Of the approximately two hundred sequenced plant genomes, how many and which ones were sequenced motivated by strictly or largely scientific considerations, and how many by chiefly economic, in a wide sense, incentives? And how large a role does publication opportunity play?In an integration of multiple disparate databases and other sources of information, we collect and analyze data on the size (number of species) in the plant orders and families containing sequenced genomes, on the trade value of these species, and of all the same-family or same-order species, and on the publication priority within the family and order. These data are subjected to multiple regression and other statistical analyses. We find that despite the initial importance of model organisms, it is clearly economic considerations that outweigh others in the choice of genome to be sequenced.This has important implications for generalizations about plant genomes, since human choices of plants to harvest (and cultivate) will have incurred many biases with respect to phenotypic characteristics and hence of genomic properties, and recent genomic evolution will also have been affected by human agricultural practices. Arabidopsis thaliana was sequenced [Oryza sativa (rice) genome was published [Arabidopsis, rice has enormous agricultural significance. Today around two hundred plant genome sequences have been published and many more are in the process of being sequenced and published. Though the cost of the sequencing itself has dropped considerably, genome sequence projects remain costly because of the preliminary steps, quality control, gene annotation and data-basing, all of which require considerable investment. At the same time, it is increasingly difficult to publish a genome sequence in the top science journals. It is of interest, for both pure and applied science, to understand what drives the choice of species to be sequenced. To what extent is it a question of surveying the nature and evolution of genomes across the plant tree of life? Or to sequence a genome in a previously unexplored family or order? And to what extent is it to furnish aid to breeders, growers, geneticists, plant pathologists and industry in improving the quality, quantity and other properties of economically important species. This paper attempts to answer these questions by documenting the taxonomic distribution of sequenced genomes as a function of species abundance within a taxon, the taxonomic novelty of species’ genome and the total economic value of species within a taxon.Genome sequencing has provided researchers with valuable insight into the evolution and genetic structure of many organisms. In 2000, the first plant genome equenced . This plublished . In contArabidopsis: “Why Arabidopsis? Why not concentrate our research efforts and resources on a species that will actually provide food for our world or useful products for industrial uses? In order to make the strides necessary to increase crop production in a relatively short time, we have to be able to move forward quickly and spend the available human and financial resources as efficiently as possible. This is the advantage of a model system: an organism that is easily manipulated, genetically tractable, and about which much is already known. By studying the biology of Arabidopsis, the model plant, we can gain comprehensive knowledge of a complete plant. In the laboratory, Arabidopsis offers the ability to test hypotheses quickly and efficiently. With the knowledge we gain from the model plant thus established as a reference system, we can move forward with research and rapidly initiate improvements in plants of economic and cultural importance” .There is a longstanding tension between the efforts to prioritize purely scientific interests versus applied and commercial demands in the choice of species to which we devote scarce research resources. This predates genomic science by many decades, but is well encapsulated in this 2002 plea to continue the focus on Mimulus, Medicago, Brachypodium and other model plant genome sequence projects initiated relatively early on.Similar arguments were made for At the same time there is no impugning the urgency of sequencing crop plants for breeders, growers, plant pathologists and industry in order to improve the quality, quantity and other properties of economically important species, and to prevent and alleviate famine and malnutrition in developing countries . A few rAnanas comosus (pineapple) [Coffea canephora (Robusta coffee) [Musa balbisiana (wild banana) [Utricularia gibba (humped bladderwort) [Three types of data were required for this research: species abundance within angiosperm (and conifer) taxa at various levels, total annual value worldwide of plant products, by species, and a list of species whose genome sequence has been published. Our initial data on plants that have been sequenced was collected from the National Centre for Biotechnology Information (NCBI). This list was not comprehensive, since plants whose genomes had been sequenced recently at the time of the data collection (spring of 2015), such as neapple) , Coffea  coffee) , Musa ba banana) , and Utrderwort)  were notIn all, we found 202 distinct species whose genome had been sequenced; however, only 172 were useful to the present study. All algae and mosses were dropped, due to the lack of any economic data. The remaining species, confined to the flowering plants (angiosperms) and the conifer order of gymnosperms, were classified by taxonomic class or subclass, order, family and genus, based on the APG III system of flowering plant classification . The APGhttp://216.48.92.133/Softwares/PlantGenomes/index.htm. As more plant genomes are sequenced, more families and orders will be included. A fragment of this dataset is depicted in Table This dataset is available at: Next, economic data relating to agricultural and forestry products was collected. For agricultural products, this data was compiled from the Food and Agriculture Organization of the United Nations . For agrData on forestry products was compiled from a United Nations Economic Commission for Europe Timber Division report on the forestry industry published in 2006 . The datAfter having collected the economic value for all agricultural  and forestry products, we classified all sequenced species taxonomically according to APG III. For analytical purposes, we retained only order and family, as class/subclass was not of high enough resolution for meaningful analysis, while genus was too high a resolution, since for almost all the species we studied no economic data distinguished between species in the same genus. Once all products were classified, we calculated an aggregate value of for each family and order. Note that some species of economic value belong to a family and even to an order containing no genome-sequenced species when these data were collected.The data on the total number of species in all of the families and orders was collected from The Plant List  and the From these data, we constructed Table An overall summary of the data is presented in Table total agricultural value of the taxon, andspecies abundance in the taxon.The first question we asked in a regression analysis was: among the taxa (families and orders) containing at least one sequenced genome and/or at least one species of economic value, what is most important in determining the number of genomes sequenced, the biological salience of the taxon in terms of the total number of species it contains, i.e., abundance, or the aggregate economic value of the taxon. More precisely, for the response, or dependent, variable, we used the number of distinct species sequenced in the taxon (family or order). The two “independent”, or predictor, variables were: The aggregate value variable is a direct measure of the effect of economic inducement to sequence genomes in the taxon. The species abundance variable should reflect the importance of more scientific criteria, as a significant effect would suggest that sequencers are trying to investigate genomes that represent a larger number of same-family or same-order species, and hence feed into an evolutionarily well-distributed sample for eventual comparative goals.An unusual aspect of this model is that we do not include families or orders that have no sequenced genome nor any species of economic value. This was largely a question of avoiding the collection of abundance data on many hundreds of families with no genomes sequenced and no economic value, and having them swamp the effect of the families of more interest. Nevertheless we will return to this question in the next section of this paper.These results show a dominant effect of the economic importance of the species in a taxon, but also an unmistakeable effect of the species abundance of that taxon.While the proportion of the variance explained is considerable , Fig. Arabidopsis, containing the first flowering plant to have its genome sequenced, Arabidopsis thaliana, plus many closely related plants whose scientific comparison builds on the many functions and structure known first in this model plant. Brassicales also contains the intensively studied genus Brassica, containing many genomes of great agricultural interest - the mustards, cabbage, turnip, radishes, canola, some of which in turn have many diverse cultivars.We see that the economic variable, measuring total value of the order, remains highly significant, but the abundance variable recedes in significance, although the trends remain much the same. Figure As mentioned previously, the regression does not really do justice to the effect of species abundance, i.e., taxon size. Only those families and orders containing sequenced genomes and/or containing species of economic value, were included in the study. The large majority of families, well more than three hundred, were thus not included, as were more than half of the orders.To compensate for this bias, we randomly sampled 100 families without genome sequences, and compared their species abundance with those in our regression study. Similarly, we calculated the species abundance