to utilize their limited resources to choose those CSFs that are most likely to have an impact upon the implementation of the ERP system.

Keywords: Critical Success Factors (CSFs), Enterprise Resource Planning (ERP), system, vendor.

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Authors: F. Azna A. Shahabuddin, Kamarulzaman Ibrahim, Abdul Aziz Jemain

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Many works have been carried out to compare the efficiency of several goodness of fit procedures for identifying whether or not a particular distribution could adequately explain a data set. In this paper a study is conducted to investigate the power of several goodness of fit tests such as Kolmogorov Smirnov (KS), Anderson-Darling(AD), Cramer- von- Mises (CV) and a proposed modification of Kolmogorov-Smirnov goodness of fit test which incorporates a variance stabilizing transformation (FKS). The performances of these selected tests are studied under simple random sampling (SRS) and Ranked Set Sampling (RSS). This study shows that, in general, the Anderson-Darling (AD) test performs better than other GOF tests. However, there are some cases where the proposed test can perform as equally good as the AD test.

Keywords: Empirical distribution function, goodness-of-fit, order statistics, ranked set sampling

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Authors: Nina Øystad-Larsen, Miran Cemalovic, Amir M. Kaynia

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The nonlinear static and dynamic analysis procedures presented in EN 1998-1 for the structural response of a RC wall-frame building are assessed. The structure is designed according to the guidelines for high ductility (DCH) in 1998-1. The finite element packages SeismoStruct and OpenSees are utilized and evaluated. The structural response remains nearly in the elastic range even though the building was designed for high ductility. The overstrength is a result of oversized and heavily reinforced members, with emphasis on the lower storey walls. Nonlinear response history analysis in the software packages give virtually identical results for displacements.

Keywords: Behaviour factor, Dual system, OpenSEES, Overstrength, SeismoStruct.

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Authors: K. K. Saju, A. R. Reghuraj

Abstract:

High reflectance of surgical instruments under bright light hinders the visual clarity during laparoscopic surgical procedures leading to loss of precision and device control and creates strain and undesired difficulties to surgeons. Majority of the surgical instruments are made of surgical grade steel. Instruments with a non reflective surface can enhance the visual clarity during precision surgeries. A conversion coating of black oxide has been successfully developed 410 grade surgical stainless steel .The characteristics of the developed coating suggests the application of this technique for developing 410 grade surgical instruments with minimal reflectance.

Keywords: Conversion coatings, 410 stainless steel, black oxide, reflectance.

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Authors: C. Felho, J. Kundrak

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The quality of machined surfaces is an important characteristic of cutting processes and surface roughness has strong effects on the performance of sliding, moving components. The ability to forecast these values for a given process has been of great interests among researchers for a long time. Different modeling procedures and algorithms have been worked-out, and each has its own advantages and drawbacks. A new method will be introduced in this paper which will make it possible to calculate both the profile (2D) and surface (3D) parameters of theoretical roughness in the face milling of plain surfaces. This new method is based on an expediently developed CAD model, and uses a professional program for the roughness evaluation. Cutting experiments were performed on 42CrMo4 specimens in order to validate the accuracy of the model. The results have revealed that the method is able to predict surface roughness with good accuracy.

Keywords: CAD-based modeling, face milling, surface roughness, theoretical roughness.

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Authors: C. Schneider, M. M. Seizmeir, T. Suchanek, M. Hutter-Mironovová, M. Bdiwi, M. Putz

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In this paper, a suitable measurement setup is presented to conduct force and pressure measurements for transient contact cases at the example of lathe machine tending. Empirical measurements were executed on a selected collaborative robot’s behavior regarding allowable operating speeds under consideration of sensor- and workpiece-specific factors. Comparisons between the theoretic calculations proposed in ISO/TS 15066 and the practical measurement results reveal a basis for future research. With the created database, preliminary risk assessment and economic assessment procedures of collaborative machine tending cells can be facilitated.

Keywords: biomechanical thresholds, collaborative robots, force and pressure measurements, machine tending, transient contact

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Authors: FiroozBakhtiari-Nejad, Hamidreza Rostami, MeysamMirzaee, Mona Zandbaf

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Dynamic tests are an important step of the design of engineering structures, because the accuracy of predictions of theoretical–numerical procedures can be assessed. In experimental test of moving loads that is one of the major research topics, the load is modeled as a simple moving mass or a small vehicle. This paper deals with the applicability of Non-contact Moving Load (NML) for vibration analysis. For this purpose, an experimental set-up is designed to generate the different types of NML including constant and harmonic. The proposed method relies on pressurized air which is useful, especially when dealing with fragile or sensitive structures. To demonstrate the performance of this system, the set-up is employedfor a modal analysis of a beam and detecting crack of the beam.The obtained results indicate that the experimental set-up for NML can be an attractive alternative to the moving load problems.

