The evidence-based literature on healthcare is currently expanding exponentially. The opportunities provided by the advancement in artificial intelligence (AI) tools such as machine learning are appealing in tackling many of the current healthcare challenges. Thus, AI integration is expanding in most fields of healthcare, including the field of hematology. This study aims to review the current applications of AI in the field of hematopoietic cell transplantation (HCT). A literature search was done involving the following databases: Ovid MEDLINE, including In-Process and other non-indexed citations, and Google Scholar. The abstracts of the following professional societies were also screened: American Society of Hematology, American Society for Blood and Marrow Transplantation, and European Society for Blood and Marrow Transplantation. The literature review showed that the integration of AI in the field of HCT has grown remarkably in the last decade and offers promising avenues in diagnosis and prognosis in HCT populations targeting both pre- and post-transplant challenges. Studies of AI integration in HCT have many limitations that include poorly tested algorithms, lack of generalizability, and limited use of different AI tools. Machine learning techniques in HCT are an intense area of research that needs much development and extensive support from hematology and HCT societies and organizations globally as we believe that this will be the future practice paradigm. About sixty years ago, a Dartmouth conference established the basis of artificial intelligence (AI). The name was coined for the use of technology in accomplishing tasks that usually need human intelligence. These tasks include, but are not limited to, interpreting language, making decisions, and applying visual perception ,2. Soon Integration of AI in medicine started about a decade after the Dartmouth conference . MYCIN wThe use of AI in medicine has led to a debate about how beneficial AI is in improving medical practice. Advocates of such integration list advantages such as increasing efficiency and helping medical practitioners to practice medicine in its real meaning. On the contrary, opponents of such integration cite different disadvantages that include concerns about the accuracy of these systems, the risk of having “deskilled” physicians, and fewer future jobs, especially in diagnostic medical fields such as radiology and pathology ,7. Despite the possible disadvantages and skepticism, the increasing complexity of medical practice and the opportunities provided by the advancements in AI make integration inevitable. Thus, growing numbers of projects have tried to integrate the tools that AI provides into different fields of medicine including hematology and oncology. Examples of integration are numerous. For instance, Watson for Oncology (WFO) is a project created by IBM Corporation that can cope with expanding evidence and learn from cases . The proThe field of hematopoietic cell transplantation (HCT) is expanding, with more than 60,000 procedures being performed annually worldwide . It is aThe literature review used Boolean logic with terms including “Machine learning”, “Deep learning”, “Neural networks”, and “Artificial intelligence” in combination with terms specific to the field of HCT such as “Bone marrow transplant”, “Hematopoietic cell transplant”, “Graft-versus-host disease”, etc. The search targeted the last 10 years due to the growth of the AI field in hematology, oncology, and HCT. The following databases were used: Ovid MEDLINE, including In-Process and Other Non-Indexed Citations, and Google Scholar. Abstracts presented at the annual meetings of the American Society of Hematology (ASH), American Society for Blood and Marrow Transplantation (ASBMT), and European Society for Blood and Marrow Transplantation (EBMT) were screened as well to avoid file-drawer bias. The terms used to screen the abstracts were “Artificial intelligence” and “Machine learning”.The number of abstracts of studies investigating the use of AI in the field of hematology has increased over the years. This literature search revealed many studies that investigated the use of AI tools in improving different aspects of HCT. These studies have targeted both pre- and post-transplant applications and are discussed below.Selection of donor and recipient pairs for HCT is a major challenge that could affect the prognosis of HCT recipients. An HLA-matched sibling can be found only in 30% of cases of HCT in the United States . Lee et More methods have been proposed to develop algorithms that can help in the selection of donor-recipient pairs. For instance, two abstracts ,20 propoDespite all the advances in HCT, recipients of HCT are at risk of many complications that might increase their mortality and morbidity, including GVHD ,22. ThusOne of the major projects in this field is AL-EBMT. In 2015, the EBMT developed the AL-EBMT predictive model to stratify AL patients according to their prognosis following allogeneic HCT . AL-EBMTStudies have also investigated the use of AI tools in predicting the outcomes of HCT. Li et al.  proposedIn addition to the use of AI approaches in diagnosis, Gandelman et al.  showed tPredicting the development of acute GVHD was investigated by Caocci et al.  in 78 thFurthermore, few studies have indicated the limitations remaining or the methods that will help us to reach optimal use of ML. For instance, Shouval et al.  investigThe complexity of the healthcare system and the amount of medical literature and evidence have increased tremendously in the last few decades and it is nearly impossible for a practicing physician to keep up with all published literature, even in a narrow field of practice. This is accompanied by the need for more documentation, especially with the emergence of electronic medical records and electronic health records (EHRs). These electronic records may influence the effectiveness of medical practitioners and can make it difficult for physicians to practice the real meaning of medicine ,33. On tAI approaches using different tools might be an opportunity to use big data to extrapolate and create beneficial algorithms that can be applied for other patients. Despite the many advantages that can be provided by integrating AI in medicine, many disadvantages may also occur. These include endangering some types of medical jobs, possible technical errors, and deskilling . Many of these disadvantages might be exaggerated as AI approaches are not alternatives but rather extensions of our currently used statistical tools . These nAI integration has been shown to be reliable, accurate, and promising in various instances. For instance, Weng et al.  used difMoreover, future research is expected to develop more tools that have more ability in detecting patterns in unstructured and unsupervised data. The concurrent development of tools for data collection that is more instant and real-time is important to increase the amount of big data. This is evident in the parallel advancements in the field of the Internet of Things, which will be able to advance our methods in collecting data via connecting the various tools we use in clinical practice  directly to our EHRs and databases . This wiIn this review, however, we demonstrate that the integration of AI in the field of HCT is still an area that needs much development. The published literature did not tackle many important aspects of HCT including survivorship, risk of infections, or pharmacogenomics. For instance, with the increasing number of HCTs done and improved management, it is expected that there will be half a million long-term HCT survivors by 2020 ,34. ThusWe have summarized many promising pre- and post-transplant studies of ML in HCT; however, these studies have many limitations. Most of these studies are still in a preliminary phase, a training set applied with a small sample size limits their power, and some of these studies have not confirmed their findings with a validation set. Other limitations include the need for technical studies that investigate the efficiency and accuracy of different AI methods and approaches. One of the concerns about using AI in the field of HCT and other medical fields is the generalizability of the systems. A system such as AL-EBMT  needs toAI integration in HCT is expanding and its role in daily activities of clinical practice is inevitable. It is time for our research and clinical community to step forward and incorporate ML usage with the existing models. Though this would be a cutting-edge advancement, AI’s integration should be cautious and must target improvements in patient care rather than a focus on technological improvements. It should be incorporated in practice, but it should not take us away from the sine qua non of medicine as an oral science and our roles as healers.Implementation of AI in HCT is still suboptimal. Future studies should try to involve more data for both training and validation sets. This necessitates more funding and support from different HCT and hematology societies globally as well as from government agencies. This support will allow AI tools to be of better quality and be generalizable.Integration of AI in medicine is inevitable. However, this integration should be cautious and well validated to improve patient care. Some concerns regarding AI use are valid and should be considered when using AI tools. The aim of AI should be to improve medical practice and healthcare.