for 35 angiosperm orders not in the regression study. The results appear in Fig. It is clear from the figure that the distribution of the number of sequenced genomes per taxon is not the result of a random sampling over all flowering plant species; otherwise more than half of the sequences would be in the single category of largest families. At the same time, the results do not reflect a random sampling of all the genomes; otherwise the proportion of families of a given size containing sequenced genomes would be the same as the overall proportion of families.To summarize, the genomes that have been sequenced are concentrated in the larger families, but they are spread out to some degree among smaller families as well. This suggests that the choice of genome is motivated to some extent by the interest of the botanical community and by the specializations of PI’s and by the search for novel and diverse results.The strategy for choosing a genome to sequence has evolved over the years. We can ask to what extent this strategy has been directed by economic interests versus broader scientific criteria, by examining each taxon to see when its first genome was sequenced.Table There are several issues regarding our data collection. The forestry data compiled was not recent or reliable . These pAnother problem in calculating forestry data is that they are presented country-by-country as exports or imports. We were able to aggregate all the export figures to arrive at worldwide values per species, but this does not take into account internal consumption, which is certainly very important in many producing countries. This means that our estimates of total value for the forestry taxa are systematically biased downward.http://216.48.92.133/Softwares/PlantGenomes/index.htm), however, does list these. The integrated taxonomic/economic database is a main contribution of this work, and we intend to update and maintain it for the foreseeable future. Currently, aside from the taxonomic, economic and bibliographic information on each species, we also note the date the sequence was published. In the future, other tracks may be added, such as a categorization of the economic sphere: nutritional, medicinal, chemical, horticultural, forestry, etc.After we completed our research, at the Plant and Animal Genomes Conference in January 2016 , we learWe have shown that the choice of plants being sequenced is most heavily influenced by the economic value of the family and order to which it belongs. There is also a significant effect of taxon size, but sequenced genomes are not distributed randomly among the 200,000 angiosperm species, as organized taxonomically and phylogenetically by botanists. Instead, many genome sequence represent smaller orders and families.There are many potential explanations for choice of genome beyond those we have explored. We have shown that economic value has an effect on early sequencing, but this result is weak. That many “model” plants have been sequenced is not really explanatory, in that it just displaces the question of choice from genomics to an earlier stage of collaborative research; once a species’ status as a model is accepted, it is almost surely destined to be sequenced.Outside of model plants, the economic status of plants in particular regions is a major motivation; one only has to look at the publication dates for the two grapevine sequence papers, or the two cacao genome papers, or the two rice papers, to infer that some major competition for publication priority was at work. One aspect of this in crop plants is the urgency of breeding programs in the face of fast-moving pathogens and climate change.On the purely scientific side, however, the focus on crops has important implications for generalizations about plant genomes, since human choices of plants to harvest (and cultivate) will have incurred many biases with respect to phenotypic characteristics and hence of genomic properties, and recent genomic evolution will also have been affected by human agricultural practices. Fortunately, biologists have been motivated to sequence the genomes of many non-crop plants.Small genome size is a frequent inducement for a genome sequence project. Similarly the existence of a double haploid genome or other genome with highly reduced heterozygosity makes sequencing easier. On the other hand, a species with no economic value, geographically restricted, and no historical involvement with human settlements, may, despite possible difficulties with sequencing, reveal insights into the natural processes of evolution without the distortions introduced by human intervention in breeding, cultivation and environment. Finally, the scientific novelty or unusual phenotypic or ecological characteristic of a species may make it a candidate for genome sequencing. This is particularly pertinent as major journals are increasingly reluctant to publish genome sequence papers unless it reports something strikingly different and widely interesting aside from the details of the sequencing.Many of these factors could eventually be entered in our database, leading to further understanding of the genome sequencing enterprise across the flowering plants.


The MediCapt mobile app has promise for clinicians to capture medical and forensic evidence of sexual violence and securely transmit the data to legal authorities for potential use in prosecution. We believe this application broadens the traditional scope of mHealth to collecting evidence, and thus name it mJustice. The MediCapt mobile app has promise for clinicians to capture medical and forensic evidence of sexual violence and securely transmit the data to legal authorities for potential use in prosecution. We believe this application broadens the traditional scope of mHealth to collecting evidence, and thus name it mJustice. Digital health development and use has been expansive and operationalized in a variety of settings and modalities around the world, including in low- and middle-income countries. Mobile applications have been developed for a variety of health professionals and frontline health workers including physicians, midwives, nurses, and community health workers. However, there are no published studies on the development and use of digital health related to human rights fieldwork and to our knowledge no mobile health platforms exist specifically for use by frontline health workers to forensically and clinically document sexual violence. We describe a participatory development and user design process with Congolese end-users of a novel human rights app for clinicians intended to standardize the documentation of sexual violence evidence for forensic and legal purposes, called MediCapt. The app, yet to be launched and still in the future proofing phase, has included several development phases: (1) initial needs assessment conducted in 2011, (2) prototype development and field-testing in 2014 with 8 Congolese physicians, (3) prototype refinement and field-testing in 2015 with 9 clinicians. Feedback from the first field-testing phase was incorporated into the design of the second prototype; key features that were added to MediCapt include the ability for users to take photographs and draw on a pictogram to include as part of the evidence package, as well as the ability to print a form with the completed data. Questionnaires and key-informant interviews during the second and third field-testing phases revealed overall positive attitudes about MediCapt, but multiple perceived and actual barriers to implementation were identified, from personal behaviors, such as individual clinicians' comfort with new technology, to more systemic and infrastructure factors, such as strong cultural preferences for print documentation of evidence and limited Internet connectivity. Next phases of development include consideration of patients' acceptance of this technology, how it actually fits in the clinical workflow, and testing of how to transfer the collected evidence to law enforcement and legal authorities. Ultimately, we plan on conducting a robust evaluation to assess effectiveness of the app on medical, legal, and human rights outcomes. We believe our experience of collecting data that will potentially serve as legal evidence broadens the traditional scope of digital health and crosses a wide range of fields including medical, technological, legal, and ethical, and thus propose refining and defining this unique field of exploration as mobile justice, or mJustice. The move toward a technology-centered world has changed the way we practice medicine and public health. This is manifested by the rapid expansion in the field of digital health, which concerns the "use of information and communications technologies to improve human health, healthcare services, and wellness for individuals and across populations."–,–Between 2002 and 2016, an increasing number of digital health interventions were implemented around the world, many of them in developing countries.Although digital health has experienced rapid expansion in recent years, there are no published studies on the development and use of digital health for human rights fieldwork. The gray literature reveals several existing smartphone and tablet applications (apps) related to human rights, but the majority provide educational and news materialsMost existing mobile apps in the human rights field focus on providing educational and news content.Extensive conversations with leaders in the field suggest there are 3 categories of technology tools being used in human rights communities: (1) those created to assist activists to gather information and documentation to expose or highlight violations, such as WITNESS' Video as Evidence programWe propose defining the use of digital health technology to collect human rights-related evidence that could potentially be admissible in courts as mJustice.In 2011, Physicians for Human Rights (PHR)—a U.S.