Objective: After passing of the National Competency-based Learning Objectives Catalogue in Medicine , the German medical faculties must take inventory and develop their curricula. NKLM contents are expected to be present, but not linked well or sensibly enough in locally grown curricula. Learning and examination formats must be reviewed for appropriateness and coverage of the competences. LIN-database. The necessary curricular transparency is best achieved by systematic curriculum mapping, combined with effective change management. Mapping a complex existing curriculum and convincing a faculty that this will have benefits is not easy. Headed by Tübingen, the faculties of Freiburg, Heidelberg, Mannheim and Tübingen take inventory by mapping their curricula in comparison to the NKLM, using the dedicated web-based MERThis two-part article analyses and summarises how NKLM curriculum mapping could be successful in spite of resistance at the faculties. The target is conveying the widest possible overview of beneficial framework conditions, strategies and results. Part I of the article shows the beneficial resources and structures required for implementation of curriculum mapping at the faculties. Part II describes key factors relevant for motivating faculties and teachers during the mapping process.Method: The network project was systematically planned in advance according to steps of project and change management, regularly reflected on and adjusted together in workshops and semi-annual project meetings. From the beginning of the project, a grounded-theory approach was used to systematically collect detailed information on structures, measures and developments at the faculties using various sources and methods, to continually analyse them and to draw a final conclusion .Results: The following resources and structures support implementation of curriculum mapping at a faculty: Setting up a coordination agency , systematic project management, and development of organisation and communication structures with integration of the dean of study and teaching and pilot departments, as well as development of a user-friendly web-based mapping instrument. Acceptance of the mapping was increased particularly by visualisation of the results and early insight into indicative results relevant for the department.Conclusion: Successful NKLM curriculum mapping requires trained staff for coordination, resilient communication structures and a user-oriented mapping database. In alignment with literature, recommendations can be derived to support other faculties that want to map their curriculum. Initially, the comprehensive catalogue should be considered as recommendation for restructuring the study of medicine until 2020 and should be tested by the faculties , , . Apart fLIN; www.merlin-bw.de/, retrieved on 15.05.2016]. A core project headed by Tübingen is curriculum mapping. To obtain an impression of the current state, the existing curricula should be mapped against the NKLM. For this purpose, instruments such as the web based MERLIN database and its deployment in practice had to be developed ..LIN; wwwIn this two-part article, the experiences with change management in terms of curriculum mapping at medical faculties are analysed and evaluated. It is the aim to provide an overview of the required framework conditions, strategies and results as broad as possible and to show the correlations from various angles. Recommendations for practical use will be derived from that for other faculties. In Part I, the focus will be on the leading question of which structures and resources have been applied for preparing and monitoring the mapping project and how conducive they affected the curriculum mapping. In Part II, the key factors for motivating the lecturers during the process are described.LIN database were immediately realised, the entries that had been made by the participating faculties were verified and work proceeded on the current version of the NKLM.The article refers to the experiences of four medical faculties in Baden-Württemberg that participated in the mapping process. The period of data collection was from April 2012  until the end of 2015 (conclusion of the first mapping round). The initial basis was the NKLM version of February, 2013. After the final NKLM version was approved in June of 2015, necessary updates in the specially developed web-based MERBefore the mapping process was started, the project has been systematically planned following the necessary steps of project and change management and have been adjusted to needs, when the project was under way. Additionally, an organisational concept was designed in advance, in which important persons were designated and structures laid down, local coordinators (“transfer agents”) were allocated and where cooperation and communication between competence centre, dean of study and teaching, dean’s office of student affairs and departments were structured.The draft  have been questioned several times about the progression and status of mapping in their faculties and about aspects of change management; additionally, they were required to subjectively assess the effectiveness of their measures and the results. In addition to the informal questioning, other methods have been used in the form of questionnaires (once a year), semi-structured group interviews and group discussions (once to twice a year) and individual interviews (once) based on guidelines.Status, progression or delays of the mapping process have been continuously documented for each faculty by the “Project Lead” , the data have been coded and analysed. Information from interviews, discussions, records, memos, and similar, have been categorised and coded. In a final summary, the results from all data, have been comprehensively analysed and allocated, with the aim of deriving correlations and conjunctions through contrasting and comparisons and of arriving at recommendations . All gathttp://www.nklm.de, retrieved on 22.03.2016] have been mapped to document the current state. Those chapters have been particularly selected for content-related reasons, because they provide a favourable mix between new aspects with the professional role concept, for which closer discussion facilitated by experts appeared to make sense, and known aspects in the form of skills, which promised a quicker success stories. For each of the four medical faculties, 85-95% of the curricular courses have been displayed. This result confirms the successful progression of mapping and change management.The NKLM professional doctor roles (chap. 5-11) and the medical skills  , . F. F12]. FPreparing for problems during the change process. In workshops and during project meetings, expected problems and impediments were discussed and dealt with in advance. Feedback from the evaluations often was that “it was a useful preparation for difficult situations, that a repertoire of solutions had to be developed beforehand in a structured way.” During all stages of the project, it was seen supportive to be able to regularly exchange experiences in the ongoing process in a structured manner and to assist each other with advice. All those working on the project reported that, during the project, great powers of persuasion and a high degree of frustration tolerance were equally required. Knowledge of the characteristic emotional stages of the change process facilitated the understanding of the project staff for the lecturers and promoted a “professional optimism”.On locations, where resources, structures and networks have been established systematically together with the dean's offices of student affairs as well as the departments, the mapping began faster and more effectively and was also completed within the set timeframe. Close linking with the staff of the dean's office of student affairs  did also have a favourable impact on coordination, the flow of information and on using the mapping data on the location. During the workshops, communication plans and strategies have also been elaborated, which permitted to communicate extensively and continuously about NKLM and curriculum mapping in the faculties (cf. Part II of the article). (Repeated) changes of persons or in responsibilities were a significant impediment in the progression of the project.During the first half year of the project, important decisions were made to revise the mapping form , 11], t, t11], tMapping and evaluation of courses now only at the level of sub-competencies . Related learning objectives could be ticked off reflectively, so that a substantive discussion at the learning target level was achieved in any case.Reduction in the number of mapping categories from the originally planned 10 categories  to 4 catExplicit retrieval and mapping also of implicitly taught content that is not documented in written form .In all, those decisions led to significantly increased acceptance of mapping and the voluntary departments showed willingness to participate in mapping again.LIN database at the conception stage and could be included in the requirements profile of the mapping instrument . Additional details about the MERLIN database in the mapping process are given in Part II of the article.The acceptance of the mapping instrument particularly depended on the user expectations: Practicability, reliable functioning, intuitive usage, easy-to-understand, convincing results for the department (cf. Part II: Usage). The early feedback of the lecturers ensured that their requirements were already known to the developers of the MERThe present multicentre study shows how the implementation of the NKLM curriculum mapping can be achieved and will be accepted by the dean's offices of student affairs, lecturers and students despite initial reservations. Successful implementation of curriculum mapping is particularly important, because with the approval of the NKLM, it is advisable for the faculties to restructure the curriculum in a competence-oriented way . CurricuOver a period of three years, data have been gathered systematically along with the project. The experiences of the four faculties are an important body of information for the nationwide implementation of the NKLM. Aspects that have proven effective and that can be planned by a faculty in advance, have been identified . At the management level, the project needs an influential “advocate”, who, particularly at the start of the project, publicly propagates the necessity and benefits of the project and who paves the way for the coordinator . Additionally, it has proven helpful to seek supporters among the lecturers at an early stage , who wiThe leading role of the Competence Centre for Medical Didactics was certainly a key factor in initiating and implementing the project. Its high level of acceptance and good connections have helped in carrying out the analyses in Tübingen. The medical faculties in Baden-Württemberg also benefit in the current project from the cooperative teaching network: The expertise of Tübingen, which particularly shows in the development of the concepts, instruments and strategies, has been stimulated through the constructive discussions with the other locations. Where it was wanted, the expertise benefited all locations. Eventually though, the project had to be introduced, discussed and implemented independently on every faculty, depending on local conditions.The trainings at the Competence Centre for Medical Didactics was very helpful in that case providing all those involved in the project, including interested medical teachers, with practical knowledge and a broad skills profile, and offering a forum for mutual consultation. The depth of experience, communication abilities and readiness to cooperate of the responsible persons is decisive, here as it is everywhere. In that regard, the faculties in Baden-Württemberg reflect the fundamental basic structures and factors, despite the mentioned advantages. That the findings and recommendations with local adjustments are generally transferable is also demonstrated by the positive experiences on other locations in Germany, where curriculum mapping has begun meanwhile, in accordance with the concept from Tübingen. A comparison of the findings has clearly demonstrated that the construction of resilient structures that are adapted to the local situation, are of key importance. Regular communication and close cooperation with the relevant levels of the deans’ offices of student affairs and the departments must be organised to start an effective development at the faculty . EspeciaLIN database on cooperation at the faculty will be explained in Part II.For a faculty to accept curriculum mapping, the following requirements for the process and the mapping instrument are necessary , 10], , , 30]: T: T30]: TA restrictive consideration is: it is an empirical multicentre study with a grounded theory approach , which mThe result is: Successful NKLM curriculum mapping requires staffing resources for coordination and supporting the medical teachers, a database adapted to the user as well as functioning communication structures, linked to the dean's office of student affairs. Realistic recommendations can be derived, which could provide practical support to other faculties.LIN Group for the stimulating discussions. We also wish to express our thanks to Dr Wolfgang Öchsner and Mrs Claudia Grab (both of Ulm University) for their contributions during pilot mapping, as well as to the deans (of study and teaching), staff of the deans’ offices of student affairs, lecturers and students, who supported the mapping project with full engagement. Particularly, we wish to thank all teaching coordinators and those responsible for modules for their energetic participation in the mapping process and the discussions. They contributed important information and gave impulses for optimising the instruments and the process.We are grateful to the entire MERLIN  of the medical faculties of the universities of Freiburg, Heidelberg, Mannheim and Tübingen, led by Tübingen, reference number: 01Pl12011A.The project is funded by the Federal Ministry of Education and Research (BMBF [Bundesministerium für Bildung und Forschung]) within the framework of the promotional programme “Quality Pact for Teaching” ; the joint project MERThe authors declare that they have no competing interests.