Auditory deprivation associated with early otitis media with effusion has been considered a risk factor for central auditory processing (CAP), as well as for the development of a number of cognitive functions.To study the neuropsychological functions of attention, working memory and executive function in adolescents with and without non-cholesteatomatous chronic otitis media (NCCOM) and analyze their interrelationships with the behavioral evaluation of CAP.Sixty-eight adolescents were recruited, 34 were diagnosed with NCCOM (study group - SG), and 34 had no otological history (control group - CG). The Neupsilin Brief Neuropsychological Assessment Instrument was used. CAP was assessed by: Masking Level Difference, Synthetic Sentence Identification, Random Gap Detection Test, Duration Pattern Sequence Test and Dichotic Digits Test.The results of Neupsilin showed lower scores in the study group when compared to the control group on the following tests: digit sequence repetition, ascending digit ordering, auditory sentence span, and phonemic verbal fluency. An association was found between central auditory processing tests and Neupsilin subtests.The effects of NCCOM on attention, memory and executive function related to central auditory processing disorder in adolescents seem to be enhanced by the severity of the disease. Central auditory processing consists of a summation of specific skills necessary for the individual to understand what they hear.,-The literature indicates evidence of attention function impairment in individuals with a history of otitis media,,,-Thus, there is great interest in the interrelationships between auditory and cognitive abilities.The aim of this study was to investigate the neuropsychological functions of attention, working memory and executive function in adolescents with and without NCCOM and to analyze their interrelationships with the behavioral evaluation of central auditory processing and with the variables: gender, age, education repetition, age of onset of otitis media, unilaterality or bilaterality of auditory alteration, maternal education and family income.This study consisted of a controlled cross-sectional, observational study for which 68 adolescents aged 12 - 18 yearsFor the control group, the following inclusion criteria were applied: adolescents from public schools, with no history of otitis media, with normal audiological assessment and typical overall development. The study group consisted of adolescents from public schools with a diagnosis of unilateral or bilateral NCCOM and average of auditory thresholds  at the frequencies of 500, 1000, 2000 and 4000 Hz ≤ 40 dB HL in the affected ear(s).For both groups, the following exclusion criteria were considered: presence of mental, neurological disorders or genetic syndromes, being left-handed, having a history of formal music education and presenting with other risk factors for hearing loss. The information about these criteria was collected by analyzing the clinical records of each patient (study group) or through anamnesis with their parents (control group).The subjects who agreed to participate in the study underwent the following procedures: anamnesis; audiological assessment (pure tone audiometry and speech audiometry); central auditory processing behavioral evaluation battery; and neuropsychological assessment of attention, working memory and executive functions . All proposed assessments were performed by duly trained researchers experienced in performing the tests described.The test battery assessing auditory processing was composed of the following tests: MLD (Masking Level Difference), SSI (Synthetic Sentence Identification), RGDT (Random Gap Detection Test), DPS (Duration Pattern Sequence test) and DDT (Dichotic Digits Test), according to the recommendations of the Academia Brasileira de Audiologia,To analyze the results obtained on CAP tests among adolescents in the study group with unilateral and bilateral conductive alterations, this group was subdivided into two groups: unilateral air gap group  (UG) and bilateral gap group (BG). It should be noted that this differential was considered even in individuals who did not present auditory thresholds indicative of hearing loss, being characterized as a conductive component caused by NCCOM, which did not necessarily induce classification of hearing loss degree. The parameter used to characterize the presence of gap was a differential ≥15dB between the tonal thresholds obtained by airway and bone pathway at the frequencies of 500 to 4000 Hz.On the reverse counting test, the maximum score was 20 points, each point representing a correct answer. On the digit sequence repetition test, the maximum score was seven points. Thus, the total score for the attention tests was 27 points.On the ascending digit ordering task, the maximum score was ten points, while, for auditory sentence span, the maximum score was 28 points.On the phonemic verbal fluency test, the score was established by the number of items uttered during the time stipulated for the test.th and 8th grades in elementary school and 1st, 2nd and 3rd grades in high school). However, some subjects in this study, although having the minimum age for administration of the test (12 years), were not yet in the 7th grade (due to school repetition). As a result the parameter indicated for the 7th grade was used, because, due to the chronological aspect, it should be the current grade for these subjects. Furthermore, by virtue of the change in the number of grades in elementary schools in the country (which rose from eight to nine years), subjects who attended the 9th grade were included in the parameters of normality for the 8th grade, since the test manual does not provide parameters for this grade.It is important to clarify that the criteria of normality set forth in the test manual had to be adapted to the study sample, since the mean and standard deviation values available in the manual are presented according to grades  or Spearman (asymmetric distribution) correlation coefficients were applied to evaluate the association between test results. The level of significance was set at 5% (p≤0.05), and analyses were carried out using the SPSS software version 21.0.This study was approved by the Research Ethics Committee of the Institution of the study, with approval protocol 41689215.7.0000.5327.The characteristics of the sample studied can be seen in No association was found between the results for the Neupsilin subtests when compared for gender (p>0.20), age (p> 0.05), school repetition (p>0.2), age at otitis media onset (p>0.3), maternal education (p>0.4) and family income (p>0.05). All SG individuals had alterations in at least two physiological mechanisms of CAP, demonstrating 100% of central auditory processing disorder (CAPD) in adolescents with NCCOM evaluated. Comparing the results obtained between the groups with unilateral and bilateral conductive changes, significantly worse scores were observed in the UG when compared to the BG in DDT in the right ear and in the left ear . Although the other tests showed no statistical difference, it is noteworthy that the scores were numerically worse in the UG on the SSI, MLD and DPS tests. It is important to note that the BG group had better results on the RGDT test, since lower absolute value represents a better result on this test.This study showed alterations and correlations of some neuropsychological functions with the CAP of the adolescents evaluated. In addition, a change in the CAP of adolescents with NCCOM was observed, with a more significant impact on subjects who had a unilateral conductive component.The Neupsilin results showed lower scores in the study group when compared to the control group on the following tests: digit sequence repetition (attention), ascending digit ordering (working memory), auditory sentence span (working memory), and phonemic verbal fluency (executive function). An association was found between the DD, DPS and RGDT tests and the reverse counting test (attention), and there was also an association between the DDT and the digit sequence repetition (attention) subtest and the overall score for the attention function and phonemic verbal fluency (executive function). In addition, the SSI was associated with working memory (ascending digit ordering subtest) and executive function .,,Regarding the changes on the attention test (digit sequence repetition), a likely relationship between attention and CAP is believed to exist, and has previously been documented in some studies conducted in individuals with a history of otitis media.It should be noted that, in this study, two subtests were used to assess the attention function. However, only one of them (digit sequence repetition) showed a significant difference between the study and control groups. This is believed to have occurred due to the ease of the reverse counting test, while the digit sequence repetition test is more complex and, consequently, poses a higher degree of attentional requirement.