Keywords: Experimental analysis, Moving load, Non-contact excitation.

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Authors: Daria Topousis, Keri Murphy, Jeanne Holm

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Following the loss of NASA's Space Shuttle Columbia in 2003, it was determined that problems in the agency's organization created an environment that led to the accident. One component of the proposed solution resulted in the formation of the NASA Engineering Network (NEN), a suite of information retrieval and knowledge-sharing tools. This paper describes the implementation of communities of practice, which are formed along engineering disciplines. Communities of practice enable engineers to leverage their knowledge and best practices to collaborate and take information learning back to their jobs and embed it into the procedures of the agency. This case study offers insight into using traditional engineering disciplines for virtual collaboration, including lessons learned during the creation and establishment of NASA-s communities.

Keywords: Collaboration, communities of practice, knowledge management, virtual teams.

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Authors: Marziyeh Yousefi, Hossein Nassaji

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This paper reports the results of a meta-analysis of studies on the effects of instruction mode on learning second language pragmatics during the last decade (from 2006 to 2016). After establishing related inclusion/ exclusion criteria, 39 published studies were retrieved and included in the present meta-analysis. Studies were later coded for face-to-face and computer-assisted mode of instruction. Statistical procedures were applied to obtain effect sizes. It was found that Computer-Assisted-Language-Learning studies generated larger effects than Face-to-Face instruction.

Keywords: Meta-analysis, effect size, pragmatics, computer-assisted language learnin, face-to-face instruction, comprehensive meta-analysis software.

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Authors: Marina Laškarin, Vlado Galičić

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Quick adoption of e-business and emerging influence of “Electronic Word of Mouth e-WOM” communication on guests made leading hotel brands successful examples of electronic guest relationship management. Main reasons behind such success are well established procedures in collection, analysis and usage of highly valuable data available on the Internet, generated through some form of e-GRM programme. E-GRM is more than just a technology solution. It’s a system which balance respective guest demands, hotel technological capabilities and organizational culture of employees, discharging the universal approach in guest relations “same for all”. The purpose of this research derives from the necessity of determining the importance of monitoring and applying e-WOM communication as one of the methods used in managing guest relations. This paper analyses and compares different hotelier’s opinions on e-WOM communication.

Keywords: Brand loyalty, e-WOM communication, GRM programmes.

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Authors: Nicolas Zufferey

Abstract:

Ant algorithms are well-known metaheuristics which have been widely used since two decades. In most of the literature, an ant is a constructive heuristic able to build a solution from scratch. However, other types of ant algorithms have recently emerged: the discussion is thus not limited by the common framework of the constructive ant algorithms. Generally, at each generation of an ant algorithm, each ant builds a solution step by step by adding an element to it. Each choice is based on the greedy force (also called the visibility, the short term profit or the heuristic information) and the trail system (central memory which collects historical information of the search process). Usually, all the ants of the population have the same characteristics and behaviors. In contrast in this paper, a new type of ant metaheuristic is proposed, namely SMART (for Solution Methods with Ants Running by Types). It relies on the use of different population of ants, where each population has its own personality.

Keywords: Optimization, Metaheuristics, Ant Algorithms, Evolutionary Procedures, Population-Based Methods.

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Authors: Robert Krause

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Primary progressive aphasia (PPA) is a neurodegenerative disease similar to frontotemporal and semantic dementia, while having a different clinical image and anatomic pathology topography. Nonetheless, they are often included under an umbrella term: frontotemporal lobar degeneration (FTLD). In the study, examples of diagnosing PPA are presented through the multidisciplinary lens of specialists from different fields (neurologists, psychiatrists, clinical speech therapists, clinical neuropsychologists and others) using a variety of diagnostic tools such as MR, PET/CT, genetic screening and neuropsychological and logopedic methods. Thanks to that, specialists can get a better and clearer understanding of PPA diagnosis. The study summarizes the concrete procedures and results of different specialists while diagnosing PPA in a patient of younger middle age and illustrates the importance of multidisciplinary approach to differential diagnosis of PPA.

Keywords: Primary progressive aphasia, etiology, diagnosis, younger middle age.

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Authors: Sh. Khalilarya, S. Jafarmadar, H. Khatamnezhad, Gh. Javadirad, M. Pourfallah

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One promising way to achieve low temperature combustion regime is the use of a large amount of cooled EGR. In this paper, the effect of injection timing on low temperature combustion process and emissions were investigated via three dimensional computational fluid dynamics (CFD) procedures in a DI diesel engine using high EGR rates. The results show when increasing EGR from low levels to levels corresponding to reduced temperature combustion, soot emission after first increasing, is decreased beyond 40% EGR and get the lowest value at 58% EGR rate. Soot and NOx emissions are simultaneously decreased at advanced injection timing before 20.5 ºCA BTDC in conjunction with 58% cooled EGR rate in compared to baseline case.