This mini-review considers three different approaches to the therapy and prevention of Alzheimer’s disease (AD): replacement therapy, disease modification, and multi-level interventions. Each of these research frameworks has direct implications at the clinical level, leading to an emphasis on different time points of the AD continuum. While all perspectives continue to play an important role in current efforts to reach the ambitious target of an effective therapy or prevention of AD by 2025, it is clear that novel paradigms are needed, including new models of clinical trial design. This goal can only be accomplished by a concerted effort of academia, governmental agencies, and industry. The increasing awareness that dementia, and in particular Alzheimer’s disease (AD), represents one of the major challenges to health systems in coming years has led to an unprecedented emphasis on the need for an effective therapy, now considered as a priority for science and society . The yeaThe modern history of research for an AD therapy can be conceptualized in three different approaches, which are briefly discussed in this review: replacement therapy, disease modification, and multi-level intervention. These approaches cannot be conceived as stages in an evolutionary process, since all of them are still playing a central role in current research. It must be, however, underlined that they have different implications for the process of diagnosing AD, as manifested by the progressive changes in diagnostic criteria, and guidelines that have taken place in the past decades, from the NINCDS-ADRDA Work Group , to the l-DOPA for Parkinson’s disease had a clear impact on the AD therapy research field. The concept that disease manifestations could be defined in terms of neurotransmitter loss was a central component of the cholinergic hypothesis, and led to the development of the leading class of drugs currently approved for AD therapy, i.e., acetylcholinesterase (AChe) inhibitor drugs. The systematic search for a biochemical fingerprint for AD began in the 1960s of past century, and was crowned by success with the discovery of reduced level of choline acetyltransferase, the enzyme responsible for ACh synthesis, in the cortex of AD patients , starting a complex chain of molecular events and cellular reactions finally leading to plaque formation and neuronal death . A modeotential . The oriotential . The pospatients ]. The fapatients . An altepatients . The ACHpatients . A less patients .Overall, the appraisal of the results of trials based on the ACH is at the moment negative. The so-called “tau hypothesis” is often considered as a competing approach, but it may be remarked that it shares most of the conceptual assumptions of the amyloid approach, i.e., the idea that the development of AD could be stopped or delayed by interfering with a primary pathological event, i.e., in this case the formation of neurofibrillary tangles. The development of drugs targeting tau aggregation has proven more challenging than in the case of β amyloid, and only recently drugs targeting tau aggregation and of active and passive immunization approaches have entered the clinical trial arena. Among the current clinical trials of DMT, 14 address amyloid targets and only 4 involve tau-related targets .in vivo assessment of markers of pathophysiology . The series of substantial failures of drugs acting on the ACH has been largely attributed to the failure to address the disease process at the earliest possible stages, i.e., before neurodegeneration has taken place. The potential of this approach to early disease stages is now actively investigated in several clinical trials and the results will become available in the next few years.The search for a “magic bullet,” which could halt or slow down the pathological process whose result is the clinical picture of dementia, has had a fundamental impact at the clinical level. Considering dementia as the irreversible outcome of a linear sequence of events unleashed by pathological protein aggregation inevitably leads to the consideration that pathophysiological process leading to dementia begins many years prior to overt clinical manifestations of disease. An early step in this direction was the definition of a “pre-dementia” stage of AD, mild cognitive impairment . The folThe molecular and mechanistic views described in the previous section maintain their crucial role in the quest for a therapy of AD, and more encouraging results of the anti-amyloid (and anti-tau) approaches may be forthcoming. It is, however, now clearly acknowledged that the “neuron-centric, linear cascade initiated by Ab and leading to dementia” , implyinMuch has changed in the two decades in the quest for an effective therapy and prevention of AD. The success rate of drug development for AD has been poor and novel paradigms are needed, including new models of clinical trial design taking into account the advances in early diagnosis, the role of genetic factors, and new epidemiological evidence. This can only be accomplished by a concerted effort, including governmental agencies, academic researchers, and industry .The author confirms being the sole contributor of this work and approved it for publication.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


The Special Topic on Embodied Cognition over the Lifespan and in Applied Settings aimed at gathering evidence on the role of EC in development, adulthood, and aging, and to shed light on the applied fields benefiting from this approach. The collection originating from it shows the variety and richness of studies falling under this umbrella. The collection is organized in five sections: the first outlines new perspectives in the potential applications of EC to cognitive development and healthy aging; the second, third, and fourth are dedicated to studies on childhood, older age, and young adults. Each section comprises work on action and language; the fifth section is dedicated to instruments and techniques to utilize within an EC framework, such as Virtual Reality (VR).Glenberg and Hayes propose a strongly embodied explanation of two phenomena characterizing childhood—infantile amnesia, consisting in the scarcity of autobiographical memories from early childhood, and childhood amnesia, the quick forgetting of situations until age of seven—and extend the same explanation to cognitive decline with aging. They ascribe a crucial role to the development of the hippocampus, the primary function of which is that of spatial navigation. Before locomotion, they propose that infants have difficulties in associating events with locations, because places are not strongly distinguished by spatial codes, and in memorizing similar events experienced in different places. When locomotion starts, place and grid cells of the hippocampus adapt to the environment and places become stable memory cues. The maturation of locomotion abilities further facilitates long-term episodic memory and lead to the end of infantile amnesia and of childhood amnesia. Within the same framework, the reduction in self-locomotion abilities is at least partially responsible of the cognitive decline with aging.This section collects proposals of new perspectives and directions of research on embodiment over the lifespan and their implications for social practices. Costello and Bloesch propose that Embodied Cognition can enhance our understanding of the changes occurring in sensory processing, mental representations, and action perception with aging. They suggest that older adults may rely more on visual inputs than younger adults, possibly due to the degradation of their internal action models, therefore potentially becoming more disembodied. EC can also help understanding the diversity of the aging process across individuals, whereby physical and cognitive aging, particularly perceptual and motor skills interplay with cognitive abilities. Importantly, the role the environment emerges as facilitator or barrier to healthy aging.Hommel and Kibele outline the principles of an embodied-cognition approach to aging, according to which abilities are not a static endowment but rather emerge from fruitful and active exchanges with the environment. The progressive reduction of resources could thus be intended as a modification in the relationship with the environment, that requires reframing. They contend that healthy aging relies on the systematic use of control resources; these resources, even if present, are often not fully exploited. They discuss three phenomena characterizing aging, i.e., the reduction of dopaminergic supply, loneliness, and the loss of body strength, that might lead to the loss and lack of maintenance of cognitive control, leading to a vicious spiral of demotivation and further lack of strategies to contrast cognitive decline. While further research on how use of cognitive control resources affects their maintenance, social practices should promote healthy aging supporting self-empowerment strategies of individuals and reconsidering current policies as retirements laws.Barca et al. show that the extensive use of the pacifier, i.e., of a device actively involving the mouth motor system, influences the acquisition of abstract and emotional concepts, leading to a different pattern of conceptual relations in children who have used it (beyond age 3). The authors interpret their work in the framework of the embodied Words As social Tools (WAT) view  of words; they show that factors traditionally considered in literature such as concreteness, imageability and frequency do not account for the variability of AoA data. AoA can be explained, however, when recurring to “groundability” in sensorimotor and interoceptive experience, i.e., considering concepts as richly embodied.Inkster et al. study the influence of words' rated body–object interaction (BOI) and imageability in 6–7 years-old and in adults. For the first time they obtain BOI ratings from parents of children (child-BOI), and compare the influence on auditory naming task of high and low imageability words and of high and low child-BOI words. Results showed that children's auditory naming times are influenced by both imageability and child-BOI, testifying the influence of embodiment and groundedness on conceptual representation even in very young children.In the same vein, Adams provides substantial evidence from the literature that learning a second language should also be grounded in action. In bilingual individuals, both the first and the second language display compatibility effects between semantic content and action. Importantly, children with Specific Language Impairment are known to present motor deficits, therefore they can potentially benefit from the involvement of the body in language learning.In this section the majority of contributions focuses