-,Concerning the differences observed between the groups on the working memory assessment subtests, it should be noted that, when there is a deficit in auditory input processing, so much effort is spent on understanding the auditory information that little energy is left for it to be remembered.With respect to the difference observed between groups on the subtest assessing phonemic verbal fluency, this is an expected result, since verbal fluency is essential for individuals to be able to present complex and interconnected behaviors, both in social/communicative interaction contexts and in complex cognitive situations that require greater mental control and reasoningRegarding the associations identified between the Neupsilin subtests and the CAP behavioral evaluation tests, a previous studyIn this regard, from a cognitive neuroscience perspective, there are few (if any) fully compartmentalized areas in the brain that are responsible for only one sensory modality,-,Prando et al.The other associations observed in this study were not found in the literature. However, it is believed that these occurred due to the overlapping of brain areas involved in performing general auditory and cognitive tasks,,The results presented in this study confirm the findings in the literature related to the correlations observed between CAP skills and attention and memory functions.As regards NCCOM, specifically, it is important to note that the extent of the auditory deprivation effect required to cause a cognitive alteration in humans is unknown,In addition, the auditory deprivation arising from NCCOM does not occur only in the developmental period of the central auditory nervous system, but accompanies the individual in a fluctuating or permanent manner over long periods.,Therefore, the role of otitis media in the development of neuropsychological aspects still divides professionals with different views.However, it is important to stress that no similar studies on subjects with chronic otitis media were found, where related studies tend to focus on early otitis media with effusion. Therefore, it can be assumed that, in NCCOM, the effects on CAP and cognition are probably enhanced by the severity of the disease.It should also be noted that, in this study, the complete neuropsychological evaluation proposed in Neupsilin was not performed, since previous studies have linked CAP to attention and working memory functions. However, we suggest that further studies be conducted using the complete assessment battery of the instrument to allow the analysis of other hypotheses involving other cognitive functions.Given that the data obtained reinforces the hypothesis that the central auditory function involves far more than a central nervous system roadmap to the auditory portion,This study found that the neuropsychological functions of attention, working memory and executive function  showed alterations in adolescents with NCCOM when compared with the control group. In addition, associations were found between the results for the subtests assessing neuropsychological functions and the tests used for the behavioral evaluation of central auditory processing in adolescents with NCCOM. Thus, the effects of NCCOM on the tested attention, memory and executive functions relating to the central auditory processing disorder in adolescents seem to be enhanced by the severity of the disease.


Annually, there are 7 million patients > 65 years who undergo noncardiac surgery in the US. This number is expected to increase by 30% over the next 3 decades, and given the prevalence of surgically correctable comorbidities, the elderly will continue to undergo multiple surgical procedures. Currently, it is unclear what factors initiate or promote the development of Alzheimer’s disease (AD). Preclinical studies suggest that exposure to anesthesia and/or surgery could be one of the environmental exposures that increase AD risk through neuroinflammation and neuroapoptosis. However, previous studies indicated substantial disparities in AD risk by gender, ethnicity, and race, but failed to explore the role of anesthesia and/or surgery exposure in the risk for AD. This presentation will review the role of disparities and anesthesia and/or surgery exposure in the risk for AD in elderly surgical patients.


Any dog is capable of biting, and dog bites can cause serious injuries to humans or other animals. To prevent dogs from biting, we need to understand the circumstances in which dog bites are most likely to occur. Once we have that information, we can act by improving public awareness and tailoring interventions to those most at risk of being injured. In this study, we assess the circumstances surrounding dog-bite injuries, by considering dog-bite severity in conjunction with information about where the incident occurred, about human victims, and about the dogs themselves. This approach was possible because The City of Calgary systematically tracks dog-bite severity. We found that from 2012–2017, the number of severe bites occurring in Calgary has fallen. That said, severe bites tended to occur in the homes where the dogs lived, and to be directed towards children and older adults. The results from our study underscore that educational communication for parents, grandparents, and other caregivers should emphasize the importance of constant supervision around dogs, including family dogs, whenever children are present. In addition, more attention should be paid to the risks that dogs pose to older adults. Failure to protect people from dog-bite injuries has implications for the dogs’ own welfare, as well as for human health. Dogs are most likely to bite when they feel insecure in the first place. Furthermore, common responses to severe dog-bite injuries in people include rehoming and euthanizing dogs.Dog bites are a public health concern that also implicates animal welfare, with negative outcomes such as rehoming or euthanasia for the animals responsible. Previous research has shown that the severity of dog-bite injuries reflects multiple factors, including the degree of inhibition exhibited by dogs and how people behave towards dogs. This study utilizes an objective dog bite injury assessment tool: The Dunbar aggression scale. Trained officers employed by The City of Calgary systematically use the Dunbar scale whenever investigating dog-bite complaints. We analyzed The City of Calgary’s administrative data on confirmed dog-bite injuries in people, 2012–2017, with a multivariable generalized ordered logistic regression model. Severe dog-bite injuries occurred more frequently in the family home than in any other setting. Young children, youths and older adults were at higher risk of more serious bites than adults. There has been a decreasing trend in the probability of a high or medium severity bite, and an increasing trend in the probability of a low severity bite since 2012. These results indicate that greater public awareness regarding dog-bite injuries is needed. Consideration should be given to campaigns targeted towards different demographics, including older adults, to provide an understanding of dog behaviour and to emphasize the need to supervise children closely in the presence of all dogs at all times, including family dogs in the home environment. Given that dog-bite injuries are not just a public health issue, but also an animal welfare issue, we endorse One Health responses in educational campaigns, policy development, and professional practice. Dogs are a common and valued household pet in many countries ,2,3. BeyUnderstanding the factors that lead to instances of dog aggression is paramount when considering methods by which to reduce the health impacts of the problem. There are numerous factors to consider including both human and canine demographics, canine behaviour, and individual circumstances of the incident, such as where it occurred, and familiarity between the dog and victim . The cirResearch and surveillance on dog bites have historically focused on zoonotic disease transmission , with thIn Canada, meanwhile, dog-bite surveillance and policy remain fragmented . Under tIn this article, we report on quantitative research that was conducted collaboratively between the University of Calgary and The City of Calgary, which has never had BSL. Indeed, The City of Calgary has earned an international reputation for simultaneously reducing per capita dog-aggression incidents and euthanasia of dogs, without recourse to BSL ,23,24,25Our study uses the administrative data collected by The City of Calgary to analyze dog-bite cases from the period 2012–2017, with the Dunbar aggression scale serving as the outcome of interest. An epidemiological approach to understanding the risk factors associated with varying dog bite severity was undertaken. Previous research into dog bite-related issues has utilized data collected through surveys ,29,30 orThe City of Calgary-Calgary Community Standards  uses a customizable software known as Chameleon© to track dog-aggression complaints and investigations. The city provided 2012–2017 routine statistics collected upon an incident of dog aggression or dog bite reported to animal services. Reports may come from multiple avenues but predominantly come from citizens. All reported incidents are followed up but only confirmed incidents are reported in the statistics. A confirmed incident is one where evidence has been provided to substantiate the incident. Evidence may not be included when: The victim changes their mind about report, statements are not completed, or the victim never calls the officer back. These incidents are recorded in Chameleon, but they are closed as unfounded. Over the six-year time period from which statistics are available, there were 4433 reported incidents of dog aggression towards people or other animals, of which 2906 (65%) were confirmed.The Chameleon software provides officers with drop-down menu choices to record information regarding the complaint. When an incident is reported, attending officers collect the following information about the dog in question: The primary