-based NGO—launched the Program on Sexual Violence in Conflict Zones. One of the main activities of the program involved the development of a multisectoral training program for health, legal, and law enforcement professionals intended to enhance the forensic documentation and reporting of sexual violence incidents in the Democratic Republic of the Congo (DRC) and Kenya, among other places. Another major activity of the program has been to advocate the standardization of sexual violence medical information collection.To that end, PHR, in conjunction with its local medical, law enforcement, and legal partners, has developed a Standard Sexual Violence form that is being used in parts of eastern DRC. The paper-based medical form was developed in-country with input from a network of doctors, lawyers, judges, and law enforcement officials, along with visiting international human rights scholars, practitioners, and experts. The information captured in the standard medical form is particular to the DRC and conforms to the local rule of law. The guiding principle behind the development of the form is that if the standard medical form is properly completed by a health professional trained in forensic medical evidence collection, more evaluations will be admissible in court, and consequently the success rate of prosecutions of sexual violence crimes will increase.One of the major problems with the paper form of the standard medical certificate is the lack of proper storage, preservation, and ability to transfer it securely to the police and justice sector. Digitizing the standard medical form minimizes the chances of loss or theft of medical evidence, while preserving chain of custody. With these considerations in mind, we aimed to develop a smartphone-based app, called MediCapt.In this article, we describe the early development phases of MediCapt, a first-of-its-kind forensic app, via a participatory design processMediCapt is being designed with 2 goals in mind: (1) to enable health care providers to gather and compile medical evidence related to sexual violence in a standardized manner, and (2) to securely transmit the evidence to authorities engaged in prosecuting and seeking accountability for such crimes . MediCapt is meant to circumvent systemic and structural barriers to gathering and sharing evidence related to sexual violence that is particular to low-resourced environments, including conflict zones, by giving health care providers a platform to share that evidence . AlthougMediCapt, a smartphone-based app, is intended to enable health care providers to gather medical evidence related to sexual violence and securely transmit that evidence to legal authorities.,,As highlighted by several studiesBetween January 2011 and October 2011, we conducted 2 needs assessments in eastern DRC to explore general approaches to the documentation of sexual violence. A multidisciplinary team of U.S.-based clinical, legal, and policy experts conducted key informant interviews with several stakeholders at various sites, including clinicians at 3 major hospitals in Bukavu and Goma; members of local NGOs; lawyers and police officers; and civilian and military justice officials. The interviewees were asked open-ended questions about barriers, gaps, and deficits, each in their respective fields, when encountering cases of sexual violence. The interviews, conducted in French via translators, were summarized and the multisectoral input was used to design PHR's sexual violence program, training workshops, and the paper-based Standard Sexual Violence form.http://home.magpi.com/).Between October and December 2013 we converted the paper-based Standard Sexual Violence form to digital format (MediCapt 1.0) using simple logic features through the Magpi platform  of data. It was especially appealing because non-programmers could easily develop customizable forms on the application and the interface was user-friendly.MediCapt was developed for use on Android phones  because of their availability in the DRC, the ease of developing and building Android applications, and the easy-to-use and high-quality cameras on Android phones that allow for the collection and storage of photographs alongside other digital data files.In January 2014, we invited 8 Congolese physicians who had previously participated in PHR's sexual violence training sessions on medico-legal documentation to participate in a 2-day session to test the MediCapt 1.0 prototype. The session included training on how to use an Android phone, explanation of the Magpi platform, practice using the MediCapt app, and a focus group discussion on the experience, functionality, usability, and feasibility of the app in its early, prototype form. During the focus group discussion, we encouraged clinicians, using open-ended and semistructured questions, to describe what features they deemed important and would like to see in a future version. A questionnaire was administered to participants assessing their background characteristics and general experience with the use of smartphone technology.Following the 2-day session, physicians were asked to use the prototype app while completing mock patient scenarios and to send feedback to the U.S.-based development team. The collective input was used to design the next prototype, MediCapt 2.0.In January 2015, we invited 9 clinicians who had previously participated in PHR's multisectoral documentation training—3 of whom had used MediCapt 1.0—for a 1-day session with members of the MediCapt development team. The session included a demonstration of MediCapt 2.0, an examination of new and desired features, and in-depth key informant interviews about clinicians' workflow and perceived barriers to the use and integration of this revised tool in the clinical setting. Participants also completed a questionnaire that included questions about background characteristics of the participants and attitudinal questions that were informed by the use of an implementation science framework.Members of the PHR-MediCapt development team, comprising clinicians, human rights lawyers, and technical experts, conducted the focus group discussions and key informant interviews during phases II and III. Qualitative data were analyzed for emergent themes that could be used to directly improve the technology and user experience of MediCapt. In the Phase III questionnaire, Likert-scale responses from the phase III questionnaire were recoded to numerical values  and averaged across participants to create mean scores for each question. We then transformed all Likert scale responses onto a 0–1 scale to ease interpretation, with 0 representing the least level of agreement and 1 representing greatest level of agreement.Data were entered into Microsoft Excel and analyzed using SAS statistical software. Written consent was obtained from all participants. The questionnaire and protocol were reviewed by the Institutional Review Board (IRB) of RTI International.Forensic medical exams are rarely conducted or they are conducted poorly.Medical charts fail to document findings sufficiently.Storage and preservation of data are limited or nonexistent.Aggregate data analysis is difficult to impossible to conduct due to gaps in storage.Communication breakdowns between sectors  occur frequently.Interviews with representatives from the medical, legal, and law-enforcement sectors revealed the following themes:Informed by the identified gaps, the objectives of PHR's sexual violence program evolved to address a number of other areas in addition to enhanced collection of evidence, including workforce development, strengthened reporting and dissemination of cases, enhanced communication between various sectors, and improved future surveillance and early detection.The focus group participants during the first prototype testing phase (N=8) were clinicians (n=5) or data managers (n=3), and the majority (n=7) practiced in a hospital (the other 2 worked in a mobile clinic). Almost all participants (n=7) were younger than 50 years old, and there was no gender discrepancy .regular mobile phone in the past, while 5 reported having used a smartphone (these types of phones were defined on the questionnaire). All participants said they were currently using a mobile phone (6 use only a regular mobile phone and 2 use both a regular mobile phone and smartphone). Half of the health workers indicated they felt very comfortable using both a regular mobile phone and a smartphone, and only 1 worker reported feeling very uncomfortable using them. In addition to making and receiving calls, the other most common reasons that health workers report using their phones were to send and receive texts , take photos , and connect to the Internet .When asked about previous use of mobile phones, 6 respondents indicated they had ever used a Participants were also asked to select their level of agreement with several statements related to their confidence in using the MediCapt technology and their beliefs about sexual violence documentation. The majority (n=7) of the respondents felt confident that they could master the use of both a smartphone and a mobile application. All the respondents believed that a mobile application would be useful in their professional work and practice in the future. When asked about documentation of sexual violence evidence, all but 1 health worker believed that documenting evidence of sexual violence using a mobile phone would have a positive impact on bringing sexual violence cases to justice and that the documentation should include an option to take photos of physical findings.During field-testing of a MediCapt prototype, 7 of 8 users thought such an app would have a positive impact on bringing sexual violence cases to justice.During the focus group discussion, participants provided feedback about what they thought were important features to include in the MediCapt app based on priority level  . Some ofBOXMust-Have Features:Digitized version of the paper-based Standard Sexual Violence formPhoto capture capabilitySecure data encryptionStorage and transmission of dataChain of custody preservedGeocoding abilityPrinting capabilityWritable pictogram of the body to draw on with touch screenShould-Have Features:Ability to link photo of injury to pictogram imageCapacity to take photographs as clinician conducts the medical examAbility to