on the role played by action and movement for cognitive activity in children.Lozada and Carro used a classical task, the Piagetian conservation task, in 6–7 years-old. They clearly demonstrated the effects of action on cognition: actively manipulating the materials led children to comprehend conservation phenomena better than when they merely observed an adult's demonstration.Wunsch et al. tested children aged 3–10 and adults in three motor tasks  and three cognitive tasks on executive functions . They found a general improvement of the performance with age, but also found that, when age was controlled, there was no relationship between motor and cognitive tasks. These results cast doubts on the assumption of a strict interrelationship between action and cognition proposed by embodied and grounded cognition approaches.In a different perspective, Pouw et al. The authors looked at the role of utilizing body analogy in explaining physical systems to school age children. They found that instructional animations based on human body were particularly useful for children with lower maths skills for a specific task, while transfer of learning did not benefit from it.Whether the human body and actions can be utilized to support cognitive tasks has also been explored by Richez et al. ask 8–11 years old children to respond to the color of a stimulus presented at different distances from the body. Only over 10 years of age, children responded faster in grasping a proximal switch when they were shown a proximal stimulus, and a distal switch when they were presented with a distal stimulus. The authors argue that this is in line with the view according to which, between 8 and 10 years, children prepare their body to more efficiently act in the environment.One final study on children focuses on the development of the ability to respond to stimuli in the environment with the appropriate grasp. Ninaus et al. investigated the Spatial-Numerical Associations of Response Codes across the lifespan, showing that it increases with age, reflecting the increased experience with the association between numbers magnitude and spatial physical space, which is culturally determined. On the contrary, the interference of flanking numbers on a line bisection task forms a U shape across the lifespan, suggesting that it is grounded in inhibition abilities, which are weaker in children and older adults.These mixed results, with some positive and some negative findings, highlight that the body plays a complex role in cognitive development, that varies depending on the age, the kind of task and the complexity of the required cognitive skills.Hainselin et al. test the enactment effect (EE), consisting in better memory for performed actions than for verbally encoded action sentences, in 6–10 years-old children. Overall, action conditions (direct action and action observation) were better than non-action conditions . Even if younger children memory performance was worse than that of older children, this difference disappeared during learning through action. Their results suggest that episodic memory might not underlie EE in young children, and highlights the importance of action for learning and memory.Galetzka offers a commentary of a paper of Radesky et al.  accordinMiklashevsky and Fischer adopt the approach outlined by Hommel and Kibele, according to which cognition changes in the dynamical interchange with the environment, to investigate how development changes in the light of the pervasive digitalization and of the extensive use of smartphones and tablets in children. They argue that using oral instead of typed language will likely link linguistic representation to the orofacial rather than to the manual activity, the reduction of hand motor activity in interacting with objects will likely lead to changes in spatial representation and in abstract conceptualization, for example replacing manual with visual metaphors , and the reduction of finger counting will render individual numbers less accessible; finally, the absence of direct social interaction will reduce the pragmatic value of language, rendering it less linked to action.When looking at cognitive development the importance of an embodied perspective emerges clearly; however very few studies have attempted to implement it in understanding age-related changes on the other side of the lifespan, in older people.Borghi and Setti focus on how older people represent abstract concepts and words. They propose an account of conceptual decline in elderly derived from the embodied WAT view  memory test. Results of the test show very distinct pattern of performance across older groups. All older individuals, with or without cognitive deficits, committed more confusion errors than young adults, likely due to a degradation in perception with age. Alzheimer patients showed severe impairments in episodic memory and committed more intrusion errors than the other groups, likely due to difficulties in multimodal integration; finally, semantic dementia patients showed the most severe deficits of semantic memory.Nowak et al. show the link between perception, assessed by temporal information processing, and executive functions in older adults. They find a correlation between temporal information processing and performance in the Tower of Hanoi.Temporal information processing, the temporal accuracy with which we perceive external stimuli has been linked with efficient cognitive performance; Hommel and Kibele and Costello and Bloesch it is important to understand the role of embodiment and action in aging, potentially shedding a new light on cognitive deficits and cognitive resources in aging.As highlighted by both Kuo and Yeh demonstrate that walking enhances divergent thinking. Specifically, older adults can reach the same performance level in a divergent thinking task, when they are free to choose their own walking path as opposed to walking on a fixed path.Creativity is a well-researched topic in young adults, however much less research is devoted to creativity in older. Niu et al. in an ERP study, show that a general decline on action preparation occurs with aging, and an age-related impairment on the effect-action retrieval of intention-based actions, possibly due to decline in associative memory.Kim et al. look at bimanual instrument playing (electronic drum), requiring coordination, in young adults, as well as healthy and Mild Cognitive Impairment older adults. They show that the ability to synchronize with an external cue correlates with cognitive skills; this indicates the close link between action and cognition in aging.Chen et al. test the hypothesis that abstract-abstract mappings can be formed focusing on the concept of time and abstract action. Results of two lexical decision tasks revealed robust priming effects when a target verb and its prime (length-changing line or sound beep) lasted the same time (time consistent condition). The authors propose that mappings between concepts are influenced by common elements, either linguistic or embodied, that are differently recruited depending on the conceptual difficulty.According to the conceptual metaphor theory, mappings are formed between abstract and concrete concepts. Chen et al. look at the role of emotions in words processing. In addition to replicating the effect of priming for words of the same emotional valence, they show that words referring to life-events also activate specific emotions, however it happens at a later stage, as shown by the longer Stimulus Onset Asynchrony compared with priming obtained when valence, as opposed to specific emotions, is manipulated.Capellini et al. investigate an exquisitely embodied phenomenon, that of motor resonance, i.e., the activation of a simulation while observing the actions of others. Italian participants were presented with videos of an Italian (in-group) or Arabian (outgroup) individuals with a neutral (box of juice) vs. a threatening object (gun) and measured mouse tracker responses. When a threatening object was present, responses were delayed with outgroup members, revealing a higher level of motor resonance with the in-group and the activation of threat-related stereotypes induced by the context.Xie et al. investigate a debated topic in the embodied literature: metaphorical associations. In two experiments, they manipulated the kind of seat where participants were sitting and recorded performance in a memory task and in a creativity task. The soft seat was associated with better performance in the creativity task, while the hard seat was associated with better performance in the memory task.Repetto et al. propose to use VR to improve memory function in elderly. Glenberg and Hayes highlighted the link between locomotion and episodic memory, by means of the alignment of place cells, encoding location, and grid cells updating the viewpoint when self-motion occurs. VR allows the individual to experience a sense of moving in the environment with much limited real movement. Several studies show that episodic memory can be enhanced by using VR exploration, therefore, the authors propose that VR should be exploited to support episodic memory in older adults, who have often reduced mobility.Johnson-Glenberg et al. are also interested in embodiment through technology. Specifically, they assess the efficacy of different levels of immersiveness and embodiment in supporting learning in college students. They assess both declarative knowledge and generative knowledge immediately after the lesson and at 1 week follow up and found that there was a significant difference after a week, with the more embodied class benefitting more the generative knowledge tests.The articles collected in this Special Topic trace novel avenues to study Embodied Cognition and its contribution to identifying strengths and weaknesses across the lifespan, and techniques to support the former and prevent the latter.All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Due to the increasing importance of reliability and availability of electric traction drives in Railway applications, early detection of faults has become an important key for Railway traction drive manufacturers. Sensor faults are important sources of failures. Among the different fault diagnosis approaches, in this article an integral diagnosis strategy for sensors in traction drives is presented. Such strategy is composed of an observer-based approach for direct current (DC)-link voltage and catenary current sensors, a frequency analysis approach for motor current phase sensors and a hardware redundancy solution for speed sensors. None of them requires any hardware change requirement in the actual traction drive. All the fault detection and isolation approaches have been validated in a Hardware-in-the-loop platform comprising a Real Time Simulator and