breed, age, sex, spay-neuter status, vaccination status, years owned, the place from which the dog was obtained, and whether the dog had previously exhibited aggressive behaviour. The officer collects data about the victim, including the gender, age, and relationship to the dog. The location of the incident, who was in control of the dog at the time of the incident, and the circumstances are recorded. As an example, the drop-down menu choices for recording the circumstances of the incident include the following options: At large, contained, dog fight, guard dog, multi-dog, on a leash, other, provoked, tethered or unknown. There were 153 confirmed incidents that involved multiple dogs. The drop-down menu for the location of the incident includes the following options: In house, off-leash park, owner’s property, or public. Where more than one circumstance might apply in a particular scenario, officers are trained to choose the circumstance that is most pertinent to the situation. For example, if the officers were responding to a call in a public place where a number of uncontrolled dogs were involved in a fight, the officer would record the incident as a ‘dog fight’ as opposed to ‘at large’.The City of Calgary systematically applies the Dunbar scale when investigating dog-aggression incidents. This is an objective, systematic assessment tool for measuring aggression in dogs , modifieData on chases  and bites  directed towards humans, provided by the City of Calgary in Excel format were merged into a single spreadsheet and imported into Stata IC v15  for all data manipulations. The outcome of interest was a three-level ordinal variable indicating if the bite was a Low (level 1 or 2), Medium (level 3), or High  severity incident . It was The distribution of all variables included in the City of Calgary data was evaluated. The frequency and percentage for categories of each variable along with the frequency of incidents at the three outcome levels of interest are presented . All varThere were 157 unique entries for the dog primary breed information. Due to the subjectivity involved in classifying dog breed , and theThere were a number of variables for which data were not collected in every year, therefore there were a large number of responses where the category is listed as ‘unknown’. This included where the animal was obtained, the number of years the owner had the dog, licensing status and vaccination status. For this reason, these variables were omitted from further analysis. There were four observations where victim gender was not recorded, four where the breed group was not specified, and two locations that were listed as ‘private’ that were all excluded from the analysis.The City of Calgary has 14 electoral ward districts, with the distribution of bites in each ward ranging from 4% to 10%. Information on the ward was unavailable for 14% of incidents. The City of Calgary is also divided into four quadrants. Each ward was placed within the appropriate quadrant for further analysis.p < 0.2) with the outcome that were considered for model building were year, breed group, incident location, the age of the victim, sex of the dog, age of the dog, whether the dog had displayed any prior aggression, and the month of the year  instead of 4 categories . This was done to allow for a more simplified interpretation of the effect of age in the multivariable model.Predictive margins were used to calculate the predicted probability of the different outcomes for each predictor, with a Bonferroni correction applied to each calculation to account for multiple comparisons. Margins predict the average probability of the outcome if every incident for the predictor of interest were treated as observed and leaving all other predictors as they are. For example, when computing margins for the breed group, margins will predict the probability for herding dogs by treating all incidents as herding dogs and keeping the other predictors at their values. It will then compute the margins for hounds by treating all incidents as hounds, etc. For this reason, the predictive margins calculated do not reflect specifically the model results indicated in Pairwise comparisons were also calculated for each predictor to indicate if the differences between groups were statistically significant. The predictive probability calculated for each predictor is presented graphically using Stata margins command and the user-written commands in the SPost13 package . Error bThere were 2723 incidents of chases or bites against humans recorded from 2012 to 2017 of which 2165 were analyzed in the final statistical model. The 2165 incidents involved 1873 dogs, of which 54 dogs (3%) were subsequently euthanized. In this study, 51% of dog aggression incidents directed towards humans reported to the City of Calgary Animal Services between 2012–2017 were classified as level 1 or 2 (low severity) on the Dunbar aggression scale. Thirty-five percent of incidents were classified as level 3 (medium severity), and 13.5 percent were classified as level 3.5 or higher (high severity).A multivariable generalized ordered logistic regression model that included the variables for year, breed group, incident location, the age of the victim, the sex of the dog and the age of the dog was fit using a manual backward elimination strategy . This mop-value. For example, the odds ratios for the terrier breed group can be interpreted as follows. Holding all other predictors constant, dogs in the terrier breed group have a 0.71 times lower odds of being responsible for a medium or high severity incident than do dogs from the non-sporting breed group. Terrier breed group have a 1.10 times higher odds of being responsible for a high severity incident than the non-sporting breed group. The difference in proportionality was statistically significant . The odds of an incident occurring in the home was 8.17 times higher than in public places. The same odds ratio was reported for all incident severity levels.The odds ratios presented represent the change in odds of observing a value above the listed severity level versus observing values at or below the listed severity level . The valThe constant odds ratio 0.40 for the low versus medium and high severity incident represent the odds of a bite in the year 2017 inflicted by an intact female dog, 0–2 years old from the non-sporting breed group, where the injury was inflicted upon an adult in a public space. This odds ratio can be compared to the odds ratio of 0.05 if the bite was in a high versus medium or low severity incident. The average predicted the probability of a low, medium and high severity incident was 0.507, 0.354 and 0.139 respectively.The predictive probabilities depicted in the graphs that follow can be considered in terms of percentages. For example, predictive probabilities of 0.49 for a low severity incident, 0.37 for a medium severity incident and 0.14 for a high severity incident in herding dogs  indicateThe model depicted in The model indicates the odds of medium and high severity incidents were significantly increased on the owner’s property (OR = 2.38), in an off-leash park (OR = 3.20) and in the home (OR = 8.17) compared with incidents taking place in public spaces. The predicted probability of a low severity incident was highest in public spaces . This was significantly higher than in all other locations and significantly higher than the probability of medium or high severity incidents in public spaces . The preThe model indicates that the odds of a medium or high severity bite (Equation (1)) was higher in males (intact or neutered) than in intact females. Spayed females did not differ from intact females. Though there was a deviation from proportionality for neutered males, the odds of a bite among neutered males was not significantly higher for a low and medium severity bite compared with a high severity bite (Equation (2)). There were no significant differences in the predicted probabilities of high severity incidents depending on the sex of the dog . Spayed p = 0.18, 95% CI: 0.13–0.24) than in adults (20–59)  . For medium severity incidents, there were no significant differences in the predicted probabilities between the different age categories.Amongst the 2165 incidents included in the final model, 25% of 306 high severity incidents were directed towards children, 15% towards youths, 55% towards adults and 17% towards older adults. The model indicates that the odds of a bite of any severity was higher in children (OR = 1.39), youths (OR = 1.55) and older adults (OR = 1.74) compared with adults, holding all other predictors at their baseline. The predicted probability of a high severity incident was significantly lower than that for low and medium severity incidents for all age categories . The preThe model indicates that the odds of a bite of any severity was higher in older dogs compared with dogs 0–2 years old, holding all other predictors at their baseline. When dog age is considered as the predictor of interest, the highest predicted probabilities were for low severity incidents in all age categories . This waThe model indicates that the odds of a low versus medium or high severity bite in 2012 was significantly different to 2017. The number of bite incidents reported in 2012 was 325. The number increased each year, to a peak of 548 in 2016. In 2017, the number of incidents reduced to 446. There has been an increasing trend in low severity incidents from 2012–2016, and a decreasing trend in medium severity incidents in the same time period. The predicted