annotate photographOption to insert e-signatureAbility for patient to indicate his/her informed consentCould-Have Features:Scanner featureVoice recognitionAbility to audio record patient's narrativeUser testing of the MediCapt protoype informed design of the next iteration including addition of photography, pictogram, and printing features.Many of the features that users identified as important to include in the next iteration of MediCapt were not possible using the Magpi platform. After conducting a mapping exercise of existing technologies and platforms, we determined there were no off-the-shelf technology platforms that met these articulated needs. Therefore, we decided to develop a unique app from scratch.All 9 participants in the Phase II usability assessment were physicians practicing in various locations within the Eastern DRC and had spent at least 3 years conducting sexual assault examinations. The majority (n=5) had previous experience using apps on a smartphone, and some had used a camera on a phone (n=3) or a digital camera (n=4).More than half (n=5) of the respondents reported taking forensic photographs while conducting sexual assault examinations. Of those who ever used a smartphone (n=5), the most popular app was the camera app (n=3) and WhatsApp (a free messenger service) (n=2).usability ratings for using MediCapt on smartphones compared with tablet devices (Supplement Table). However, participants reported greater ease with holding the smartphone than the tablet and greater suitability of the smartphone for documenting sexual assault examinations. Respondents thought it was easy to take photographs with both the smartphone and tablet.Overall, respondents had slightly less positive appropriateness domain (Supplement Table). In particular, respondents had positive opinions concerning the promise of MediCapt in helping personnel do a better job of documenting sexual assault and saving time in conducting sexual assault examinations.Respondents had favorable responses to items within the acceptability domain, respondents indicated (1) they would likely need special training in order to use MediCapt with a patient during an exam, (2) there would be cases where they would not use MediCapt with a sexual violence patient, and (3) existing practices of completing a paper-based medical certificate for examinations of sexual violence patients may make acceptability of technology more difficult (Supplement Table). Still, respondents had generally favorable attitudes about their patients accepting use of MediCapt during examination and feeling comfortable themselves with using MediCapt in clinical practice.In the feasibility and sustainability, the largest area for improvement was that additional measures would need to be put into place to make sure the device gets used (Supplement Table). In particular, the respondents perceived it would be difficult to get reliable Wi-Fi or Internet access to transmit the files or even to have electricity to be able to charge the phones daily. In this domain, the most favorable responses were that (1) the respondents could foresee using MediCapt at their health care center, (2) they could train other colleagues on how to use MediCapt, (3) MediCapt would save time in documentation, and (4) MediCapt would ensure records are transferred to the appropriate law enforcement and legal personnel. In addition, the respondents generally felt that MediCapt was intuitive to use—even though their responses in the acceptability domain suggested they needed special training to use the app.Regarding Overall, the highest positive ratings were related to the helpfulness of the app in documenting sexual assault examinations and the ease with which they could take forensic photographs using MediCapt. The lowest ratings were related to smartphone size , tablet size (too large), ease in learning to use MediCapt during an examination, and feasibility of adopting MediCapt for use in practice.Key informant interviews identified multiple barriers to integrating MediCapt into the workflow in their respective health centers, which fell into 3 groups: infrastructural, systemic and organizational, and personal behavior . The maiDuring a second round of field-testing, users suggested the main barriers to integrating MediCapt into their workflows would be shifting cultural preferences for stamped paper copies of sexual violence evidence collection.We describe a collaborative development and design process with Congolese end-users of a novel human rights app for clinicians intended to standardize the documentation of sexual violence for forensic and legal purposes. NGOs working at the global, regional, state, and local levels are increasingly looking to mobile technology as a tool for the collection of documentation and evidence. To the best of our knowledge, this is the first report of a digital application in the field of human rights and forensic medicine designed specifically to incorporate local legal and forensic needs.In its current state, MediCapt is an Android-based app built with a NoSQL, eventually consistent database platform called Couchbase. Eventually consistent means changes made on 1 machine with a copy of the database, such as a user's mobile app, will eventually be transmitted to all other machines with that database, thus allowing the mobile app to work in cases without Internet connectivity through delayed, secure upload of information to the web-based system for use by external parties, such as police and justice officials.not within the photo gallery of the phone.All medical records, photos, and diagrams are stored using 256-bit Advanced Encryption Standard (AES) encryption. To ensure authenticity, metadata, including geolocation, network connectivity, and several other phone or tablet sensor data, are available. All activity is logged, and access is roles-based for security and authenticity. The photography technology relies on built-in hardware intended to bypass regular system storage to protect against access to the underlying data. For security and confidentiality purposes, the photos are stored within the local database on the app and User feedback on MediCapt highlighted the challenges with successfully transitioning workflows from paper-based systems to digital data. In the DRC, one important issue is the lack of electronic health record systems in most health care settings. Clinical encounters, even if captured digitally, still have to be printed and stored in paper forms and in existing paper charts. This creates additional steps for app users, rather than simplifying the process. Moreover, material restrictions  further complicate this transition. The expectation of other sectors and stakeholders  to receive paper copies of sexual violence reports is another issue to overcome in digital data collection and recordkeeping. To address these issues, we have added a Bluetooth-based printing capability, so that clinicians can print the completed forms and give them to the patient at the point-of-care, or any other stakeholders, when requested. At this point in time, we have yet to transfer data to law enforcement or legal authorities. Later phases of MediCapt development will include the transfer of these data to the police, then to local lawyers and judges, but only after specific training of these sectors. Any efforts to implement use of this app in its paperless form will have to include the education and buy-in of multiple players.Lack of electronic health record systems in the DRC poses an important challenge to transitioning workflows from paper-based systems to digital data.Digital health technologies produce digital evidence, which is often difficult to manage and poses issues related to data security.It is important to consider that currently common practice means that sensitive documentation  are kept in the open, piled up on desks, or strewn on the floor in clinics, hospitals, and court facilities for anyone to access, compromise, or destroy. MediCapt aims to bring some measure of security and protection to ensure those records are stored in a secured, encrypted space, allowing only those key individuals with passwords to access the sensitive materials. There is a risk that third parties may hack into the system where the aggregated and consolidated sensitive materials are stored. However, we have retained a dedicated expert to build out strong security mechanisms to minimize that risk. We are also retaining an independent security expert to run a security audit to expose any potential weaknesses or gaps in the system. And we plan to make the app open-source code to allow for the widest opportunity for independent technologists to test and maintain the code and help us identify and rectify any issues that may arise.The MediCapt development process has highlighted the importance of building an app within a larger ecosystem of training and partnerships and within an enabling environment. In the participatory context of this endeavor, MediCapt represents 5 years of ongoing conversations and feedback with professionals responsible for the collection of forensic evidence in sexual assault cases. Because the tool itself is a digital version of the documentation codeveloped and tested in-country, the Standard Sexual Violence form itself is known to end-users as credible and acceptable in local courts. Moreover, PHR has worked with key stakeholders in the hospitals and police force, as well as with justice officials at the grassroots level and government and ministry leaders at the highest levels. This has helped PHR and the MediCapt development team obtain the national political investment necessary to be able to pilot the app.The participatory context of MediCapt's development and its alignment with local legal and regulatory policies places a premium on long-term, strategic, political, and technical investment in the stakeholders and the community where the app will be used. The challenge, of course, is the organization's ability to do that in other countries and settings and raises the question of scaling up and disseminating the app in a meaningful way elsewhere.Another