a commercial Traction Control Unit for a tram. In comparison to safety-critical systems in Aerospace applications, Railway applications do not need instantaneous detection, and the diagnosis is validated in a short time period for reliable decision. Combining the different approaches and existing hardware redundancy, an integral fault diagnosis solution is provided, to detect and isolate faults in all the sensors installed in the traction drive. In the last few decades, electric drives have become more important with the increase of machinery electrification and electric vehicles. Moreover, in Railway applications, the availability of the traction drive is directly linked to the availability of the complete system, as a train could stop in case of a failure in the traction drive. Maintenance activities have an important influence on the availability of the system, being an ideal maintenance the one which prevents a failure , based oFault diagnosis functionalities or tools can differentiate between some industrial applications and companies from others. With fault diagnosis, we refer to the sequence of actions needed to detect, locate, and identify the fault mode in a system. Moreover, the severity of the fault can be obtained. This is known in the literature as Fault Detection and Diagnosis (FDD) ,3. If thDifferent FDI approaches have been presented in the literature. In , a classIn this research, on-board Model-based FDI approaches are proposed and implemented in a commercial Traction Control Unit (TCU) for a tram. In complex systems, a fault can concern several signals, being a Model-Based FDI a suitable solution to improve detection sensitivity . The modOn the other hand, as model-free approaches need a large quantity of historical data, on-board diagnosis has limitation due to computational requirements . On-boarOnce a fault occurs, system performance deteriorates from the nominal zone to the degraded zone. Thus, a Model-based FDI for early detection of faults in traction drive elements, before the system passes from degraded mode to failure, is an important point to increase the availability and reliability of the system. The types of faults in traction drives can be classified as sensor, actuator, and process faults . Fault DIn  a reviewThe aim of this article is to propose an integral FDI solution for sensors in a Railway Traction drive, based on different FDI approaches. The applied approaches do not imply any hardware change. Railway applications are not safety-critical systems as aerospace systems. In aerospace applications, it is critical to react instantaneously to the fault, in order to activate a fault tolerant solution. On the other hand, in Railway applications, the control system can stop and restart the traction unit in seconds maintaining the motion of the train. Thus, the proposed approaches in this article for Railway application should be evaluated during a short time period in order to confirm the fault detection.The most suitable FDI approach for each sensor has been selected, based on the following factors: algorithm complexity, hardware and software resources available in the traction drive, tuning difficulty due to parameter variation/uncertainties and reliability. A simple model for an observer, avoiding several motor parameter variation during operation , the avaAmong the FDI solutions for DC-link voltage and catenary current sensor, an observer-based FDI approach based on the input filter is proposed. In , a similIn the Railway Traction drive studied, only two phase measurements are available. Thus, low computational cost FDI approaches for phase current sensor, such as those based on the sum of three current measurements cannot be applied . There aperation . In concFinally, in case of the speed sensor, due to the hardware redundancy already available in the Railway Traction drive configuration, observer-based FDI approaches for speed sensor faults , have noPrevious works in sensor FDI in Railway applications have been validated in simulation ,32 or inIn contrast to previous works, a commercial Railway control unit was used for Hardware-in-the-loop simulation (HIL). The HIL platform is composed of a Real Time Simulator and a Traction Control Unit (TCU) for a Railway application. The TCU is a commercial unit for a tram developed by CAF Power & Automation (Spain). Thus, the FDI algorithms were implemented together with the same control software utilized for a real tram application.The paper has the following structure: There are different traction unit topologies but this research has been applied to the traction unit shown in 1 and K3.Main and pre-charge contactors, represented as KF, CB and RF, with functions being the catenary current ripple reduction, protection against catenary voltage changes, and a DC-link voltage setting.Input filter, composed of L7 and braking resistor.Braking unit given by IGBT TIGBT-based inverter that supplies two induction motors in parallel.Traction control unit, where software for the control strategies, protections and alarms, is executed.The traction unit is supplied from a 750 V DC catenary. The traction unit can be divided into:The list of sensors in the traction unit is given in The proposed Integral Sensor Fault Diagnosis strategy provides the most suitable solution for each sensor, based on the architecture of the traction unit shown in Among the several FDI strategies developed for the traction drive, the ones presented in this article are shown in The different FDI strategies are executed in parallel. A suitable feedback gain selection for observer based FDI, makes residual for detecting catenary current sensor faults sensitivity low to DC-link voltage sensor faults, and residual for detecting DC-link voltage sensor faults sensitivity low to catenary current sensor faults. Thus, both residuals are decoupled.In order to avoid any false detection, as observer based residual sensitivity depends on observer gains selection, a procedure is proposed to implement the integral diagnosis strategy for FDI in current and voltage sensors.The estimation of fault severity is not deeply described in this article. In case of current and voltage sensors faults, a previous fault injection and analysis, for developing an enhanced Failure mode and effects analysis (FMEA) is needed . This anSeveral FDI approaches were presented for DC-link sensors. In , a compaTaking into account the solutions presented in the literature and their advantages and drawbacks, a FDI approach that is independent of motor parameters and based on the input filter of the traction unit was proposed.Similar to previous publications , the modBefore designing the observers, the observability and controllability of the system, given by (1) was checked. The controllability for a linear system is given if Expression (2) was fulfilled, The next step was to check the observability of the system, given if Expression (3) is fulfilled. The rank is 2, so it can conclude that the system is fully observable.Based on , the detThus, from the results presented in In the following subsection, a FDI approach based on a bank of observers for proposed , providiIn order to isolate DC-Link voltage sensor faults from catenary current sensor faults, a bank of two Luenberger observers was proposed. Observers are based on the model of input filter system in (1), and in consequence, the strategy is independent from the motor model. The input filter model is simpler than the motor model and it has fewer uncertainties and parameters, so the observer implementation was easier and it had less computational requirements.A different feedback strategy for each observer is used depending on the fault that is being detected. If the detection is focused on DC-Link sensor faults, the observer equations for DC-link voltage are given in (4), for In The system dynamic is given by the poles obtained solving the equation presented in (5). Normally the closed loop poles are fixed to be between three and six times faster than the open loop poles . Higher The traction system and the sensor faults injection blocks have been modelled in Matlab-Simulink. Based on the most common sensor fault modes  and infoThe real Once, the fault is detected, the isolability of the sensor is analysed. It has to be taken into account that a faulty DC-Link voltage sensor is not the only one that can change the value of In case of an offset fault injection in sensor The only shortcoming of this approach occurs when a Based on the residual obtained during fault injection in steady state, and the likelihood ratio calculation, it is possible to estimate the fault severity. Thus, in Similar to the DC-link voltage sensor, a second Luenberger observer can be proposed for The observer model is presented in Although, a transient in With regard to phase current sensor FDI in electric drives, in  a bank oOn the other hand, in  a FDI apFinally, in ,41 a comBased on the actual traction drive configuration, where only two phase current sensor are available and there is not any phase voltage sensor, the approach selected in this work was the analysis of the oscillations in the current components The residual generation process is divided into three different steps, as it is shown in his task . The filb, parameters to calculate in function of bandpass and sample frequency. Finally, the oscillation envelope is obtained in step 3.The second step is based on two passband filters , centereanalysis , it is kThe residuals generated for different motor phase current sensor fault modes injection are shown next, being the references for torque and speed 600 Nm and 600 rpm, respectively. In The fault severity estimation should be done as it was explained in previous sections, using information obtained from FMEA analysis and statistical tools.Analytical redundancy for speed sensor diagnosis, based on observers, has been previously used in railway applications , but norThe FDI structure is shown in Depending on the combination of indicators, the faulty sensor is isolated. A relevant The HIL platform used for validation is composed of a Real Time Simulator, from OPAL-RT Company, and a commercial Traction Control Unit, develop by CAF Power & Automation, for a Railway application, as it is shown in The TCU is externally connected to the Real Time Simulator through analog and digital ports. Conditioning modules to adapt the inputs and outputs between TCU and Real Time Simulator are needed. This platform allows injecting faults, easily and quickly, in order to test the different FDI approaches.The simulation step for model running in the Real Time Simulator is 15 µs. The TCU has a DSP for high speed execution. The sensor measurements are captured and monitored every 120 µs for validation purposes.The Hardware-in-the-loop simulation results for DC-link voltage and