probability of a high severity incident peaked in 2012 , and dropped to 0.12 (95% CI: 0.09–0.15) in 2016 . In 2017The predicted probabilities of incidents at each outcome level were evaluated in the different age groups and in the different incident settings . The corThe aim of this work was to use an internationally recognized aggression scale tool to examine City of Calgary dog aggression related administrative data with the purpose of gaining a better understanding of the circumstances in which bites at varying severity levels occur amongst the biting dog population in a Canadian city. Utilization of such data from administrative systems for the purpose of assessing the impact of dog bites is novel, and the results of this study highlight the usefulness of utilizing such an approach when assessing the severity of dog aggression incidents in urban areas. The results of this study may be generalizable to other large cities in developed countries where administrative systems use similar methods to record dog bite severity.The following variables were found to be significant predictors of bites of varying severity amongst the biting dog population from 2012–2017: Breed group, incident location, the age of the victim, dog sex and age, and the year of the incident. It is important to consider that the results of the model need to be evaluated in relation to the baseline values and that the predictive probabilities calculated based on the model represent scenarios where the predictor of interest is manipulated, and all other predictors are held at their values.Three percent of dogs responsible for bites in this study were subsequently euthanized by the owner, or as a result of the investigation by The City of Calgary. This is an unfortunate outcome, considering that dog bites are generally a preventable public health issue. This raises the question of how we can better educate dog owners and the general public about safety around dogs. The results of this study indicate that such education programs should target all demographics.This study utilized the Dunbar bite scale as a three-level ordinal outcome of interest for predicting attributes of dog bite incidents in the City of Calgary. These data provide information on the number of dog-related aggression incidents that have taken place in the city between 2012–2017. While this is very useful information, it is likely that it is an underrepresentation of the number of incidents that actually take place, particularly incidents that may be deemed less serious. For an incident to become a part of this dataset someone needed to report it. The likelihood of this occurring may depend on the severity of the incident and the knowledge and attitude of the victim . Dunbar It is thought that incidents that might not result in an injury that requires medical attention (low or medium severity) may be less likely to be reported, particularly if it happens within the home. Dog owners may be less likely to report an incident where their own dog is responsible for a bite, particularly if it does not require medical treatment. Of 301 bites reported in a recent survey of 385 UK households, just 33% required any medical treatment . SimilarIt is important to consider the implications of minor dog aggression incidents to physical and psychological health. A person may feel unsafe utilizing public spaces for walking or recreation where they have been the subject of a dog attack or threat. Additionally, exposure to such incidents may invoke feelings of fear  or symptThere is little information available regarding the severity of dog aggression incidents such as presented in the present study. However, one recent study from the UK did gather self-reported information on bite severity, with bite descriptions comparable to the Dunbar scale. In that study, there were 145 (34%) instances where a dog made one to four punctures from a single bite, with no puncture deeper than half the length of the dogs’ canine teeth, similar to a level 3 or 3.5 bite. This frequency is comparable to the percentage of level 3 outcomes reported in the present study (35.5%). This use of objective methods of describing dog bites highlights the merits of using the Dunbar scale as a tool for assessment of dog bite severity by The City of Calgary.The results of this study indicate that dog bite severity is not dictated by the dog breed grouping. In the model, with the non-sporting breed group as the baseline, and holding all other predictors at their baseline value, sporting, and terrier breed groups had lower odds of a medium or high severity incident. However, based on the predicted probabilities calculated for each breed group, dogs classified as non-sporting were no more likely than the other breed groups to be responsible for any of the severity classifications of bites. Overall, this finding is supportive of the growing body of research that indicates that breed specific legislation is not a successful approach to dealing with dog aggression issues ,46. DogsHowever, the level of subjectivity involved in the classification of dogs, particularly mixed breeds, into breed groups should be considered. Breed information is reported by the owner when they license their dog. If upon visual inspection an animal services officer thinks that a dog breed has been miss-reported then the record for the animal is updated with the new breed classification. Additionally, within the Canadian Kennel Club breed group classifications, there is some variation, particularly in the non-sporting dog category. Dogs included in this category include three bull breeds, Spitz breeds, Tibetan breeds, Poodles, and others. The CKC notes on its non-sporting breed group information page that “the vast variety of breeds, purposes and personalities make it difficult, if not impossible, to assess the group’s capacity to learn” . In futuThe results of this study indicate that the severity of the incident increases when the incident takes place in the home, compared to on the owner’s property, in an off-leash park, or in a public space. Incidents taking place in off-leash parks were also shown to be a higher severity than incidents taking place in public spaces. Additionally, increased severity in the home is seen in all age categories. Medium and high severity incidents were significantly more likely to occur in the home than low severity incidents, with the reverse true when the incident was in a public space. These findings relating to increasing incident severity in the home can be considered in combination with previous research that has indicated that the majority of dog bites occur in home settings ,49,50,51Male dogs were the most commonly reported sex responsible for bites in a number of studies ,48,52. TIt was hypothesized that children would be more likely the victim of high severity incidents than older persons. This hypothesis was based on previous research indicating children are highly represented in studies utilizing hospital data examining dog bites issues ,49,50,51The higher predicted probability of a high severity bite in older adults compared to adults in the current study is notable. In the older adult population, an association between fractures and walking dogs on leashes has recently been reported . It is lBy calculating predictive probabilities it was found that the most severe bites occurred in the home in all age categories, compared to when on the owner’s property, in an off-leash park, or in a public space. This is in agreement with other international research on the subject. For example, in a questionnaire conducted in Belgium, 65/100 dog bite victims under 16 years of age were bitten in the home, while 35 were bitten in a public place . HoweverPrevious research has implicated dog age as a risk factor for dog bites, with incidents in the home directed towards unfamiliar people , young dResults indicate that while the overall number of bite incidents increased between 2012 and 2016, the number of high severity incidents did not increase, and the number of medium severity incidents decreased. There has been an increase in the predicted probability of a low severity (level 1 or 2) incident, with the majority of bites in each year being a low severity incident. This may indicate that citizens are actively reporting instances where a dog barks, growls, threatens or chases at a more frequent rate, or that such incidents are making up the majority of the reports made to animal control services. The increase in dog bite reporting may reflect the efforts of the City of Calgary Community Standards team to educate dog owners and the public regarding responsible pet ownership, and the importance of reporting all instances of dog aggression to the authorities.There are a number of limitations to this study. For example, the skewed distribution of a number of variables such as the circumstances of the bite, and the relationship of the victim to the dog excluded them from analysis in the multivariable model building process. It is possible that these variables will be confounders for the relationship between dog bite incidents and the actual incident setting. This should be re-evaluated when further data are available. There were a small number of incidents that involved multiple dogs, and a small number of dogs that were responsible for more than one incident. Failing to account for these types of incidents is a shortcoming of these analyses. Future analyses will aim to account for a lack of independence where multiple dogs are involved. There were a number of variables