challenge is the need to invest heavily in technical human resources not only in the design phase but also at launch to make sure there is a dedicated IT person on the ground for troubleshooting at each point of use . This may be particularly burdensome for NGOs that are not traditionally used to handling and managing long-term technology projects.Such organizations are advised to work closely with partners who have technical, political, and financial expertise from the earliest stages of the initiative, even before embarking on technological design. The use of validated toolkits will help anticipate and mitigate common hurdles experienced by many in the mHealth field. A particularly useful one is the mHealth Assessment and Planning for Scale (MAPS) toolkit—a self-assessment tool that guides project teams when developing or scaling up their innovations.We have developed and built out MediCapt so that it can be scalable. This article describes early phases of development of the app in the DRC. However, we are working on extending the MediCapt pilot to Kenya in the near future, and comparing the experiences of users in these 2 very different settings. MediCapt has been designed to be ultimately used in many countries and it has been future-proofed to allow custom configuration of any standard national forms documenting not only sexual violence but also other kinds of human rights violations including torture, as well as configuration in multiple languages.Our study has several weaknesses. First, our project was carried out with a small number of participants in a unique setting with its own cultural and structural barriers. While this approach is appropriate for the specific purpose of obtaining qualitative feedback from intended end-users on prototypes and we believe our conclusions to be useful in informing future iterations of the app, the findings cannot be generalizable to other locales, sectors, and clinical data collection purposes. Second, during this pilot phase, we did not compare data collection with the app with the current standard process of collecting data with paper forms to assess accuracy, completeness, and ease of use, among other possible outcomes. We plan to evaluate these issues in the near future, via a "standard practice" control group. Finally, our participants' input and experience may not reflect those of others in their field or geographic location because of inherent differences in education, technological savviness, and technical expertise.–Despite the increased usage of digital health applications, the majority have not been tested and properly evaluated.It is critical that the human rights and technology communities come together to explore these issues that cross a wide range of areas—not only technological but also legal and ethical. Future consideration and development of operational, technical, and legal frameworks may help NGOs ensure that the collection of evidence and documentation of human rights abuses using digital technology is done in a manner that enhances local capacity, strengthens documentation, reduces risks to the documenter, survivor, and witness, and promotes human rights principles and justice.It is critical for the human rights and technology communities to explore together the technological, legal, and ethical issues posed by use of digital technology to document human rights abuses.data collection for medical, health, and public health purposes, we believe that our experience of collecting data that will potentially serve as evidence broadens the traditional scope of digital health and mHealth. As more human rights-oriented NGOs rely on mobile technology for digital evidence collection, we see a need to refine and define this as a unique field of exploration, which we would like to term mobile justice, or mJustice.Finally, whereas digital health, and specifically mHealth, focuses on


People’s participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project “self-help for health,” to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project’s implementation, impact, and reflective learnings.Following a self-help conceptual framework and PAR, the project focused on building the capacity of SHOs and their members through training on organizational issues, imparting health literacy, and supporting participatory planning and monitoring. Quarterly activity reports and process documentation were the main sources of qualitative data used for this paper, enabling documentation of changes in organizational issues, as well as the number and nature of initiatives taken by the SHOs in the intervention area. Health and demographic surveillance system (HDSS) data from intervention and comparison areas since 1999 allowed assessment of changes in health indicators over time.Villagers and members of the SHOs actively participated in the self-help activities. SHO functionality increased in the intervention area, in terms of improved organizational processes and planned health activities. These included most notably in convening more regular meetings, identifying community needs, developing and implementing action plans, and monitoring progress and impact. Between 1999 and 2015, while decreases in infant mortality and increases in utilization of at least one antenatal care visit occurred similarly in intervention and comparison areas, increases in immunization, skilled birth attendance, facility deliveries and sanitary latrines were substantially more in intervention than comparison areas.Building community capability by working with pre-existing SHOs, encouraging them to place health on their agendas, strengthening their functioning and implementation of health activities led to sustained improvements in utilization of services for over 20 years. Key elements underpinning success include efforts to build and maintain trust, ensuring social inclusion in project activities, and balancing demands for material resources with flexibility to be responsive to community needs. Individuals and groups interact, formally and informally, within health systems to ideally improve the health of those living in communities. These interactions facilitated by active community engagement or participation can enhance the utilization of health services , 2. For One way to facilitate community participation is by using Participatory Rural Appraisal (PRA) –9. The cDespite the recognition given to community participation and to PRA for sustained health and development, documentation of such initiatives over the long term and their impact on unlocking community capability is not common in the literature . It is aUpazila (sub-district) with a population of about 474,000 (as of 2011) spread across terrain of which one fifth consists of rivers and canals [Chakaria is located in the southeast coast of the Bay of Bengal. The location of Chakaria has made it very vulnerable to cyclones and tidal waves in addition to regular monsoon flooding. Climate change has heightened the risk of extreme weather events. Administratively, Chakaria is an d canals –16. The Upazila had one 31 bed government hospital located at the Upazila headquarters, two Health and Family Welfare Centres at the union level and two Rural Dispensaries [In 1994, at the time of starting our efforts, Chakaria ensaries . In 2014ensaries , as wellThe focus of ICDDR,B’s efforts to strengthen community capability from 1994 until 2006 through promotion of self-help for health at both individual and collective levels was based on the framework  getting to know the community and building relationships; (2) conducting a needs assessment and designing activities to address the needs identified, and (3) implementation. A summary of the range of PRA techniques used and their purposes are presented in Table  getting The functioning of village health posts, which was an outcome of community initiatives triggered by the ICDDR,B programme, continued by the SHOs for five years from 1999 to 2004 and then had some slackness until 2010 due to reduced support from ICDDR,B because of lack of funding. ICDDR,B inputs to promote self-help were stopped after 2010 other than implementing a micro-health insurance in the area with village health posts being the point of care.The ICDDR,B project team, overseen by one project director, was comprised of two groups that worked independently from each other: implementers and those conducting monitoring and evaluation. Some of those involved in monitoring and evaluation were also involved in the Health and Demographic Surveillance System (HDSS). The project team members involved in implementation were trained extensively in PRA methods both at a theoretical level in classes and also through practical experience in communities.To understand the community and to establish a confident relation with the community, ICDDR,B staff members started with a transect analysis. This involved walking through the villages, getting introduced to people and explaining the purposes of the project in a very informal way. The entry point was talking in common meeting places, such as shops, about common health problems faced by the villagers and ways the villagers manage them. Information about the number of schools, mosques, clubs, other community organizations, and local key and resource persons were also gathered during these informal visits.Janaja , sports and cultural functions, Milad (religious gatherings), Juma (Friday) prayers and other important social events.Participation in social events as they occur in communities facilitated outside entry into local social systems, enabling familiarity with community members, and building relationships with trust with them. ICDDR,B staff members participated in social events like, Project staff supported community health by participating in government programmes such as EPI sessions and national immunization days. Staff members also participated, on invitation from high schools (6th to 10th grade), in school maternal and child health sessions held in observance of maternal and child health weeks declared by the government. Subsequently, school children spoke highly of the project staff and the sessions