catenary current sensors are shown in If the diagnostic observer dynamic is fast enough, only transients are appreciated in the residual The FDI approach was implemented in the TCU and validated in the HIL platform. The following results are obtained for a torque reference of 600 Nm and motor speed of 600 rpm. The average value of the envelope depends on the operating point, so for a severity estimation of the fault, a previous relation between the envelope average value and the fault injected for different operating points should be obtained in HIL simulation. Thus, an adaptive threshold based on In In The sensibility of the FDI approach is better for low speeds, being higher in In In this article, different FDI approaches have been presented to build an Integral Sensor Fault Detection and Isolation for a Railway traction drive. Furthermore, a proposal for the fault severity estimation has been presented too. An observer based FDI approach has been used for DC-link voltage and catenary current sensors, a signal analysis based FDI approach for phase current sensors and a hardware redundancy based FDI for speed sensors. Each approach has been justified as the most suitable one for the traction drive presented. The FDI approach selection has been done based on the following factors: algorithm complexity, hardware and software resources available in the traction drive, tuning difficulty due to parameter variation/uncertainties and reliability. The observer-based FDI for DC-link voltage and catenary current sensor uses the input filter model instead of the motor model. As input filter model is simpler, the influence of parameter variations and uncertainties is lower. Furthermore, a Luenberger observer is proposed, due to lower algorithm complexity in comparison to other solutions. The signal analysis based FDI for phase current sensors need low computational resources, as some algorithms are already available in the control strategy. Furthermore, as it is not based on a motor model, motor parameter estimation during operation is not needed. Finally, a redundant hardware based FDI is proposed for speed sensor faults, due to reliability and low computational cost.Furthermore, the approaches developed in Matlab-Simulink have been simulated and implemented in a HIL platform with a real Railway TCU, designed for a tram. FDI approaches have been implemented in the DSP of the TCU, being the execution period 20 µs.The presented fault severity calculation was not implemented in real time, in order to reduce the computational requirements for the DSP. The Integral Sensor Fault Detection and Isolation presented, allows detecting and isolating faults in all the sensors presented in the traction drive.The FDI for the DC-link voltage and catenary current sensors is based on the input filter model of the traction drive, and it is not dependent on the motor model. The uncertainties and variability of parameters in the input filter are lower than in the motor model, which makes this solution easier to implement in a real application. Moreover, this FDI approach is not influenced by the operating point of the motor. The balance between the robustness and the sensitivity of the strategy is given by the observer feedback gain. Higher gains allow setting lower thresholds to increase the detection sensitivity, but this implies a lower robustness due to false alarms caused by measurement noises or other sensor faults. This work has set as a threshold of 20 A for current residual and 20 V for voltage residual, based on fault free behavior, so lower values should not be considered as a degraded zone. This FDI approach in combination with hardware redundancy, allows detecting and isolating faults in catenary current, crowbar current, return current, DC-link voltage and catenary voltage sensors. The fault severity estimation is calculated offline, based on previously obtained relations between the injected faults and generated residuals. Then a likelihood ratio is calculated with the residual values obtained in real time to estimate the most probable fault severity.The FDI strategy for phase current sensors is able to detect two fault modes, offset and gain. Its main limitation is that, it is not possible to isolate between the two available phase current sensors, so both should to be checked to isolate the faulty sensor. Phase current sensors faults generate an oscillation which depends on the operating point, so in case of fixed threshold, the sensitivity for the same threshold is different depending on the operating point. An adaptive threshold to maintain the same sensibility is recommended, based on current components, estimated torque and motor speed. Residual envelope and fault relation is obtained by fault injection. The oscillation extraction is subject to motor electrical frequency estimation and bandwidth around it. The extraction filter should be redesign in case of a change in the execution period.The FDI algorithm for speed sensors is the least demanding solution in terms of computational cost for traction drives where more than one speed measurement is available.The main contribution of this work is the definition of an Integral Sensor Fault Detection and Isolation for a Railway traction drive, in opposite to most of the research works, which focus on only one or two kind of sensors. Moreover, it has been validated in a real Railway traction control unit, whereas the previous works have been validated in test benches without commercial control units, in rapid control prototyping devices.Further research should be done with regard to fault severity estimation and fault reconstruction, in combination with information coming from other available tools in industry as FMEA. Fault injection and performance analysis under faults can provide information for an enhanced FMEA. This enhanced FMEA combines with FDI approaches, can provide reliable fault severity estimation. Furthermore, an adaptive threshold automation should be developed to optimize the sensibility of the detection and robustness for the different operating points of the motor.This article has presented an Integral Sensor Fault Detection and Isolation for a Railway traction drive. The research aim was to implement an early fault detection in sensors, which allows improving the availability of traction drives. Taking into account that the strategy has to be executed by an embedded commercial traction control unit, low computational cost FDI approaches have been selected, due to commercial traction control unit limitations. Moreover, the use of easy to tune FDI algorithms for each application is a key point to obtain a successful industrial acceptance. The FDI approaches presented here, as well as the proposed Integral Sensor Fault Detection and Isolation, can be adapted to electric drives in other applications.


An academic physician is faced with the unique challenge of balancing clinical practice with demanding education and research obligations. These competing tasks often result in a lack of time dedicated to research, which can result in incomplete and unpublished projects. One study found that abstracts presented at emergency medicine conferences were subsequently published only 23%–47% of the time.6The objective of this innovation is to describe a novel approach to assist with scholarly productivity by intentionally incorporating a graduate student research assistant (GSRA) into a research team to help with manuscript preparation.The Medical Education Research Group (MERG) at the University of Michigan, the structure of which has been described elsewhere, created the position of a GSRA as part of its research team in 2013.A master’s student from the University of Michigan’s School of Public Health was hired as a GSRA, and was paid $15 per hour for approximately 10 hours per week. Half of this funding came from the federal Work-Study Program and half of it through departmental funding. The GSRA was supervised by the leader of MERG, who spent about two hours per month on this task. Steps of integrating the GSRA were as follows: First, the GSRA provided input into data analysis, interpretation, and determining the scope of the project. Second, the GSRA conducted a literature review and began working on writing the introduction with the first author. Meanwhile, another member of the team produced a draft of the methods and results sections. Third, the research team as a whole discussed ideas for how to frame the paper, which relevant background topics to include, and what conclusions should be drawn. Fourth, the GSRA organized these ideas, fit them into the framework of the existing literature on the topic, and completed a draft of the introduction, discussion, and conclusion sections for a paper. Finally, these sections were disseminated to the entire team, who actively revised them. All of the GSRA’s projects involved preexisting data or data that were being collected. Because of this, the GSRA had a rapid turnaround of projects and completed about one per month. Since the GSRA made significant contributions during each of these steps, from clarification of the research question to background data interpretation to initial writing and final revision, the GSRA met authorship requirements for each project.7–12 The GSRA also provided minor assistance on an additional project that has not been published. Therefore, at a cost of <2,000 dollars, the GSRA helped publish five papers. Precise measures of increased productivity remain unknown; however, MERG members reported reduced time to paper submission.The addition of a GSRA was associated with more rapid project completion and paper submission. During the first academic year, seven papers were completed with the GSRA. Five of them have since been published, one was published as an abstract and is being edited for resubmission, and one is unpublished and is being edited for resubmission.8A key to the success of MERG has been maintaining a high degree of structure with well-defined roles, regular meetings, and committed leadership. We found that a GSRA was a cost-effective and productive addition to our team. A GSRA is likely not appropriate for some research groups though. This model may not increase productivity when limiting factors beyond time constraints exist, such as a lesser robustness of data, lack of research mentorship, or motivation on the part of faculty. In addition, many groups may find it difficult to recruit graduate students with interests in both writing and medical education. Finally, our results are not generalizable beyond structured research teams, as it remains unknown what effect a GSRA could have when used with individual physicians. In teams such as MERG, however, our experiences show that a GSRA could provide valuable writing assistance and lead to more efficient research output.