for which data were missing, including where the dog was obtained, and the years owned. Information on these variables was not collected prior to 2015. Future analyses of the dataset from 2015 forward would allow for utilization of these variables. Population-level data such as the number of licenced dogs in the City of Calgary for each year were not currently available. Future work will aim to include these data in new analyses. Census data on the human population in the city in each year would also be useful to allow for calculation of incidence rates for dog bite outcomes.Dog bites are a significant public health issue that also results in negative outcomes for the animals in question, such as relinquishment or euthanasia. This article has taken a novel approach to utilizing data collected by a large urban administrative system to examine the risk factors for dog bites of varying severity. Bite prevention strategies can be informed with context-specific data regarding the type of dogs that are committing serious bites, and the situations in which these incidents occur. In utilizing the Dunbar aggression scale as the outcome of interest in this study, we can report on the probability of bites of varying severity occurring based on the dog breed group, incident setting, the victim age, and the age and sex of the dog. The results presented provide useful information that can be used to inform public policy regarding where education programs relating to dog bite prevention should be targeted. In the City of Calgary, the most severe dog bites are more likely to occur in the home and be inflicted upon all age groups, but particularly children, youths and older adults.These results reinforce the need for education of both dog owners and the general public, including the older adult population and parents of young children. Dog owners should be aware that previous signs of aggression may predicate future incidents, and learn to read their dogs behaviour to anticipate issues before they arise. Owners of dogs responsible for low severity incidents should seek guidance from dog behaviour specialists to understand why the incident occurred and work with their dog to curtail the issue before it potentially becomes more serious.Parent or guardian awareness and understanding of dog behaviour is critical to reduce bites ,56. Cons


The uncontrolled sale of topical corticosteroids has become an important risk factor for the development of iatrogenic Cushing syndrome in children, especially in countries where medications are sold over the counter. This is exacerbated by the lack of information for both the patients and pharmacists. This report documents a series of eight cases of iatrogenic Cushing syndrome secondary to an inappropriate use of topical steroids, due to a misdiagnosis of scabies. Sarcoptes scabiei var. hominis. Transmission mainly occurs through direct skin contact, often from family members. Scabies is estimated to affect 200 million people worldwide [Scabies is a highly contagious skin disease caused by the mite orldwide . Reporteorldwide . Common In Mexico, a common superstition suggests that infants can develop illness if they are not held by a person who gazes at them, as it puts the infant at risk of acquiring ‘the evil eye’. Therefore, parents commonly encourage others, even complete strangers, to touch and hold their child . There iTopical steroids are graded in terms of potency as either low, medium, high or very high. Whilst low potency steroids are often well tolerated, the absorption of higher potency steroids through the skin can cause Cushing syndrome due to suppression of the hypothalamic-pituitary-adrenal axis, especially if used over large areas of skin, or for prolonged periods ,8. In MePermethrin is the most effective topical treatment for scabies, but, it is expensive, which limits its use in Mexico. Other topical treatments for scabies include benzyl benzoate (the most widely available in Mexico), sulfur cream or ointment, crotamiton and lindane . TopicalThis report documents a series of cases involving eight infants, aged from 3 months to 1.5 years . All patAll cases had a history of continuous or discontinuous use of topical corticosteroids (betamethasone (0.5%) combined with clotrimazole and gentamicin), applied to affected lesions or used on the entire body’s surface. All scabies patients were diagnosed at the Dermatology department of the Acapulco General Hospital in Guerrero, Mexico. Diagnosis was made clinically in all patients based on the typical rash, itch and affected cohabitants. The patients with crusted scabies had extensive scaling lesions on the back, palms and soles with moderate papules and discrete nodules on the rest of the body’s surface, particularly in the skin folds. Symptoms of scabies had been present for 1 to 7 months prior to diagnosis. In all cases, the mothers also had clinical lesions of scabies, and in four of eight cases, the mothers had a history that was suggestive of scabies during pregnancy. The number of family members in each household that had daily contact with the patients ranged from 3 to 12. In all cases, the use of the steroid cream was reported to have resulted in initial improvement of symptoms. However, the signs and symptoms would return and worsen whenever the usage of corticosteroid was suspended. Affected family members did not seek medical advice until symptoms worsened. None of the parents were aware that the weight gain and other physical signs of Cushing syndrome were related to the use of the steroid cream. Two patients experienced recurrent upper pulmonary infections during the use of topical steroids that required referral to a physician. All patients were treated with sulfur cream (4%). Family contacts were treated with oral ivermectin. Twenty-four-hour urine cortisol was requested for patients, but this was often not completed in the majority of cases due to lack of financial resources. One case had the investigation performed one month after cessation of betamethasone, which was reported to be within normal limits. Follow-up information for patients was limited by the fact that families resided in distant places. All patients were referred to the pediatric service, while two attended for a consultation, with no further complications found. The rest of the patients did not attend a consultation, possibly due to the resolution of scabies symptoms after effective treatment and cessation of steroids. A telephone contact follow-up was attempted but unsuccessful. A check of the patients’ hospital files did not reveal any further visits for outpatient consultation or to the emergency department.Scabies has recently been added to the list of Neglected Tropical Diseases designated as priorities for control by the World Health Organization . OrganizThere are many factors that contribute to the development of Cushing syndrome in this case series and the many other cases we have observed in our practice. Scabies is often not accurately diagnosed, particularly as a medical opinion is not sought after by families, which leads to erroneous treatment. Scabies has recently re-emerged as a major health problem in parts of Mexico, and families are searching for effective treatments for this highly symptomatic disease. At the same time, over-the-counter creams have been promoted to pharmacies and general practitioners as low-cost treatments for a broad range of bacterial, mycotic and inflammatory skin conditions. Previously, steroid-misuse complications have been widely reported, but most reports relate to either eczema in developed countries or to skin lightening creams or fungal infections in underdeveloped countries ,16. PatiParents may not recognize the rapid weight gain as one of the signs of the infant’s developing health problem , due to The incidence of Cushing syndrome secondary from the use of topical steroids is unknown and quite likely underreported ,20,21,22Sulfur and benzyl benzoate are the most available topical scabies treatments in Mexico. Even though they are effective if applied to the whole body for the recommended duration, they frequently cause irritation, erythema, scaling, intense pruritus or even contact dermatitis, all of which may lead to the interruption of treatment or discontinuous therapy, which ultimately reduces the effectiveness of the treatment. Alternative treatments for scabies, such as tea tree oil, are under investigation but their effectiveness is unproven . EconomiThe education of health workers is of great importance, as they are the point of first contact. Health workers need to know how to recognize, diagnose and appropriately treat common scabies, and to avoid the use of corticosteroids, especially in children. Complicated cases, or those that do not improve with first-line treatments, should be referred for further assessment. In countries like Mexico, in which there are fewer regulations on the sale of medications, it is essential to inform the general population of the potential risks when medications are not used as intended. We have introduced teledermatology as part of the Community Dermatology program in Mexico  for the The study protocol was approved by the Ethical Review Committee of the Community Dermatology A.C. and was supported by the Health Secretary of Guerrero State prior to the study. Informed consent was obtained from the parents or legal guardians of the minors after a detailed explanation of the study’s protocol. In accordance with the ethical review committee requirements, patient information was made confidential.