to their parents, thereby facilitating further trust building and relationships between project staff and families . This exTraditionally Bangladeshi society has been rich in community organization and initiatives; Chakaria was not an exception to this. A list of self-help organizations along with their contact persons was prepared based on the transect walks, individual and group discussions, and subsequent visits made to the organizations and local key and resource persons. Organizations were selected that had highly representative membership, broad community support, regular meetings, ongoing activities, and resources at their disposal. Attempts were made to keep in touch with organizations and key resource persons that were not selected for active engagement to avoid misunderstanding.Project staff started to participate in the routine meetings of selected SHOs and observed the procedures followed in their meetings. None of the organizations initially had health on their agenda. Project staff requested permission from SHO leaders to discuss the major problems people faced. In most cases SHO members identified economic, social and religious well-being as their priority. After intensive discussion between project staff and SHO members, SHO members concluded that good health was also a priority as it was needed for everything, including prayers, education and any activity for making a living.Discussions with SHO members indicated that although villagers took initiative to address local issues, they did not perceive a role for themselves in health. Preventive measures, such as immunization and epidemic control, was viewed solely as a government responsibility, while curative care was an individuals’ responsibility, managed through consulting with healthcare providers and therefore not perceived as a collective concern . The issMeetings were concluded with the inclusion of health in the SHOs’ agendas and an expression of willingness by the organizations to get engaged in health related activities. It was decided that SHO members would go back and discuss the meeting outcomes with other SHO members who were not present in the meeting. If they considered that the issues discussed should be addressed, they needed to find ways to incorporate them into their activities. ICDDR,B was willing to provide technical and planning support in this regard, if the organizations desired.Wealth ranking and mobility mapping were used to understand people’s health seeking behaviour and its relationship with household socioeconomic status. SHO members conducted wealth ranking by classifying households into high, medium and low categories in terms of socioeconomic status. They also drew maps that helped to understand the location of households and nearby health facilities and what kind of health services people resorted to when people became sick in both dry and monsoon seasons. These exercises helped to understand how the utilization of services was linked with household wealth ranking and whether existing health services were accessible or adequate.While SHOs had the experience of making plans, they were new to participatory planning and required orientation. Project staff first familiarised SHO representatives with the common health issues and problems prevailing in their communities to ensure that participatory planning sessions focussed on health and health related issues. Subsequently SHOs convened meetings to carry out participatory planning and invited project staff to help facilitate the first couple of sessions.Participatory planning started with recollecting the past health and development challenges people faced. In most cases the challenges they faced were socioeconomic and developmental in nature. Examples of health challenges included epidemics of cholera, smallpox and outbreak of malaria and other prevalent disease conditions, environmental health issues and harmful practices. This was followed by participatory discussion of root causes of the problems they faced earlier. At the third stage the participants discussed the possible ways to tackle the problems and what resources they had for this purpose. In their opinion communities had human resources , who could be trained to enhance knowledge and capability on health and development issues, and carry out the health education activities. At the final stage of participatory planning they focused on the future and made short and long term action plans.Analysis of the monitoring data by the project team showed that in most of the participatory planning sessions, only male members participated, and although male villagers from poorer families participated, their voices were not heard. The issue was raised by project facilitators at the participatory planning meetings while presenting data on who participated and who did not. After discussion, SHO members felt the need to support participation by women and poor members in health development activities. They also noted the problem of social exclusion in the school health education programme which did not include children from very poor households because children from poorer families did not attend schools . In contDue to religious and social sentiments, which limited the mobility of women and sustained a highly hierarchical society, it was agreed that women and poorer community members should be included in health activities through a separate process. Health education for women in clusters of households was started with female volunteers. In addition, women’s groups formed by development non-governmental organizations (NGOs) for the poorest of the poor were also linked to the SHOs to work collaboratively.Male Health Volunteers: Disseminated health educational messages to men in male-dominated spaces, such as mosques, tea stalls, clubs, group meetings, village gatherings, gatherings in the neighbourhoods. This health message dissemination was done in an informal manner following a guideline developed by the SHOs with technical support from project staff members.Female Health Volunteers: Disseminated health messages using flip charts among women in their neighbourhoods when the women assembled in leisure time.School Health Volunteers: Students of grade six to 10 disseminated health messages among classmates in schools, playmates in the neighbourhood, family members and other peer group members they found appropriate. This involved role playing wherever appropriate.Village Health Post Volunteers: Adult male and female villagers nominated by the SHOs to help manage the operation of the village health posts. This group was formed after the establishment of the village health posts.Considering the importance of health knowledge, SHOs decided through participatory planning to train SHO volunteers. Nearly 4,500 volunteers selected by the SHOs were trained and subsequently conducted health awareness sessions throughout the year. Three types of volunteers were identified for training: Male Health Volunteers (831), Female Health Volunteers (1743), School Health Volunteers , and Village Health Post Volunteers (177), both male and female. The trained volunteers disseminated health message to respective target populations as indicated below.After 2 years of health promotion activities the SHO representatives raised the issue that despite all the health education, people still got sick and pregnant women continued to suffer as local health care providers lacked training. SHO members wanted to establish primary care centres in the villages, and also wanted their women trained in community midwifery. While the project did not have any mission to get involved in clinical services, ICDDR,B staff agreed to provide technical assistance by deploying six paramedics, a government recognized cadre of health professionals having a formal diploma in healthcare, for six village posts established by SHOs. The health posts were built with resources mobilized by the SHOs on land donated by a villager. SHOs also identified 15 women from their villages for a 6-month residential course on midwifery with project resources.SHOs established a system to monitor progress and share information between partners, i.e. from project to SHO representatives and also from SHOs to project staff. SHO representatives were oriented to conduct Participatory Impact Monitoring and Evaluation. Volunteers collected information on EPI, sanitary latrines, and other related information decided in consultation with the project team. SHO members compiled the data, initially with help from project staff, and presented it in SHO meetings, where SHO members and villagers participated and analysed the information. This became a regular activity that encouraged SHOs to meet the targets set in their work plans and created an environment of data based decision making.The self-help for health program was implemented by following a quasi-experimental study design with an intervention area  and a comparison area . Intervention and comparison areas were selected on the basis of similarity of socioeconomic background and from the neighbouring area within the sub district to ensure comparability as much as possible . The comData used in this paper came from surveys carried out in various points in time, project process documents, work plans, project activity reports, and published and unpublished materials. Data for health and demographic outcomes came from the HDSS, which has been in operation since 1999. HDSS, in 1999, included 20,252 and 6,727 randomly chosen households in the intervention and comparison areas respectively . The proBased on the organizational capacity building activities offered by the project, SHOs were able to strengthen their internal organizational management and also how they planned and undertook activities Tables  and 3. OAs detailed in Table Some of the major health initiatives undertaken by SHOs and community members during 1994–2003 and post 2003 are detailed in Table The self-help for health project aimed to improve the health status of the villagers by increasing collective health promotional actions and utilization of modern healthcare services. Changes in some of