Speeding and passing are considered to be the main human factors resulting in road traffic injuries (RTIs). This study aimed to estimate the population attributeable fraction (PAF) of speeding and passing in RTIs in rural Iran during 2012.The contribution of speeding and passing to RTI-related morbidity and mortality was estimated using the PAF method. The prevalence of speeding and passing was obtained from the national traffic police data registry. A logistic regression model was used to measure the association between the above risk factors and RTIs.Speeding accounted for 20.96% and 16.61% of rural road-related deaths and injuries, respectively. The corresponding values for passing were 13.50% and 13.44%, respectively. Jointly, the PAF of these factors was 31.63% for road-related deaths and 27.81% for injuries.This study illustrates the importance of controlling speeding and passing as a high-priority aspect of public-health approaches to RTIs in Iran. It is recommended that laws restricting speeding and passing be enforced more strictly. Road traffic injuries (RTIs) are an important public health problem worldwide . In low Human-associated risk factors make the greatest contribution to the incidence of RTIs. Of the causes of RTIs, human elements are more complex than environmental elements . Among tThe population attributable fraction (PAF) is a useful index for estimating the epidemiological burden of a cause of disease. It provides an estimate of how much of the disease burden of a population would be eliminated if the effects of certain causal factors were eliminated from the population . This inThe high incidence of RTIs is a serious problem in Iran, and two of the main contributing factors are speeding and passing. If these factors were eliminated, a considerable reduction in adverse effects and negative consequences would be achieved. This study aims to estimate the PAF of speeding and passing on rural roads and to present a guide for policymakers and health planners regarding plans for interventions.In this study, all crashes occurring on rural roads in 2012 were investigated using the census method. Special attention was given to RTIs involving at least one motor vehicle with more than two wheels. Overall, 70,963 traffic crashes that occurred on rural roads in Iran were analyzed. Frequencies, percentages, and the chi-square test were used to analyze the epidemiological characteristics of the RTIs.We used the comparative risk assessment (CRA) methodology to estimate the PAF of the two modified risk factors of RTIs that we investigated. The CRA methodology can be defined as the evaluation of the changes in population health that occur as the result of modifying the population distribution of exposure to a risk factor . For theIn order to calculate the prevalence of speeding and passing to be used in the PAF calculation, the data registry of the national police forces was used to obtain and study form CAM 114. This is a form that police officers use at the scene of RTIs to record information related to the events as well as the reason for their occurrence in the following five major sections: information related to the conditions in which the crash occurred, characteristics of the involved vehicle(s), road conditions, characteristics of the driver, and the applicable traffic laws. These forms are used in fatal crashes, crashes in which injuries take place, and property-damage crashes on both urban and rural roads.In this study, rural crashes were considered and urban crashes were excluded. The prevalence of speeding and passing was obtained separately for fatal crashes and crashes resulting in injuries. The total population was used after subtracting the number of drivers for whom no information had been recorded regarding speeding and passing.In this study, the effect sizes for speeding and passing were obtained using odds ratios (ORs). Statistical analysis was performed using SPSS version 20.0 , and the effect sizes were obtained through logistic regression analysis. The effect size was calculated separately for deaths and injuries. For each factor, the 95% confidence intervals associated with the ORs were estimated. In order to control for confounding effects, variables regarding human factors, road defects, characteristics of the road surface, safety belt use, age, sex, education level, and occupation were adjusted for in the logistic regression model. ORs were calculated from data incorporating all registered crashes that took place on rural roads in Iran during the study period, such that the data were representative of all crashes in the country.P is the prevalence of risk factors and OR refers to the effect sizes of the risk factors. Risk factor-attributable deaths were estimated using In order to calculate the PAF, the information related to the prevalence of risk factors and their effect size obtained using the above methods was entered into The total number of deaths and injuries was obtained through police records.The general characteristics of the population studied are presented in The odds of death in accidents involving speeding group was 3.32 compared to accidents in which speeding was not involved. Additionally, the odds of injuries in accidents involving speeding was 2.60 compared to accidents in which speeding was not involved. Similar results were found for passing. The PAF for speeding leading to death at the scene of the crash was 20.96 and the corresponding value was 16.61 for injuries. For passing, these values were estimated to be 13.50 and 13.44, respectively. The PAF of these two risk factors considered jointly was 31.63 for deaths and 27.81 for injuries. This indicates that 574 deaths and 3,495 injuries would be preventable if the speeding prevalence were to fall to zero, while 370 deaths and 2,822 injuries would be preventable if passing were eliminated. The elimination of both of these risk factors would lead to the prevention of 867 deaths and 5,854 injuries.The PAF values for the upper and the lower limits of prevalence, the estimated ORs for each of the risk factors alone, and the joint effect of both risk factors are presented in Our findings demonstrated that drivers who engaged in speeding and passing had a higher risk of death or injury. According to our results, if we could reduce the prevalence of speeding to zero, 20.96% of deaths occurring at the crash scene and 16.61% of injuries would be preventable. The corresponding values for passing are 13.50% and 13.44%. If both risk factors were eliminated completely, 31.63% of deaths occurring at the crash scene and 27.81% of injuries would be prevented.The relationship between speeding and RTIs has been well established. Numerous studies have examined the relationship between speeding and crash risk. In these studies, it has been shown that high-speed vehicles are at a much higher risk of crash than low-speed vehicles . AdditioThis study showed that speeding is one of the most important risk factors contributing to RTIs in Iran, and that by reducing it to zero and eliminating this risk factor we could prevent many traffic deaths and injuries. Although the relationship between speeding and traffic crashes is very complicated, speed is a clear contributing factor to the severity of a crash. At high speed, it is more probable for the driver to lose control of the vehicle, and the resultant possibility of overcorrection in combination with an impaired reaction time leads to an increased probability of crashing, injury, and death .Passing, which is the result of a sensitive judgment made by the driver, is an important risk factor. One study reported that 10% of deaths occurred as a result of, passing . This faThis study showed that passing was just as important as speeding as a risk factor, and that reducing passing to the lowest possible level will considerably increase road safety and prevent a large number of deaths and injuries.A strength of this study is that it derived the current distribution of risk factors from a national source, namely the national traffic police data registry, using valid and reliable tools. However, police data are the only available source for such data that can be used in Iran. These data only include deaths that occurred at the crash scene, not deaths that may have occurred later as a result of RTIs. Therefore, we believe that the possibility of having underestimated the ORs could be considered a limitation of our study.Additionally, a possible limitation of this study results from the fact that form CAM 114 is completed at the scene of crashes, meaning that death or emotional distress on the part of the driver could result in the omission of some data.The PAF can be a helpful tool for showing the preventable fraction of deaths associated with a risk factor, if it were to be eliminated. However, this method involves some limitations; for diseases or injuries with multiple risk factors, the PAF may be overestimated because multiple ways may exist to prevent diseases with more than one risk factor.Speeding and passing are dangerous behaviors with a high prevalence in Iran. Speeding was found to be more prevalent and to play a larger role in traffic accidents causing injury or death than passing. The PAFs for these two factors suggest that controlling speeding should take priority over passing, so it is recommended that related legislation should be considered more seriously and enforced more rigorously. Lastly, it is noteworthy that considering the joint effect of these risk factors considerably increases the PAF.


Information and communication technologies (ICTs) have enabled the evolution of traditional electric power distribution networks towards a new paradigm referred to as the smart grid. However, the different elements that compose the ICT plane of a smart grid are usually conceived as isolated systems that typically result in rigid hardware architectures, which are hard to interoperate, manage and adapt to new situations. In the recent years, software-defined systems that take advantage of software and high-speed data network infrastructures have emerged as a promising alternative to classic ad hoc approaches in terms of integration, automation, real-time reconfiguration and resource reusability. The purpose of this paper is to propose the usage of software-defined utilities (SDUs) to address the latent deployment and management limitations of smart grids. More specifically, the implementation of a smart grid’s data storage and management system prototype by means of SDUs is introduced, which exhibits the feasibility of this alternative approach. This system features a hybrid cloud architecture able to meet the data storage requirements of electric utilities and adapt itself to their ever-evolving needs. Conducted experimentations endorse the feasibility of this solution and encourage practitioners to point their efforts in this direction. Contrary to the fast evolution experienced in the last decade by ICTs, electric power distribution systems have remained exceptionally steady for a long time. Therefore, the advent of the smart grid concept, that is the addition of a telecommunication infrastructure to the electrical domain, has enabled a plethora of new services and opportunities , which is actually driving a significant revolution in the energy sector ,2. In faDue to the complexity  and magnitude  inherent to smart grids, practitioners have recently addressed the digital transformation of power electric networks following a “divide and conquer” approach . That isIndeed, the smart grid has brought to the energy domain a new set of actors  that require a continuous upgrading on the features, timings and functionalities offered by the grid to meet market demands, which is a situation never seen before in traditional power electric networks . TherefoIn this regard, novel software-based architectures recently coined as software-defined networks/anything (SDN/SDxs) ,11 combiIn SDN/SDxs-based architectures, the data plane and the network control plane are natively decoupled , which eOverall, the advantages of using software-defined architectures in the context of Smart Grids are found in the following. First and foremost, most of the services and smart functions  that areHence, the benefits of software-defined systems could finally transform smart grids into real (and reliable) autonomous systems able to properly react to any adverse situation in a scalable and software maintainable fashion. The purpose of this work is to propose the usage of SDN/SDxs-based architectures, and hence SDUs, in smart grids to enable an adaptive operation and seamless deployment of electric power infrastructure services. More concretely, it presents the implementation of a SDU-based smart grid’s data storage and management system prototype developed according to the on-field experiences and knowledge collected during the development of the FINESCE (Future INtErnet Smart Utility ServiCEs) and INTEGRIS  FP7 European projects ,9. As smA review of the state-of-the-art on the existing software-defined strategies to meet the requirements of smart grids.A proposal of a cloud-inspired smart grid’s data storage module designed by means of SDN/SDx and service composition suitable for real-time electric functions.The contributions of this work are the following:The remainder of this paper is organized as follows. The digital transformation of the electrical distribution grid is an increasing need by DSOs and a subject under an intense research study in several fields, ranging from communication and network protocols to cloud computing architectures . As SDN/As far as the communication and network protocols field is concerned, the smart grid has an inherent heterogeneous nature which forces system architects to consider different telecommunication technologies  such as Unfortunately, these promising technologies are still far from being implemented in the SDN context. Latest attempts on using IEC61850 and SDNs in smart grids have aimed to meet the increasing security risks and threats that the digitalization of the electrical grid encompasses . Indeed,Indeed, one of the major architectural changes of smart grids is the inclusion of renewable energy systems, also referred to as distributed energy resources (DERs), as an active part of the electric network. Hence, classic centralized schemes used to manage  generation resources in traditional electric networks are not suitable for smart grids due to their inherent distributed nature. Therefore, novel communication