N = 27) spending approximately 10 months at the Concordia station completed the Utrecht Coping List, the Positive and Negative Affect Schedule (PANAS), and a structured sleep diary at regular intervals (x 9). The results showed that several variables reached a minimum value during the midwinter period, which corresponded to the third quarter of the expedition. The effect was particularly noticeable for coping strategies . The pattern of results could indicate that participants during Antarctic over-wintering enter a state of psychological hibernation as a stress coping mechanism.Human activity in Antarctica has increased sharply in recent years. In particular during the winter months, people are exposed to long periods of isolation and confinement and an extreme physical environment that poses risks to health, well-being and performance. The present study aimed to gain a better understanding of processes contributing to psychological resilience in this context. Specifically, the study examined how the use of coping strategies changed over time, and the extent to which changes coincided with alterations in mood and sleep. Two crews ( Antarctica is the darkest, coldest and most hostile region for humans on Earth. Antarctica has no permanent residents, but many of the nations that are signatory to the Antarctic Treaty send personnel to conduct seasonal (summer) and all year round research on the continent and the Southern Ocean environments. Securing the human side of such expeditions is a matter of concern as many participants are exposed to challenging living and working conditions that pose risks to their safety, performance and psychological health. During the winter months, depending on the location, people may be totally physically isolated from the outside world, with darkness and weather conditions putting severe constraints on the possibility to travel. There are periods when supplies cannot be transported to the stations and evacuation in case of emergencies may not be possible. Although telecommunication between station and outside world has greatly improved in recent years, these systems may temporarily break down and outside experts may not be available for consultation at all times if help is needed. Key stressors for participants include lack of social variation, monotony of the physical environment, confinement and limited privacy, and emotional and physical deprivations. While there are large individual variations in psychological resilience, foregoing research has long since documented that personnel overwintering on Antarctic stations are vulnerable to mental and somatic health problems . Indeed,Over the last decades, many research efforts have been dedicated to explain the nature and causes of seasonal variations in psychological resilience among personnel over-wintering in Antarctica. The concept of resilience refers to the human capacity to cope successfully (and even grow) under significant adverse conditions . Three dThe third-quarter perspective suggests that psychological resilience to some extent is associated with expectancies about the duration of the stay. This idea is in line with contemporary stress models which emphasize that appraisal is critical to how individuals cope with challenging situations, in turn predicting physiological activation , psychological responses , and behavior . While data from several studies conducted among groups operating in polar environments have indicated declines in mood and moral around the third quarter , empiricDespite considerable research into how the Antarctic environment impacts on psychological resilience, the process by which people try to manage the demanding living conditions is not well understood. According to The overall aim of the study was to build on previous work and add to knowledge on processes contributing to psychological resilience in the Antarctic context. Specifically, we monitored coping strategies among personnel spending 10 months on a research station in Antarctica, and examined to what extent these changes coincided with alterations in mood and sleep. We studied the time-based changes in four coping strategies: active problem solving, palliative reactions, avoidance and passive expectancies, and comforting cognitions. Active problem solving is reflective of beliefs about own capacities to handle the situation, a coping strategy that is associated with stress resilience . In contM = 38.3, SD = 10.64]. Eight were Italians and six were French. The study sample from Crew 2 included 13 respondents, among whom three females, the age of the subjects ranged from 22 to 51 years , seven Italians and six French. Four members of Crew 1 and five members of Crew 2 had previously overwintered on Antarctica. Medical and psychiatric screening was undertaken as part of the selection of participants. The crews also underwent a 2-day long psychological training program prior to departure preparing them for possible psychological and social issues that may arise during the stay. The training program focused on self-reflection, team building processes and coping with communication problems.The sample consisted of members of two crews overwintering on the Concordia station in Antarctica from the beginning of February until November. Among station members in Crew 1, 14 consented to participate in the study. All of them were males, with ages ranging from 23 to 58 years [2 and comprises three towers connected by enclosed walkways. The first tower, called the quiet building, contains individual sleeping quarters, two bathroom, three toilets, hospital, laboratories . The second tower, dedicated to noisy rooms, houses the canteen, workshop, the waste water treatment plant, social rooms , a gym, the kitchen, and storage rooms. The third tower is made up of eleven container size modules where the electric power plant, the boiler room and a second workshop holding devices to measure atmospheric data such as wind speed and humidity, are located. The temperature inside the base is usually between 21 and 23°C.The Concordia Station , number and duration of awakenings, time of final awakening, rise time, and sleep quality . In thisThe PANAS  is a selThe Regional Medical Committee for Research Ethics  approved the experimental protocol. All subjects were fully informed as to the nature of the investigation and were told their rights, such as the right to withdraw from the experiment at any time, and signed a Declaration of Consent Form providing this information. One of the investigators met with the participants prior to their departure to Antarctica to inform them about the study. A unique code was assigned to each participant in order to monitor longitudinal data and to protect participant anonymity. All questionnaires were administered in the native language of the participants .Data was analyzed using SPSS statistics 24 . We firsp = 0.06). Cubic equations tended to produce small effects, only reaching significance for the coping strategy, comforting cognitions.Scales means and 95% confidence intervals from the repeated measures multivariate analysis of variance are presented in Figures Findings from the correlational analysis are reported in Table The findings from this study suggest that coping strategies, sleep quality, and PA were influenced by the environmental conditions to a smaller or larger degree during midwinter. Quadratic time-based models demonstrated the greatest effect sizes, suggesting that when the conditions are harshest, resources are more depleted and participants were less involved in any form of coping and reported less PA. Also subjective sleep quality showed a negative trend over time, a result consistent with other research  althoughPerhaps the most striking result from this study was the reduction in all of observed coping strategies during the midwinter period. This pattern contradicts the idea that emotional strategies and avoidance take over from more active strategies in situations involving chronic stressors. Our findings may reflect that participants became more indifferent or emotionally flat during the winter months. This interpretation is consistent with early research which noted the occurrence of a mild psychological fugue state known as the Antarctic stare, around the third quarter of the stay . The pheN = 3).We acknowledge that the present findings need to be replicated on a larger or multiple samples. A limitation of this study is that data is based on self-reports (questionnaires), and that responses may be influenced by report biases such as social desirability . Overall, our findings raise further questions regarding the nature of adaptation and the day-to-day and month-to-month functioning of expeditioners in extreme and unusual settings. The existence of “the third quarter phenomenon” characterized by low motivation, interpersonal tension and low mood has been controversial among researchers . While tGS conceived the study and conducted the data collection. FvdV analyzed the results. NS contributed to theoretical and empirical background. All authors reviewed the manuscript.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.