the relevant indicators in the intervention and comparison areas are presented below.While infant mortality data were not available for the period 2000 to 2003, a larger decline in infant mortality rate was seen between 1999 and 2000 in intervention areas vs. comparison areas, during the most active period of the project. Subsequently, these gains were lost , 30 and The percentage of fully immunized children in the intervention area increased substantially more from 47 % in 1994 to 80 % in 2014, compared to 61 % in 1994 to 75 % in 2014 in the comparison area  of children was collected in the HDSS area in 1994 and 1999 , 32. TheInformation on sanitary latrines and health benefits of the use of sanitary latrines was shared in the meetings of the SHOs and to the villagers through the trained volunteers imparting health messages. This resulted in SHOs taking initiatives to install sanitary latrines in the community and some SHOs also established manufacturing units for construction components of sanitary latrines in the villages. Between 1994 and 2014, this resulted in a higher increase of households with sanitary latrines in the intervention area 18 to 58 %) compared to that in the comparison area (17 to 42 %) (Fig.  to 58 % The experience gained from supporting health promotion with self-help organizations following Verhagen’s framework  and applAs mentioned, among the challenges faced, earning community trust was one of the first encountered by project staff. Initially, there was a strong anti-NGO sentiment prevailing in the area, leading project staff to consider deferring its training of volunteers. Instead the project decided to continue with the training plans, but moved the venue from isolated locations to villages where anybody could see and listen what the training was about. In addition to such measures supporting transparency of project actions, building trust required intensive work involving meeting key resource persons at their convenience and explaining the objectives of the project in clear terms, being respectful of community needs as much as possible, and demonstrating a listening mood. Confidence by community members in the project was bolstered by project staff demonstrating reasonableness in decision making and ensuring that what has been said by the project staff was followed through with. Trust was also facilitated by project staff emphasizing community solidarity by including everyone in the village irrespective of social and economic status.Trust was an outcome of working against social divisions, but also key in facilitating inclusive participation. For example, SHOs initially only nominated men for training. After nearly a year into the participatory planning, the situation was reviewed in SHO meetings on request from the project after having built strong relationships with SHOs. After project staff raising the issue, the SHO members who had exposure to the training programme and who had received feedback from the volunteers realised that the training on health, hygiene, water sanitation, and management of diarrhoea would be more beneficial if women were trained to serve as trainers who could reach other women in the community. This realization led to training of women, which was thought almost impossible at the beginning of the project.The process of working together not only led to many health activities undertaken by the SHOs, but also the self-realization of community members of their own strength and capability. Moreover, the project played the role of a catalyst to realize the capability of the community for their own wellbeing without creating a dependency relationship between the community and the project. In doing so, the project contested the tendency by villagers of asking for material assistance from outside parties for things which could be managed with their own resources. In some instances, villagers expected project staff to lead activities in their villages -project staff were very particular in communicating that initiatives were not ready to be initiated until villagers were willing to lead them.Demand for curative services was another challenge because the project was not designed to provide these services. A key learning has been the importance of flexibility in interactions with the SHOs/community members. No blueprint for the project other than the strategy depicted in Fig. This paper reflects on the experience of the project in supporting community capability over twenty years. A key feature of our work was our partnership with existing SHOs, instead of forming new groups or approaching community members directly. This helped mitigate the challenge of sustainability after phasing out of the project. As noted through DHSS data, to date some of the health indicators and health care utilization data indicate that positive effects still persist. The strongest of the sustained effects have been the functioning of village health posts, villagers’ response to membership in the recently launched health insurance, and continuation of the project trained community midwives.In the context of Bangladesh, community clinics, as the lowest level of health facilities, have sought local ownership by way of donating lands. Our experiences highlight that to succeed over the long term, engaging with communities, supporting their capabilities and ownership of community health requires a deeper engagement. Without involving the community in development activities, be it health or other, health planners and managers are unlikely to achieve their expected goals.In conclusion, key learnings and recommendations for any initiatives of this kind to unlock community capability has to have the realization that there is no shortcut and that fixed blueprints are unlikely to work. The key is to listen to the community, showing respect to their concerns and jointly acting to tackle them. Wherever possible interventions should be in partnership with existing community organizations for it will not only increase the chances of success, but will also make the change lasting and will strengthen the local level organization of the people. Any investment on community created and owned organizations, empowers and equips the community to tackle future challenges.


After the preparations were completed the teeth were scanned , and the crowns were designed and machined using CAD/CAM technology . The adaptation of the pieces was evaluated using polyvinyl siloxane replicas and stereomicroscope photographs with 70x magnifications. The normality test indicated a nonnormal result, so a Man–Whitney nonparametric test was performed. One out of the 24 measured regions showed a statistically significant difference (p = 0.0494). With this study it can be concluded that crowns fabricated by CAD/CAM technology performed on unpolished preparations are not influenced by the internal marginal adaptation and the ceramic part and are different from polished preparations. The polishing step of teeth preparations for crowns is a step often performed, so that there is an increased time during the clinical procedure. The aim of this study is to evaluate the marginal and internal adaptation of all-ceramic CAD/CAM lithium disilicate crowns in polished preparations for crown and nonpolished preparations for crowns. For this purpose, 20 first molars were selected, which were divided into two groups ( Several ceramic systems and manufacturing processes were introduced to the dental market as a consequence of highly aesthetically demanding patients , 2. FromThe high demand for aesthetic dental restorations made ceramic crowns popular. Three important factors must be emphasized when addressing ceramics: marginal adaptation, internal adaptation, and strength of the material; therefore all ceramic materials used for restorations and crowns must meet these three factors in order to meet the clinical requirement and prolong clinical lifetime –18. The Adequate internal adaptation is especially important for placement of ceramic restorations because it results in homogeneous distribution of masticatory loads under stress , 26–28. The relevance of this research is given by the interest to evaluate whether the polishing for crown preparations is truly necessary for the ceramic restoration to be well adapted, in addition to observe the CAD/CAM system behavior while acquiring images with different degrees of polishing. This study evaluated whether finishing of crown preparations influences the marginal and internal adaptation of lithium disilicate-based ceramic crowns fabricated with the Cerec system. The evaluation was made by a measurement technique at the tooth/ceramic interface with silicone replicas and evaluated through photographs with stereomicroscope under 70x magnification.Therefore the aim of this study was to evaluate in vitro whether the polishing of crown preparations influences the internal and marginal adaptation of lithium disilicate ceramic crowns fabricated using CAD/CAM technology. The null hypothesis was that the polishing preparation would not influence the internal and marginal adaptation.For the development of the research, a plastic manikin was used , in which the maxillary left first molar teeth was the focus of the study. Twenty premade plastic teeth element number 26, the brand P-Oclusal, with full-crown preparations, were used. The selected teeth were fixed in the plastic manikin, in the position correspondent to the tooth #26. Each tooth was included for the establishment of the procedure according to the group. This procedure was intended to facilitate the subsequent stages of the research.(i) Cavity preparation: the artificial teeth with full-crown preparations were divided into 2 groups. Group 1. Preparation shipped from the factory was roughened with ground particle size diamond bur , simulating preparations without finishing and polishing steps. Group 2 (Control). Preparation shipped from the factory has not been modified. A preparation was simulated with diamond bur in decreased sequence of particle size, fine , and extra-fine , following the steps of finishing and polishing. Upon completion of the preparations step, the teeth were cleaned with compressed air-water to remove any debris that remained on the surface . Since these blocks are precrystallized after the milling completed, they were led to a furnace at 840°C for 20 to 25 minutes according to manufacturer's recommendations.