standards , together with the new communication features brought by ethernet have emerged as a promising alternative to evolve the management and protection policies in modern electric networks. Also, the inclusion of the DER paradigm in the smart grid has some implications on the protection of the electric network at the distribution layer. Specifically, advanced relaying techniques used to protect High Voltage networks in traditional electric grids need to be used in distribution networks as well in the context of the smart grid. As shown in The extension of the concept of smart grids to distribution networks faces the problem related to the difficulty of designing an ICT infrastructure that covers the whole power distribution network with the required high reliability and low delay.Hence, the aforementioned protection relays that have been used in old high voltage electric networks and their functionalities are now needed at the distribution level of the smart grid, have evolved to what has been coined as intelligent electronic devices (IEDs). These systems are designed to control relays, record faults, report faults, measure the grid, and protect the network in a fast and efficient way. Such efficiency is achieved by the distributed nature of DER and its associated IEDs, which is a great improvement over the traditional centralized schemes found in classic electric networks.Indeed, the protection, control, and operation of the DERs can be best seen and addressed as a set of software services—thus enabling practitioners to improve the automation of the smart grid management while diminishing the operational costs—that need to be deployed in a large-scale and heterogeneous distributed system  . As a fiThe adoption of the cloud-computing paradigm in organizations and enterprises has become a reality during the last decade. Certainly, the advent of hybrid clouds that combines the benefits of public and private clouds has contributed to the consolidation of this approach . This neAs far as cloud computing architectures for the smart grid are concerned, it has been shown  that theFollowing the idea of decomposing large-scale systems into small software components easy to interoperate, in  authors Overall, after reviewing all of these architecture proposals, there is an increasing need on building and deploying a software-defined system able to incorporate all the aforesaid individual advances  in a real-world smart grid. The following section details the architecture of the software-defined utility used in the FINESCE European project , which iOne of the objectives in this paper is to propose a hybrid approach to handle real time data collected from the smart grid domain at the distribution level . This system will store data from historic logs at the private side of the hybrid cloud and use the public source to outsource bursts and answer low-priority queries. This proposal will be tested in a real-world environment composed by data centers placed in both public and private clouds. As it will be shown, data will be replicated to different sites (belonging to public and private clouds) to boost the system availability, minimize the overall latency, and meet the cyber-security restrictions posed by smart grid experts.The complexity of this proposal relies on the fact that distributing smart grid services among a distributed architecture composed by a public and a private cloud, keeping the specified quality of service (QoS)  is far fContext-aware security. This module is aimed to individually provide the needed security level for the proper operation of every smart function. Cybersecurity policies are served on demand by means of service composition and continuously revised by the module itself. For instance, for the use case of smart metering, this module can update all the encryption keys of the smart grid once an unauthorized access to the metering infrastructure has been detected.Hybrid cloud data management: This module provides a data storage and processing system that intrinsically adapts to the smart grid’s topology in a scalable and flexible way. Specifically, it implements a software-defined version of ,37, resuWeb of energy: This module provides a ubiquitous  monitoring interface  that enaThe aim of the SDU is to enable the digital transformation of the smart grid towards an intelligent and programmable grid. As with other software-defined architectures ,35, our However, despite the benefits associated to the service composition paradigm, implementing these three logical modules in existing intelligent electronic devices (IEDs) that currently populate the smart grid becomes unfeasible. Nowadays, deployed IEDs that mostly implement the ICT side of the smart grid are closed devices that, once approved for operation, certified, and installed are difficult to upgrade with new advancements  as experimental devices do . Hence, Overall, a FIDEV can be best seen as a single, yet distributable and interconnected element that belongs to a fog computing architecture that, thanks to the three aforementioned modules, is able to solve existing and future real time smart functions  by offerThis section presents the implementation of a distributed data storage system aimed to store, process, and serve the required data for smart functions in the smart grid by means of the proposed FIDEVs and their SDU paradigm.The main goals of the proposed data management subsystem are: (1) ensure high-availability and reliability on stored data, (2) minimize the delay between user requests and data delivery at any point , (3) provide the smart grid with a cyber-secure strategy to share its data with external players and (4) enable service applications and data to be flexibly and smoothly moved over the smart grid to take advantage of the available resources in both public and private clouds. In fact, promoting (or replicating) information and data from local sites to the public cloud will, additionally, contribute to increase their availability and reliability, reduce the response time , and help to change the data privacy degree , including local resources running out of capacity . Hence, to enable the gradual incorporation of cloud resources to the Distribution System Operator (DSO) infrastructure an epidemic data replication protocol inspired by the fog computing paradigm has been implemented.This epidemic replication protocol see  37] is  is 37] iHence, smartly defining the replication layers the smart grid manager can select the most appropriate place to store every datum: either locally at the facilities owned by the utility company or by means of alien public cloud providers . Indeed, coming up with the optimal configuration of resources topology in a hybrid cloud storage infrastructure may result in great savings . HoweverTherefore, the current version of the HCDM includes an orchestrator that implements a set of rules that cover basic parameters such as privacy, throughput, distance to client, and smart function data requirements to move data between clouds. Considering the large number of situations and possible combinations for these HCDM status parameters, the data migration and placement rules are built as follows.First, the system is exposed to different real-world situations for long periods of time . These example scenarios are proposed by industry experts and are aimed to model distinct and representative events . Meanwhile, system parameters and statistics are accurately measured and stored every 10 s. Next, a decision tree is built from all collected data using a standard C5.0 classifier. Next, a set of human-readable production rules is derived from the decision tree as done in . FinallyAs shown in After detailing the internals of the HCDM module, a real-world trial scenario has been set up to experimentally evaluate the benefits of this proposal. In this regard, we have used the facilities provided by the FINESCE European project  that conThe aim of this scenario is to share electric data between the clients attached to both locations and publish them to clients connected to the public cloud. Hence, we have deployed the aforementioned HCDM system to maintain data generated by ESB (the Electricity Supply Board is a public electricity company from the Republic of Ireland) replicated both locally and in the hybrid cloud .The proposed experiment aims to test whether the proposed system can keep the QoS (delay and latency) for the smart grid data under three different situations. In this regard, three different replication regions have been defined: Ireland, Barcelona, and Public Cloud. We have considered that the QoS will be maintained as long as the overall performance of all nodes is under 100%. The proposed experiment aims to evaluate the overall data access latency under different situations.System idle .Medium load (50% data read operations and 50% data update operations)Update intensive load (20% data read operations and 80% data update operations) andRead intensive load (80% data read operations and 20% data update operations).On the one hand, four different load patterns have been defined in order to evaluate time restrictions:On the other hand, the data encryption service from the Context-aware security subsystem has been remotely installed and uninstalled—by means of an OSGI service framework—several times during the trial to assess its effects on the data access latency. When this security service is enabled, all data written/read to disk is encrypted/decrypted using AES and a 256-bit key. Additionally, the HCDM module has been configured with three different replication regions have been defined: Ireland, Barcelona, and Public Cloud.In the first scenario I in , it has In the second scenario II in , we haveIn the third scenario III in , we haveFinally, in the fourth scenario IV in , we haveAlthough the physical architecture of the FIDEVs remains stable , the system has logically adapted its epidemic replication chain according to the incoming load . SpecifiTo sum up, the latency ranges from 33 ms to 241 ms once the system is stabilized depending on the load pattern, the replication scheme, and security policy status. The cyber security service installation and uninstallation time ranges from 18 to 61 s and has a strong dependency on the network congestion and load at each node. Finally, the HCDM replication reconfiguration scheme time ranges from 28 s to 151 s. Recall that moving from “RW” to “R” is cheaper than moving from “R” to “RW” due to the replica synchronization overhead. However, these few minutes are tolerable when compared to the cost of manually updating the IEDs of a whole country (which would take few days). Actually, these numbers are in the same order of magnitude of other related presenting the application of SDN to control smart grid communications  and exhiOverall, this experiment exhibits the advantages of the proposed epidemic data replication protocol and shows the ability of the system on adapting to incoming loads. The development and deployment times of this software-defined architecture have been considerably smaller  than the ones obtained in similar projects ,37.This work presents the evolution and redesign of the distributed storage architecture to address the challenges arisen at the distribution level of modern smart grids. An initial version of the proposed epidemic replication protocol was successfully deployed in the scope of INTEGRIS, but its complexity, high number of dependencies, and long development times have driven practitioners to evolve to what has been presented in this paper by means of service composition and software-defined architectures in the context of the FINESCE project. In addition to the operational advantages of using the service composition paradigm, this new version of the data management system addresses the access control to stored resources, natively manages passwords and encryption keys, and is fully integrated to a real cloud computing infrastructure.The proposed HCDM system is built inside a SDU that is composed by three artifacts: concept . For the implementation of the data management system, services borrowed from the Web of Energy enable users to access the data storage system, services borrowed from the context-aware security guarantee that cybersecurity policies are being respected, and services borrowed from the HCDM ensure that data are properly stored. This module decoupling is inspired by existing proposals on using software-defined architectures for the smart grid. To the best of our knowledge, this is the first real-world implementation of an operating software-defined system that addresses the data requirements of the smart grid by taking advantage of the hybrid cloud-computing paradigm.Overall, the proposed SDU-based data management module addresses the smart grid data requirements by (1) providing high-availability and reliability on data through an epidemic replication protocol, (2) minimizing latency by proactively replicating data where it will be needed, (3) injecting cyber security services to provide different degrees of privacy and access and (4) moving services and applications on demand. Moreover, to speed up the transference of new services and applications , smart grid administrators can take advantage of the epidemic nature of the proposed HCDM system and split the service to be transferred into small pieces and let the replication protocol to populate all the system in parallel. Indeed, computing intensive smart functions might also take advantage of this replication strategy and natively conduct computations following the map/reduce approach .Nonetheless we have found that the proposed hybrid cloud-based approach requires considerable effort to obtain the optimal data replication topology—specially in large scale systems—due to the diverse data contexts and cybersecurity constraints associated to the smart functions. An inappropriate replication configuration usually derives in an overusage of a set of FIDEVs or leaving some FIDEVs underused. Therefore, defining and deploying a system able to predict the system status and automatically define a set of configuration rules is planned as the future directions of the authors.Furthermore, future work directions shall include a revision of the standardization and performance analysis of existing protocols to communicate services in a software-defined system, implementation of other smart grid modules by means of service composition, and an enhancement of the primitive data orchestrator proposed in this work.