Remote access to XAFS beamlines is an attractive option to reduce costs and provide an access route for educational and collaborative purposes. Any degree of automation of the operations, even if partial and limited to routine procedures, allows simplification of the remote user interface with significant improvement in the overall beamline efficiency. Here, some useful steps towards achieving this goal are introduced and the experience in this regard at the XAFS beamlines at LNLS and Diamond is described. Although remote access to beamline synchrotron facilities is now a common operation mode at macromolecular crystallography beamlines thanks to substantial efforts in automated processes for sample preparation and handling, experiment planning and analysis, this is still not the case for XAFS beamlines. Here the experience and developments undertaken at LNLS and Diamond in automation are described, in an attempt to tackle the specific challenges posed by the high variability in experimental conditions and configurations that XAFS measurements require. To fully benefit from the improved source characteristics, such enhancements require advances in the development of new detectors and more efficient optical systems. Therefore, it can be expected that, as occurred following the step from second- to third-generation facilities, a significant fraction of the standard experiments that now require long acquisition times and dedicated sessions could be planned in shared beamtimes and will benefit from remote access mechanisms which will maximize efficiency. In turn, this gain in efficiency will require a better organization of research and support teams as well as improved experimental planning and management.The rapid progress in synchrotron radiation source technology is now providing brighter and smaller beams at new facilities such as Sirius  Samples can be well conditioned in standard cryogenic holders.(ii) Robotic sample changers are available and the technology is now well established.(iii) The sample alignment procedures work in well defined conditions, and image recognition software has benefitted from substantial development in recent years.etc.(iv) Thanks to the adoption of large two-dimensional detector systems, the experimental procedure has been greatly simplified: collect one or more images, determine the crystal lattice, measure Bragg peaks and angles, calculate the crystal lifetime, calculate the strategy and data collection time, feed in beam parameters, (v) The data evaluation and analysis chain is reliable and well developed.et al., 2013This means that, with few exceptions, all MX beamlines now include the possibility of remotely controlled experiments, or even practically dispense with human operation . These proposals often host a high number of short experiments, each consisting of measurements of a limited number of samples mounted on large capacity sample holders. The automation allows for non-expert users, coming from a large number of institutions participating in the BAG consortia, to access the beamline for a short period and provide a high efficiency for the BAG visits.Automated procedures help in addition to pursue an intense program of rapid-access experiments, usually run by the beamline staff, which is very effective scientifically and supports a very broad range of science areas. These beamtime access requests are limited to a restricted number of measurements not requiring special sample conditions. The samples delivered to Diamond for the rapid access sessions can be grouped for overnight measurement sessions or scheduled during beamline commissioning days.et al., 2012et al., 2015The Brazilian synchrotron (LNLS) started providing users remote access to several beamlines some years ago with the LabWeb project (Sherry 2.etc.) and then the experimental setup  for the specific measurement.The automation of the beamline setup is the core process allowing remote access. We start from the choice of the edge energy of the element of interest and the experimental conditions. This defines first the beamline optical setup  in parallel with other algorithms aimed at reducing the time needed for optimizing the beamline optics: principally mirror adjustment, crystal monochromator parallelism checks and harmonics rejection mechanisms.The implementation of the automation process on XAFS2  parallelism. We used the Py4Syn , the optical design adopted on B18  at a pressure of 0.5 bar. Historically, the gas exchange was performed manually and the composition was calculated using the On B18, the ion-chamber gas-fill system feeds the three ionization chambers and an additional feedline is available both as a spare in case of failures and if experimental devices need inert gas pressure control. Low-level control and serial communication is implemented with a PLC unit, and the EPICS layer Fig. 4 is integGeneric Data Acquisition (GDA), the open-source framework data-acquisition software developed at Diamond. For the spectroscopy beamlines, each XAS measurement is associated with a set of data-acquisition-configuration files controlling the experimental parameters . The detector configuration file . The tuning tool performs a scan on all available gains in the preamplifier, saving the results in a vector and setting the gain corresponding to the result closest to the ideal output (around 3 V for each ion chamber).GDA detector setup configuration file used for programming the gas filling. Currently, automatic amplification adjustment is run by calling a separate script , which adjusts the output voltage so maximum amplification is obtained with the sample and a reference foil (placed between the second and third ion chamber) in the beam. Amplification levels are checked at two energies, a few eV before the absorption edge and at the end of the scan to avoid saturation of the amplifiers across the whole XAS scan energy range.On B18, each amplifier setting can be programmed in the same 2.3.3.For transmission experiments at XAFS2, we have developed an edge-energy calibration automation procedure that performs the scanning of a metallic foil of the corresponding element. The procedure identifies the first derivative of the acquired spectrum, finds the first maximum (first inflection point), positions the theta motor in this position and performs, if necessary, the calibration energy, assigning an offset value to the theta-motor position. On B18 this procedure is not yet automated, as, once a full beamline configuration change is completed, the calibration remains sufficiently accurate over a large angular range for the DCM. However, a large wheel array of metal foils and reference compounds is permanently installed in a He-filled vessel placed between the second and third ionization chamber, and is used for a simultaneous acquisition of an energy-calibration scan for each transmission experiment. For experiments in fluorescence or total electron yield, we can obtain a reference sample measurement using part of the low-angle diffuse scattering from the last window of the first ionization chamber, and reading the fluorescence (or transmitted beam) from the foil placed close to main beam path.3.et al., 2013Some years ago, the Brazilian and Canadian light source laboratories, in a joint effort, implemented a solution to remote operation of a beamline, which is known as LabWeb Fig. 6 .In the second phase of this project, we intend to extend the automation to give to remote users the possibility of controlling furnaces, cryojets and mass flow controllers. This is expected as an advancement in Sirius operation with improvements to safety that will come in the form of a closed experimental hutch with a controllable atmosphere that can minimize the risk of fire and extract toxic gases. Following this aim, we are revising all technologies used in LabWeb which is based on Java, and considering the opportunities offered by more flexible programming frameworks like Python. An option under evaluation is moving to 4.Our main objective in this contribution is to highlight, based on the experience gained at LNLS and Diamond, both the challenges posed and the immediate benefits offered by the development of automated methods and remote access systems. Beyond the differences in hardware and software solutions implemented, different levels of automation and user community requirements, we find that common strategies, aims and areas for development have emerged and are driven by the continuous interaction with our evolving user communities. Development of consistent and self-explanatory software interfaces, associated with a robust level of automation, is essential to improve the efficiency of beamtime sessions open to new and inexperienced users, and to allow successful implementation of web-based remote control systems.