(ii) The ceramic crowns restorations were fabricated by a CAD/CAM system . Each preparation was covered with titanium dioxide spray  and scanned . To standardize the contour anatomy and as the original restoration design was not changed, only “Position,” “Add,” and “Smooth” tools of the software  were used in the free surfaces to ensure the correct thickness of all regions of the preparation and optimal adaptation. The following parameters were used: Biogeneric Individual, film thickness: 60 Following the fabrication of the ceramic restorations, began the stage of evaluation of marginal adaptation. The twenty ceramic restorations were divided into two groups according to the type of polishing and finishing of preparations. The marginal adaptation evaluation was performed in all aspects . The seating of the ceramic restorations was performed by the same calibrated researcher (BSS), by finger pressure. Then, the tooth-restoration interface was then taken to an optical microscope with 70x magnification, where snapshots of the interfaces were taken. No mismatches of the restorations were observed, so the need for internal adjustments was discarded.The plastic teeth previously divided into two groups and evaluated for marginal adaptation were fixed to a device in order to assist the impression steps with silicone film. To facilitate the apprehension of the teeth to carry out the subsequent stages of evaluation of the internal fit of the preparation, the root portion of each tooth was fixed into a plastic ring . A polyvinyl siloxane (PVS) impression material was inserted inside the ring . The teeth received demarcations on the buccal, mesial, distal, and palatal aspects of the root, 2 mm below the preparation, to standardize the fixation of the specimens for all groups. (iii) Internal fit evaluation: for the evaluation of internal fit, the cementation of crowns on their respective teeth was performed with a PVS material. Subsequently, the thickness of this silicone film was measured in 24 different sites for each crown. A PVS material for occlusal registration was used , according to manufacturer's guidelines. Immediately, the silicone was injected into the ceramic crown and seated with finger pressure on its respective tooth. The crown/silicone/tooth assembly was fixed in the metallic device, and a constant load of 1 kg was applied for 2:30 minutes, as recommended by the manufacturer.After the polymerization time, the silicone overflowed was cut with a #15 scalpel. The scalpel blade was replaced by a new one every 3 crowns, to avoid tearing of the PVS material. Then the assembly was removed from the device and the crown was carefully removed from the tooth. Each film was evaluated for possible defects, such as lack of material or even rupture during its removal from the crown. In case of deficiencies, the process was repeated until a silicone film without defects was obtained.For capture and stabilization of the PVS material film, a PVS material with contrasting color  to that of the film used for cementation was selected. Therefore, a low viscosity PVS impression material  was selected for the stabilization of the film (yellow shade), different from the PVS material used for measurement of the internal fit (green). This contrast facilitates the subsequent measurement of the film thickness. A low viscosity addition PVS material  was injected on the Flexitime film, with the help of an automixture syringe, starting from the occlusal aspect. With rotary motion, the coverage of the whole film was performed. Simultaneously, an additional portion of the silicone was discharged inside a plastic cylinder, and this was settled on the plastic part with the tooth.The device seated on the tooth preparation was stabilized until the setting of the material occurred, as recommended by the manufacturer, that is, 4:30 minutes. After polymerization, excess silicone was removed, and the silicon portion Light Body Regular Set was identified by letters for the mesial, distal, buccal, and palatal surfaces. The groups were identified by a thin layer of the low viscosity materials; that is, Flexitime Correct Flow was applied to the surface for identifying the roughened group, and Virtual Light Body was applied to the other specimens for identifying the polished group .At the end of identification, plastic parts were separated, and the silicone film Flexitime Correct Flow was removed from the tooth by the stabilization silicone . Subsequently, more low viscosity silicone was injected  inside the film, and the assembly was poured and stabilized on a glass plate. After polymerization, the silicone film was sectioned in the buccolingual and mesiodistal directions, resulting in 4 pieces. For this purpose, #22 scalpel blades were used, which were replaced every five sections to maintain the pattern and not tear the film. (iv) Measurement of the film thickness: for each of the four segments—buccal, lingual, mesial, and distal—images of the cervical, axial, and occlusal areas were obtained. The images were obtained 24 hours after the manufacturing of the replicas, under microscope with a magnification of 70x. To measure the film thickness corresponding to the internal gap of the tooth/restoration interface, an image analysis software was used  .For each section in the buccolingual direction 12 measurements were performed at different locations of the extent of film, and another 12 were made mesiodistally, in the same measurement sites. Thus, 24 measurements were performed for each crown. Three readings were made at each measurement site. The average of the readings was considered as the final value for each site.The measurement points of the buccolingual and mesial-distal sections are listed as follows : (a) cerIn order to avoid confusion when performing the statistical test, the mean values obtained were plotted so that each region could be evaluated by comparison between groups. Thus, Group 1 was odd-numbered and Group 2 was even-numbered, so each number was correspondent to the region of the surfaces and evaluated within its group.The statistical test used during this study was Shapiro-Wilk's and Mann–Whitney's at a significance level of 0,05%.p > 0.05), except for the region of the Cervical-Axial-Palatal Angle of G1 which presented higher value than G2 (p = 0.0494)  .The null hypothesis was accepted because, within the results found, one may observe that the statistical variation between both types of preparation finishing was virtually minimal. The only variable in measurement of the regions occurred in only one region and located only in the palatal region. The success of all-ceramic crowns is associated with several factors and laboratory steps that must be respected. Beyond aesthetics, a good marginal and internal adaptation are the ideal when implementing full crowns. This prevents any interference of the biofilm and possible marginal discoloration and caries recurrence among other factors . If the Obviously, further studies become necessary for us to extrapolate these scientific findings to clinical practice. But, within the results of this research, one might consider the possibility of clinical time saving during polishing of the preparations and the technical feasibility of crown preparation. Noticeably the acquisition device  performed correctly in reading its function, from which it can be concluded that the polishing or not polishing preparation does not interfere with reading and computer-assisted design of all-ceramic crowns.The instruments for evaluation and measurement of the marginal discrepancy can be optical microscopes , 13, 25,During the evaluation phase of the internal fit, no interference was found to be enough to require further adjustment; thus the ceramic restorations were crystallized without any sharp object contacting in addition to the milling cutters of the CAD/CAM, during the milling step. We believe that the CAD/CAM technology helps in manufacturing of ceramic crowns, because the steps that were previously made in the laboratory, taking days or weeks, now can be performed in a practical and easy way in less than 20 minutes for each crown .Computer aided systems (CAD/CAM) are designed to simplify the processing of dental prostheses, producing restorations in less time and with equipment that enables an accurate reading . PreviouIn this study, the measurement of the internal fit reproduced previous studies. The choice for the internal replica technique was recommended by McLean and Von  because One out of the 24 regions measured for each crown was found to be different between groups, in the region of axial-pulpal cervical angle. This led us to believe that during the roughening stage of restoration, which simulated the preparation unpolished, excessive pressure might have occurred. The preparations were sprinkled simulating the oral environment, so the tooth was placed on the mannequin. This variation may have occurred due to a slight difference in the angle of the diamond point during the surface roughening procedure.A recently published study that evaluated the marginal and internal fit, of two different milling systems, where a system used selective laser melting and the other a CAD/CAM system, found that the first system presented superior results for marginal and internal fit . Maybe iDespite the limitations of this study it can be concluded that the full crowns manufactured with CAD/CAM technology on preparations with or without polishing showed no statistically significant differences in the evaluation of marginal adaptation. Also it can be concluded that polishing preparations of full crowns fabricated with CAD/CAM technology are optional. This may be waived by the dentist reducing the clinical time during the preparation procedure. However it would be interesting to carry out further research evaluating these parameters on natural teeth.