Keywords: Diesel Engine, Low Temperature Combustion, High Cooled EGR Rates, Combustion, Emissions

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Authors: R.M.V. Silva, D.N. Souza

Abstract:

This paper presents a model for the characterization and selection of beeswaxes for use as base substitute tissue for the manufacture of objects suitable for external radiotherapy using megavoltage photon beams. The model of characterization was divided into three distinct stages: 1) verification of aspects related to the origin of the beeswax, the bee species, the flora in the vicinity of the beehives and procedures to detect adulterations; 2) evaluation of physical and chemical properties; and 3) evaluation of beam attenuation capacity. The chemical composition of the beeswax evaluated in this study was similar to other simulators commonly used in radiotherapy. The behavior of the mass attenuation coefficient in the radiotherapy energy range was comparable to other simulators. The proposed model is efficient and enables convenient assessment of the use of any particular beeswax as a base substitute tissue for radiotherapy.

Keywords: Beeswaxes, characterization, model, radiotherapy

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Authors: Jevgenijs Carkovs

Abstract:

The paper is devoted to stochastic analysis of finite dimensional difference equation with dependent on ergodic Markov chain increments, which are proportional to small parameter ". A point-form solution of this difference equation may be represented as vertexes of a time-dependent continuous broken line given on the segment [0,1] with "-dependent scaling of intervals between vertexes. Tending " to zero one may apply stochastic averaging and diffusion approximation procedures and construct continuous approximation of the initial stochastic iterations as an ordinary or stochastic Ito differential equation. The paper proves that for sufficiently small " these equations may be successfully applied not only to approximate finite number of iterations but also for asymptotic analysis of iterations, when number of iterations tends to infinity.

Keywords: Markov dynamical system, diffusion approximation, equilibrium stochastic stability.

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Authors: Murniwati, Nurul Khairiyah, Putri Ovieza Maizar

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The association between general and oral health is clearly important, particularly in adults with medical conditions. Many of the medical systemic conditions are either caused or aggravated by poor oral hygiene and vice versa. Hypertension is one of common medical systemic problem which has been a public health concern worldwide due to its known consequences. Those consequences must be related to oral health status as well, whether it may cause or worsen the oral health conditions. The objective of this study was to find out the association between hypertension and oral health status in adults. This study was an analytical observational study by using cross-sectional method. A total of 42 adults both male and female in Padusunan Village, Pariaman, West Sumatra, Indonesia were selected as subjects by using purposive sampling. Manual sphygmomanometer was used to measure blood pressure and dental examination was performed to calculate the decayed, missing, and filled teeth (DMFT) scores in order to represent oral health status. The data obtained was analyzed statistically using One Way ANOVA to determine the association between hypertensive adults and their oral health status. The result showed that majority age of the subjects was ranging from 51-70 years (40.5%). Based on blood pressure examination, 57.1% of subjects were classified to prehypertension. Overall, the mean of DMFT score calculated in normal, prehypertension and hypertension group was not considered statistically significant. There was no significant association (p>0.05) between hypertension and oral health status in adults.

Keywords: Blood pressure, hypertension, DMFT, oral health status.

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Authors: Saimir Heta, Ilma Robo, Vera Ostreni, Glorja Demika, Sonila Kapaj

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Suturing, as a procedure of joining the lips of the lembo or wound, is important at the beginning of the healing process. This procedure helps to pass the healing process from the procedure per secundam to the stages of healing per primam, thus logically reducing the healing time of the wound. The purpose of this article is to publish some data on the clinical characteristics of periodontal suturing, presenting the advantages and disadvantages of different types of suture threads. The article is a mini-review type of articles selected from the application of keywords on the PubMed page. The number of articles extracted from this article publication page is in accordance with the 10-year publication time limit. The element that remains in the individual selection of the dentist applying the suture is the selection of the suture material. At a moment when some types of sutures are offered for use, some elements should be considered in the selection of the suture depending on the constituent material, the cross-section of the suture elements, and whether it collects bacteria in the "pits" created by the material. The presence of bacteria is a source of infection and possible delay in the healing of the sutured wound. The marketing of suture types offers a variety of materials, from which the selection of the most suitable suture type for specific application cases is a personal indication of the dental surgeon based on professional experiences and knowledge in this field.

Keywords: Suture, suture material, types of sutures, clinical application.

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