The Specialized Dental Clinics (SDCs) represent the first government initiative in Latin America aimed at providing specialized oral health services. This study sought to evaluate the organizational accessibility to specialized oral health care services in Brazil and to understand the factors that may be associated with accessibility from the user’s perspective. This epidemiological, cross-sectional and quantitative study was conducted by means of interviews with individuals who sought specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, and consisted of a sample of 590 individuals. Users expressed a favorable view of the classification and resolutive nature of specialized services offered by Brazilian public health. The binary logistic regression analysis revealed weak points highlighting the difficulty involved in obtaining such treatments leading to unfavorable evaluations. In the resolutive nature item, difficulty in accessing the location, queues and lack of materials and equipment were highlighted as statistically significant unfavorable aspects. While many of the users considered the service to be resolutive, weaknesses were mentioned that need to be detected to promote improvements and to prevent other health models adopted worldwide from reproducing the same flaws. The study of the current organization and delivery of health services in Latin America involves an understanding of political and social contexts, which are strongly influenced by historical factors, marked by the state’s absence in the formulation of public health policies geared toward the interests of the majority. The re-democratization process of the continent’s main countries seeks to overcome social inequalities, such as problems involving agrarian issues, indigenous people, high population densities in major cities and the precariousness of respect for human rights. These aspects are closely related to the concept of health and are translated into health planning and practices. Understanding health services in this context represents an interdisciplinary field of study of great international importance .In Brazil, the 1980s marked the resumption of the democratic process, which was accompanied, at the beginning of the 1990s, by the institutionalization of public health services in the country, characterized mainly by a universal, comprehensive and equitable nature. Oral health services go hand in hand with this process and therefore face the challenge of implementing actions that can respond to the demands of society, characterized by precariousness, high prevalence of oral disease and lack of access to health services ,3. In 2004, the Brazilian government adopted the National Oral Health Policy , which aims to reorganize primary health care services, with targeted treatment for families based on epidemiological indicators . The SDCThis time of change means that the evaluation of health services, especially those of a public nature, should be a paramount, recommended and routine practice , both inWith regard to access to oral health services, it is known that socioeconomic status ,13, liviThis epidemiological, cross-sectional, quantitative study sought to better understand factors relating to the access to specialized public oral health services in the city of João Pessoa, Paraíba, Brazil, which is located in the northeast of the country and has unfavorable social indicators, with a Human Development Index (HDI) of 0.763.Between August 2012 and December 2013, adults seeking any of four specialized public service dental practices were interviewed during the morning, afternoon or night shift, thereby diversifying the user profile and ensuring populational representativeness. The sample, defined according to statistical criteria, considered the prevalence estimate of the investigated event, coupled with a relative margin of error of 3%, a confidence level of 95% and a 20% non-response rate. Thus, considering that the variable analyzed in this study—difficulty in obtaining dental care in specialized services—has an estimated prevalence of 13% in Northeast Brazilian adults , a samplData were collected using a structured questionnaire that addressed aspects relating to socioeconomic status, access to services, difficulties with regard to consultations and examinations and type of requested specialization. The researchers took part in technical training to establish standards for analysis and application of the questionnaire. To that end, a pilot study was conducted with 30 subjects who were not included in the final sample.The dependent variables in the study were grouped into two categories: classification of oral health services offered by the SDC (both favorable and unfavorable) and the resolutive nature of oral health services offered by the SDC (both favorable and unfavorable). The data collected were entered and processed using Statistical Package for the Social Sciences 22.0 software  and were subjected to descriptive and inferential statistical analyses. The independent variables were dichotomized for bivariate analysis (Fisher’s exact test), followed by binary logistic regression to determine the factors with the greatest effect on access to specialized oral health services, considering α = 5%.The study was approved by the Research Ethics Committee of the Federal University of Paraíba with project identification code 69735 , ensuring the participant’s anonymity and privacy.Characterization of the sample revealed that most subjects were female, less than or equal to 44 years of age and had an educational level ranging from completed high school education to higher education. Most respondents were characterized as economically active and as belonging to the low or middle-low class. p < 0.001). Other aspects were also referenced by users, such as care disqualifiers , but these factors were not statistically significant based on the sample composition.Binary logistic regression analysis when the user’s perception was unfavorable in relation to the health service  revealedRegarding the resolutive nature of services provided in the specialized dental clinics, the majority were satisfied as to problems relating to oral health being resolved (positive classification), with no significant differences when considering dimensions such as gender, age and sociodemographic aspects .p = 0.032). Difficulty in accessing locations where SDCs were established also negatively affected users’ views (p = 0.049), as did the existence of queues (p = 0.008) and the absence of materials and equipment (p = 0.007).Although most respondents considered the resolutive nature of oral health problems in the SDCs as favorable, a binary logistic regression analysis of unfavorable perceptions of the service’s resolutive nature was performed . RegardiRecent studies have clearly emphasized the current gender difference with regard to seeking health care and accessibility to the same, with work being the main aspect explaining men’s greater absence or difficulty . It is wJudgment of the quality of service provided in the SDC revealed no significant differences when evaluated by respondents of different genders, education levels, ages and social classes. These dimensions did not have a significant effect on service classification, which was said to be favorable by most respondents. Scientific research evaluating specialized oral health services in Brazil is scarce. In a study on specialized dental clinics in the city of Recife, in the state of Pernambuco (PE), situated in the northeast of Brazil, service quality was analyzed, and respondents’ evaluations of the quality dimensions were largely positive, especially when related to human relations between the dentist and assistant, efficacy/discomfort after treatment, technical and scientific quality or technology of equipment and acceptability/explanation of treatment by the professional .When these positive results are compared to studies evaluating SDC services from other perspectives, differences become apparent. In an evaluation performed by  on the pSuch disagreement can be explained by the differences in the populations used to obtain the data. Studies focusing on people’s opinions have a subjective nature, as subjectivity is inherent to the different perceptions of each individual when evaluating whether something met his/her expectations, along with psychosocial factors and the effects of previous experiences as references. Using factor analysis , verifieIn developed countries such as the United States, the quality rate of urban oral health services evaluated by users exceeds 90%, although difficulties relating to access can be identified, especially among the uninsured, particularly for dentistry, oral surgery, and dental prosthesis services . HoweverThe mere existence or availability of a health service does not guarantee accessibility. It is necessary to subdivide this concept into geographical accessibility , affordability (possible payments or contributions for using the service should not constitute obstacles), cultural accessibility  and functional accessibility  .p < 0.001). With regard to the resolutive nature aspect of oral health problems, the existence of queues was statistically significant as a negative aspect (p = 0.008). These data are similar to those observed in other studies conducted in Brazil [n = 478) of users of these services belong to the lower or lower-middle class. In this respect, it is interesting to note the possible relationship with the good results presented, as despite the fact that an association between satisfaction and income has not been identified in the international literature, in Brazil, there seems to be an inverse correlation, with users from more popular social classes being more likely to report being satisfied with services [From the point of view of this broad concept of accessibility, it can be observed that users report difficulty in accessing specialized care in these centers. This factor is the most significant and critical aspect in the formation of the respondents’ negative opinions  data capture, which in turn gives managers indispensable decision-making material . AnotherHowever, it is essential that studies aimed at better understanding the work process in specialized dentistry care services are conducted to make it possible to understand the organizational structure, working relationships, planning, scheduling and impacts of actions on user health, considering locoregional differences, whether related to the municipality’s size, coverage area , and social and cultural characteristics.The vast majority of users had a favorable opinion of the service quality in the SDCs, and there were no associations between respondents’ perceptions and gender, age or socioeconomic status. While many users considered the service resolutive, weaknesses were mentioned relating to access, existence of queues and lack of materials, supplies or infrastructure.